Poison in Small Measure: Dr. Christopherson and the Cure for Bilharzia

Poison in Small Measure: Dr. Christopherson and the Cure for Bilharzia

Studies in Global Social History Series Editor

Marcel van der Linden International Institute of Social History, Amsterdam, The Netherlands Editorial Board

Sven Becker Harvard University, Cambridge, MA, USA

Philip Bonner University of the Witwatersrand, Johannesburg, South Africa

Dirk Hoerder University of Arizona, Phoenix, AR, USA

Chitra Joshi Indraphrastha College, Delhi University, India

Amarjit Kaur University of New England, Armidale, Australia

Barbara Weinstein New York University, New York, NY, USA

VOLUME 2

Poison in Small Measure: Dr. Christopherson and the Cure for Bilharzia By

Ann Crichton-Harris

LEIDEN • BOSTON 2009

On the cover: New Civil Hospital, Khartoum, opened in 1909. JBC and his staff. Photo courtesy of Dr. T. Peter Ormerod. This book is printed on acid-free paper. Library of Congress Cataloging-in-Publication Data Crichton-Harris, Ann. Poison in small measure : Dr. Christopherson and the cure for bilharzia / by Ann Crichton-Harris. p. ; cm. Includes bibliographical references and index. ISBN 978-90-04-17541-9 (pbk. : alk. paper) 1. Christopherson, John Brian, 1868–1955. 2. Physicians—Sudan—Biography. 3. Schistosomiasis—Sudan—History—20th century. I. Title. [DNLM: 1. Christopherson, John Brian, 1868–1955. 2. Physicians—England— Biography. 3. Physicians—Sudan—Biography. 4. History, 20th Century—England. 5. History, 20th Century—Sudan. 6. Schistosomiasis—drug therapy—England. 7. Schistosomiasis—drug therapy—Sudan. 8. Schistosomiasis—history—England. 9. Schistosomiasis—history—Sudan. WZ 100 C5567C 2009] RA644.S3C47 2009 610.92—dc22 [B] 2009014373

ISBN 978 90 04 17541 9 Copyright 2009 by Koninklijke Brill NV, Leiden, The Netherlands. Koninklijke Brill NV incorporates the imprints Brill, Hotei Publishing, IDC Publishers, Martinus Nijhoff Publishers and VSP. All rights reserved. No part of this publication may be reproduced, translated, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the publisher. Authorization to photocopy items for internal or personal use is granted by Koninklijke Brill NV provided that the appropriate fees are paid directly to The Copyright Clearance Center, 222 Rosewood Drive, Suite 910, Danvers, MA 01923, USA. Fees are subject to change. printed in the netherlands

For the amazing John W. Senders: a true Renaissance man and a wonderful husband

CONTENTS

Foreword ............................................................................................. Acknowledgments .............................................................................. Abbreviations ..................................................................................... List of Illustrations ............................................................................

ix xi xv xvii

Introduction ........................................................................................

1

Chapter One Worms and Dead Eggs in the Long Hot Summer ...........................................................................................

31

Chapter Two Three Generations of Christophersons: Tanner to Clergyman to Physician ............................................

49

Chapter Three The Boer War Experience: The Imperial Yeomanry Hospital—A Palace in the Desert ...........................

67

Chapter Four Sudan 1902–3: Smallpox Delivers Both Fear and Opportunity ............................................................................

97

Chapter Five

1904 and the Appointment Blunder ...................

119

Chapter Six The Wellcome Laboratory on the Nile and a Relapsing Fever Dispute. A Storm in a Teacup? Some of What Really Happened is Revealed Only in 1923 ...................

141

Chapter Seven Christopherson’s Difficult Years: Surviving Disaster; 1908–1911 ......................................................................

171

Chapter Eight 1912 Marriage and the Decision to Remain in Sudan ..........................................................................................

203

Chapter Nine With the Red Cross in Serbia, and Rudolph Slatin’s Role as ‘Fairy Godfather’ ................................................

215

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Chapter Ten France 1917. The Commission on Medical Establishments ...............................................................................

239

Chapter Eleven

The ‘Aha’ Moment and Consequences ..........

269

Chapter Twelve On the Practice of Medicine, Sudan 1902–1919 .......................................................................................

301

Chapter Thirteen Life after Sudan—The Varied Life of a London Consultant .......................................................................

323

Chapter Fourteen

Heavensgate, Gloucestershire ......................

349

Chapter Fifteen Looking Back from the Twenty-First Century ...........................................................................................

365

Appendix A An Analysis of J.B. Christopherson’s Dosing Method ............................................................................................ Appendix B Published Papers and Letters by J.B. Christopherson ....................................................................... Appendix C Chronology ...............................................................

397 404

Select Bibliography ............................................................................

409

Index ....................................................................................................

415

391

FOREWORD

In 2003 it made us so happy here in the Sudan to give Ms. Ann Crichton-Harris a very warm welcome when she visited Khartoum and lectured upon the dedicated life of her great-uncle whose life-story she has been researching for eight years. Her book is a fascinating and gripping biography of a highly qualified English doctor, later Nobel Prize nominee, employed by the condominium government of the Anglo-Egyptian Sudan over one hundred years ago. Dr. John B. Christopherson was a medical pioneer attracted to the colonial service by the challenges of a vast African country, and the possibilities of success and recognition in the hope of discovering a cure or treatment for a tropical disease at a time when tropical medicine was first emerging as a separate discipline. Arriving in Khartoum in 1902 he devoted his energies to tackling clinical duties, establishing the hospital, and managing an epidemic of smallpox for which he was officially commended. This was followed by his discovery in 1918 that an ancient poison, antimony [tartar emetic], could be used against bilharziasis [schistosomiasis], a highly debilitating tropical disease. For years he laboured to refine the dosage for treatment, and it is probably from this process that the thrilling title of the book Poison in Small Measure was coined. However, conflict with the governing military elite brought about Wingate’s condemnation of his managerial skills in 1908. Dr. Christopherson’s great-niece has spent eight years investigating the mystery of the meagre acclaim accorded to him, in a skilful and lucid biography of scholarly documentation from widely diversified sources, including interviews, archival data, private letters, medical sources, and obituaries. I have enjoyed reading Poison in Small Measure: Dr. Christopherson and the Cure for Bilharzia. This engaging life-history of a devoted humanitarian, articulate and well-discussed as it is, illuminates much contemporary social history. An attitude of objectivity is frequently apparent throughout the book, especially in the quotation [in Christopherson’s own words] on page 313: “The Mohammedan Religion has never done anything in the World except engender a selfish peace of mind to the individual and a total disregard for other peoples feelings. It breeds wars for nations

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by its intolerance. It has never invented anything, nor am I aware that any Mohammedan has initiated peaceful work of any time. It is the opposite to the Christian Religion of Charity, Peace, diligence and Usefulness.” These words are unacceptable from a learned, humane doctor perhaps fearing fanaticism; however the author’s comment is correct and highly appreciated. “. . . what stand out from Dr. Christopherson’s career in the Sudan, are his refusal to comply with the hierarchical rigidity and his ignoring of the exclusionary tactics of the Administration. His stance was not admired; it was maintained at considerable personal cost.” A century has passed, the pages of history have turned and appreciation for his selfless work is long overdue. The author is assured of receiving the warm and gratified approval of her readers in the Sudan. Yusuf Fadl Hasan Professor of History University of Khartoum

ACKNOWLEDGMENTS

Writing on any aspect of Sudan brings one inevitably to Durham University, UK; their Special Collection holds the largest Sudan archive (other than that found in Khartoum). The amazing Jane Hogan is the archivist. Her efficiency, in-depth knowledge, and personal generosity have contributed immensely to the success of my project. My brief visit to Khartoum, in February 2003, stands out as the highlight of my years of research. I was invited to talk at a symposium on schistosomiasis, and to attend the unveiling of a memorial plaque to Dr. J.B. Christopherson, (my great uncle), in what was originally, ‘his hospital,’ Khartoum Civil Hospital. This came about through the sheer luck of finding Dr. Abdel A’Al Abdella Osman’s paper on the history of the Sudan Medical Department in the Bulletin of the Postgraduate Medical Studies Board, edited by Professor El Rasheid Ahmed, my first contact. Built in 1909, the old Khartoum Civil Hospital is now home to the ‘Sudan Medical Specialization Board’ whose president, Professor Abdel Rahman M. Musa, officiated on that historic day. Also present were Professor Mamoun Homeida, and Dr. S.M. Mahmoud whose advice was most useful. The same week I met the husband and wife team, Professors Gasim Badri and Amna Badri, principals of Afhad University, an academic opportunity for the young women of Sudan. Professor Gasim, grandson of Babikr Bedri known throughout Sudan for his championing of women’s education, presented me with Volume II of his grandfather’s memoir, a story that includes mention of his experience as a patient of Dr. Christopherson at the Civil Hospital. In Khartoum I also met Professor Yusuf Fadl Hasan, former Vice Chancellor of the University of Khartoum, who later read and endorsed my manuscript. I thank also Dr. ‘Ali Saleh al-Karrar of the National Records Office, and Mr. Hashim Mohamed Awad Al Karin who drove us around Omdurman. Dr. Ahmed Adeel, Professor of parasitology at King Saud University, Saudi Arabia, is also a medical historian interested in doctors in Sudan during the ‘colonial’ period. Originally Dr. Adeel offered to collaborate in writing an article; then, learning that I was embarking on a full

xii

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biography, answered many questions and eventually read my entire manuscript. He has been a most generous friend. In Khartoum we stayed, on the recommendation of Jane Hogan, at the Acropole Hotel run by the legendary George and Eleanora Pagoulatos. The Acropole is without doubt the most rewarding place to stay in Khartoum. George is famous for ‘getting things done.’ Whatever you need, visas, recommendations, rides here or there, connections made, George cheerfully and speedily accomplishes miracles. The Acropole is an experience of hospitality, friendship and diversity. In North America I owe thanks to my friend, journalist Alsir Sidahmed, who has assisted most enthusiastically in translations and advice, and to Heather Sharkey, a fount of knowledge on colonial Sudan, who suggested I contact the Maloufs, René and Sonia. René’s father, Dr. Nikola Malouf, worked with Christopherson in Sudan for many years. Through the Maloufs I met their friends Alfred and Madeleine Morhig, now living in England. Alfred’s family had owned Morhig’s English Pharmacy and export business in central Khartoum in Christopherson’s time. All had tales to tell, although none had been able to hold on to family papers. Both Susan Kenyon and Heather Bell have written about Christopherson and the Sudan Medical Department, and both were generous in sharing their work. Susan sent me her enormously helpful unpublished article on Christopherson. Here too, I thank my good friend Cornelia Baines, who critiqued the manuscript with an eagle eye and made many useful comments, and Jacalyn Duffin, who answered dozens of emails and assured me the book would be published. Thank you also to Carl Benn, friend and neighbour who proofed my last book and whose thoughtful advice I usually follow, and to Dan Sellen and Richard B. Lee of the University of Toronto, who opened a window on a new way of thinking for me when I took their course—Medical Anthropology. The good-natured librarians at the Gerstein Science library, University of Toronto, were most helpful, particularly Roy Pearson who can find any book in the stacks. My nephew, E. Wayles Browne of Cornell University, read my chapter on Serbia in World War One, and supplied me with readings and maps for that very complicated era of history. Jennifer Keelan took me under her wing in the early days, patiently critiqued my work and introduced me to the History of Medicine at the University of Toronto;

acknowledgments

xiii

Pauline Mazumdar who taught me so much from her course and whose friendship I value. To all of them, my gratitude. I appreciate the assistance of: Robert Desowitz, June Engel, Beth Gebreyohannes, Marni Jackson, Jane Little, Iona MacNaughton, Viviane Pescov Maschoieff, Kathy Vatcher, Susan Wall, and Justyna Paterek for ‘Photo-shopping’ a great many photographs at the last minute. In Australia: David Grove, a world authority on helminths, discussed with me Christopherson and the bilharzia history. June Harper, formerly Christopherson, (daughter-in-law of JBC’s elder brother, Arthur) kindly passed on to me many Christopherson family treasures. In South Africa: Steve Watt, historian of the Imperial Yeomanry Hospital in Deelfontein, advised on the Boer War chapter; Joan Marsh of the South African History Journal offered information about the Karoo, and, I thank Israeli, Gabriel Warburg, expert on General Wingate and Rudolph Slatin for our discussion. In England my sources were myriad: The librarians and archivists at the Wellcome Trust, Richard Bland—Clifton College archivist, Phillip Bowcock, Alick Cameron, Gordon C. Cook, James Cox—Caius College archivist, John Emsley, Dick Field, Mark Harrison, the late Peter Jordan, Henry Keown-Boyd Pasha, Victoria Killick—London School of Tropical Medicine and Hygiene archivist, Richard Ogier Ward, Mary Pattison, Norman Pearce, Peter Prime, Helen Pugh—British Red Cross Archivist, C.S. (Kit) Rawlins, Marion Rea—Barts Hospital Archivist, Ruth Richardson, Morven Roberts, John Rugg, Hannah Scott of the Neave family trust who put me in touch with Digby Neave, grandson of Sheffield Neave; the late Susan Sloper—a Christopherson grand-daughter, Peter W.F. Sterry, military specialist Iain Swinnerton, John Udal, Peter and Angela Vaux and Justin Willis. My cousin, the late Ena Edwards (née Christopherson) who entrusted me with JBC’s medals and many family stories. Special thanks go particularly to my friend Lise Wilkinson of the Wellcome Institute, London and to Martin Taylor of the London School of Hygiene and Tropical Medicine who was another source of schistosomiasis information and a most amusing correspondent and, Jack Meadows of Loughborough University, a polymath who writes on history of science. At the last minute, after a seven year search, Angus McDonagh, grandson of Dr. J.E.R. McDonagh, Christopherson’s rival for priority, noticed one of the many messages I left somewhere in cyberspace. He and his wife gave my husband and me a handsome lunch and showed us photographs of his grandfather.

xiv

acknowledgments

In Switzerland, I received collective assistance from Lorenzo Savioli, Albis Gabrelli and Antonio Montresor, at the WHO in Geneva, who found me a photo of the ‘dosing pole’ to use in Appendix A. In the United States, the late Robert O. Collins, Sudan expert, was there from the beginning. I am so sorry he’s not here to see the end. I offer major thanks to John Farley of Dalhousie University, Canada, author of Bilharzia: A History of Imperial Tropical Medicine, with whom I spoke many years ago, before I had any thought of writing about Christopherson. I rang John up in high dudgeon to complain that he had missed my uncle’s name in the index of his book and had hardly mentioned him in the text. John took my irritation with his usual good humour and so began a great friendship centred on, what else, bilharzia! Of the greatest importance was the assistance given me by Joyce Christopherson’s nephews: Walter (and Elizabeth) Ormerod for long talks about Jack Christopherson over tea and fruit-cake and Peter (and Christine) Ormerod, who held the Christopherson archive. Peter, a Barts doctor, is married to Christine, a Barts nurse. They cared for Joyce in her old age; in consequence, those letters, photos and other family memorabilia, carefully saved by Joyce, remained in the Ormerod household. Once I embarked on this biography, these were entrusted to me. Without the hundreds of letters there would be no book. With Peter’s agreement all of this material will be deposited in the Durham archive. Peter and Christine have hosted me in their home in Cheltenham on numerous occasions. Our emails and telephone conversations must add up to hundreds over the years. I am grateful for their faith in me and their standing behind my work from the beginning, taking whatever I found about our uncle with cheerful equanimity. My patient friend, Barbara MacLennan, who copy-edited every word of the final draft has worked miracles and I’m grateful. Thank—you too, Warren, Stefan, Daniel, Abigail, and Adam—our children, who have endured the eight year gestation of the Christopherson saga. My best thanks I save for my dear husband, friend, editor-par-excellence, and the kindest man I know. Without his love and support there would be no book. Despite all the help over the eight years of work, there are sure to be errors and these I fully acknowledge as mine alone. If anyone has answers to the unsolved enigmas, please be in touch. Ann Crichton-Harris Toronto, Canada January, 2009

ABBREVIATIONS

AAMC AG AGS BMJ CIVSEC DGMS FRS GHQ IYH JBC LSHTM MOH PMO RAMC RWRL RWTRL SAD SMD SMSB SMO UMCA WT

Australian Army Medical Corps Adjutant General Army General Staff British Medical Journal Civil Secretary Files, held at the National Records Office, Khartoum Director General Medical Services Fellow of the Royal Society General Headquarters Imperial Yeomanry Hospital John Brian Christopherson London School of Hygiene and Tropical Medicine Medical Officer of Health Principal Medical Officer Royal Army Medical Corps Report of the Wellcome Research Laboratories Report of the Wellcome Tropical Research Laboratories Sudan Archive, Durham University Library Sudan Medical Department, (after 1924, SMS, Sudan Medical Service) Sudan Medical Specialization Board Senior Medical Officer Universities’ Mission to Central Africa Wellcome Trust Archive

LIST OF ILLUSTRATIONS

The photos in this book appear by courtesy of a number of institutions and individuals, all of whom have kindly allowed their reproduction here. They remain copyright, and may not be reproduced without permission. 2.1.

‘Jack’ Christopherson aged 4. His sister wrote on the back ‘Isn’t he sweet?’. Photo courtesy of Dr. T. Peter Ormerod ................................................................................... Little ‘Ted,’ with Claude and Denton Christopherson. Source: author ......................................................................... Rev. Brian Christopherson with Caroline, Muriel and Eva. Source: author ................................................................. Caroline Christopherson with Jack, Arthur and Evelyn. Source: author ......................................................................... JBC in his Barts Hospital days. Source: author .................

2.2. 2.3. 2.4. 2.5. 3.1. 3.2. 3.3. 3.4. 3.5. 3.6. 3.7. 3.8. 3.9. 3.10.

1

JBC in his Boer War uniform. Photo courtesy of Dr. T. Peter Ormerod1 ........................................................... IYH, Hunt ward. Note the names of the donors over the beds ..................................................................................... Col A.T. Sloggett, commandant of the camp. Taken by JBC 17 June, 1900 ................................................................... Camp, with IYH carved into the hill behind ..................... Operating theatre, IYH camp ............................................... JBC at the convent, Mafeking. Note damage by a 100 lb Boer shell .................................................................................. Patient Cruickshank being questioned by the Commission ............................................................................. The ‘Deelfontein Plate’ ........................................................... JBC on the winning horse, ‘The Widow’ ............................ JBC on R & Surgeon Ballance ...............................................

All photos in Chapter Three appear by courtesy of Dr. T. Peter Ormerod.

56 57 58 59 64

69 73 76 78 80 82 85 88 88 90

xviii

list of illustrations

3.11. JBC’s convalescent Typhoid patients ............................ 3.12. IYH. X-Ray room ............................................................. 4.1. 4.2.

4.3.

4.4.

5.1. 5.2. 5.3. 5.4. 5.5. 5.6.

6.1.

6.2.

7.1.

91 94

Original Hospital, Khartoum, 1905. Dr. Zaki on JBC’s R. Photo courtesy of Dr. T. Peter Ormerod ..... 102 Smallpox Map drawn for JBC by Sergeant Laurie. (The numbers refer to the list of cases detailed in the full 26 page report held in the Sudan collection at Durham University). Sudan Archive (407/1/28), courtesy of Durham University Library ....................... 108–109 Ismail Aly, smallpox victim—a severe case. Sudan Archive (407/4/3), courtesy of the Durham University Library ............................................................ 110 Hassan Eff. Zaki vaccinating. Sudan Archive (407/4/10), courtesy of the Durham University Library ................................................................................ 113 JBC on a donkey, 1906. Sudan Archive (2/2/39), courtesy of the Durham University Library ................ Dr. Nicola K. Malouf, taken in Morhig’s studio, Khartoum. Photo courtesy of René Malouf ................ Regimental jaguar in JBC’s care, with friendly dog. Photo courtesy of Dr. T. Peter Ormerod ..................... Dr. E.S. Crispin. Photo courtesy of Mrs. P. Thorne .................................................................. Dr. J.B. Christopherson. Photo courtesy of Dr. T. Peter Ormerod ..................................................... Dr. A. Balfour. Photo courtesy of London School of Hygiene and Tropical Medicine ....................................

120 131 137 139 139 139

Telegram from JBC to Dr. C.W. Daniels, 18 November, 1909. Photo courtesy of The Wellcome Library, London ............................................ Dr. S. Neave’s Microscope, given to JBC in 1904. Photo courtesy of Dr. T. Peter Ormerod .....................

169

Morhig’s English Pharmacy, Khartoum. Sudan Archive (744/11/2), courtesy of the Durham University Library ............................................................

178

160

list of illustrations 8.1. 8.2.

9.1. 9.2.

9.3.

Joyce Eleanor Christopherson, née Ormerod. Photo courtesy of Dr. T. Peter Ormerod ....................................... Bishop Gwynne & W.R.S. May in the operating theatre, KCH, 1912. Photo courtesy of Dr. T. Peter Ormerod ..... Map of Serbia showing Vrnjacka Banja. Map courtesy of Profs. J.B. Allcock & A. Young ............................................. JBC’s postcard—the railway station at Vrnjacka Banja, one of the few pieces of mail to get through. Photo courtesy of Peter Vaux ........................................................... Sir Reginald Wingate and Sir Rudolph Slatin Pasha. Sudan Archive (13/6/7), courtesy of the Durham University Library ...................................................................

11.1. Dr. J.E.R. McDonagh. Photo courtesy of Angus McDonagh ................................................................................ 11.2. Sir Leonard Rogers. Photo courtesy of The Wellcome Library, London ...................................................................... 11.3. Front of case sheet No. 10, part of the group in JBC’s major paper. Sudan Archive (407/5/14), courtesy of the Durham University Library ................................................... 11.4. Back of case sheet. Sudan Archive (407/5/14a), courtesy of the Durham University Library ....................................... 11.5. New Khartoum Civil Hospital, opened in 1909. JBC and his staff. Photo courtesy of Dr. T. Peter Ormerod ........... 12.1. JBC’s home in Khartoum, No. 3 Virtue Villas. Sudan Archive (2/2/130), courtesy of the Durham University Library ....................................................................................... 13.1. 29 Devonshire Place, London, taken by JBC Oct. 1933. Source: author ......................................................................... 13.2. 29 Devonshire Place, taken by the author in 1994. .......... 13.3. Heavensgate, with roses climbing the porch, and the farm workers. Photo courtesy of Dr. T. Peter Ormerod ................................................................................... 13.4. Heavensgate, a woodcut by Joyce for their Christmas card. Photo courtesy of Dr. T. Peter Ormerod ..................

xix

205 208

218

228

235

270 277

284 285 300

320

324 324

347 347

xx

list of illustrations

14.1. JBC with Joyce’s cat, Timotheus. Photo courtesy of Dr. T. Peter Ormerod ............................................................

363

15.1. Plaque honoring JBC, at the original Khartoum Civil Hospital, unveiled in 2001. (Now home to the Sudan Medical Specialization Board.) Source: author ..................

390

Appendix A: A.1. Dose-Pole in use in Africa. Photo courtesy of World Health Organization, Dr. Albis Gabrielli ..........

396

INTRODUCTION

The British Empire was fading when I was growing up during the Second World War. Nevertheless our family, like so many others, had an unshakeable faith in what great uncle this-or-that had accomplished in the colonies. There was no room for criticism. We took particular pride in Dr. John B. Christopherson, the kindly old uncle, the intellectual star of his generation. For almost two decades, in Sudan, beginning in 1901, he had battled away in heat and extraordinarily trying conditions, to bring medicine to Europeans and Africans, both sorely in need of good medical attention. In 1917 he achieved something spectacular: he found the cure for bilharzia (schistosomiasis)—a scourge of the tropics, a debilitating and sometimes fatal parasitic illness. Decades later he concluded his career as a consultant in the elegant Harley Street area of London. This is the story of one man’s experience in Africa when tropical medical was coming into its own, a time seen retrospectively as the ‘golden age of tropical medicine.’ Opportunities for discovery, treatments, cures, and maybe even the reward of a knighthood, were all possible. The cream of our family crop had passed the Indian Civil Service (ICS) or the Indian Medical Service (IMS) exams, and gone out to the colonies to rule for the betterment of the world, or so it was understood. Those who settled for that pseudo-colony, the Anglo-Egyptian Condominium, were graded for character and prowess in sports: written exams were not required, nevertheless, they enjoyed the same high regard in the family. It was my discovery of a recent book about the Sudan Medical Service in the Wellcome Trust Library in London, England that made me reconsider Jack Christopherson’s reputation.1 The author quoted from a letter written in 1908 by the Governor General of Sudan, Sir Reginald Wingate: “. . . there can be no doubt that he [Christopherson] has

1

Heather Bell, Frontiers of Medicine in the Anglo-Egyptian Sudan 1899–1940 (Oxford: Clarendon Press, 1999).

2

introduction

altogether failed to obtain the friendship or the confidence of any of his Profession, including even those actually in his own Department.”2 I was taken aback. Maybe the Christopherson story would be worth investigating. Was this the same man, known to be kind to animals and people alike, credited with building a hospital in the desert of Sudan and treating all comers during his two decades in an outpost of empire? Jack Christopherson died in 1955. I read his obituaries. Many were laudatory of course, but one written by his friend Sir Philip MansonBahr, a colleague in the field of Tropical Medicine, was more candid than the others: During his service in the Sudan he [Christopherson] rediscovered the spirochaete of the local relapsing fever and there ensued a battle about the nomenclature of this parasite with Andrew Balfour—a battle that resounded throughout the deserts and filtered down the Nile to the Tropical School in London.3 It was indeed a battle-royal and in the end Christopherson won. But this was by no means his only claim to fame: we owe to him entirely the antimony treatment of bilharzia disease (schistosomiasis), which he discovered in 1917 in Khartoum.4

Manson-Bahr also disclosed that Christopherson had been involved in one of those ‘who published first?’ academic squabbles: “Although there have been other claims to this discovery there can be no doubt that the credit goes to Christopherson, though it has not always been accorded to him, as he undoubtedly deserved.”5 I soon learned that this was the least of Christopherson’s problems in Sudan. Against the background of Empire and the Sudan Medical Department, the maverick Dr. Christopherson managed, without even trying, to make life uncomfortable for his superiors in the capital city of Khartoum. Others have written about those who refused to compromise their values. Albert Memmi considered the subject in The Colonizers and the Colonized;6 and Clive Dewey in Anglo-Indian Attitudes looked at the troubles evoked by a couple in India who chose not to fit the mould, and socialized with Indians.7 2

Ibid., p. 24. Sir Andrew Balfour, director of the Wellcome Laboratory on the Nile. 4 Philip Manson-Bahr, Memoir II: History of the School of Tropical Medicine in London 1899–1949 (London: H.K. Lewis, 1956), p. 203. 5 Ibid. 6 Albert Memmi, The Colonized and the Colonizers (Boston: Beacon Press, 1957). 7 Clive Dewey, Anglo-Indian Attitudes: The Mind of the Indian Civil Service (London: The Hambledon Press, 1993). 3

introduction

3

Anthropologist Susan Kenyon of Butler University came upon Christopherson’s detailed and personal Smallpox Report of 1902 in the Durham University archive. She wondered why this man, with so much initial promise, had vanished from the records. “Dr. Christopherson was demoted by the colonial government in a case which remains shrouded in mystery” she wrote.8 It appears that Christopherson’s life in earlytwentieth-century Africa was one of contradiction and turbulence. What was really going on inside the Sudan Medical Department when Christopherson was Director? And later, when he was removed from this post and worked from his bases at the Khartoum and Omdurman civil hospitals? As Christopherson’s great-niece, I knew something of the background that formed his character (although we never met). When he was a teenager the family moved from chilly northeast England to the sunny southwest. I visited Cornwall’s south coast, a magical land washed by the Gulf Stream with a climate that grows, unlikely as it might seem for England, palm trees. In the parish church in Falmouth I sat in the ‘family pew’ (six rows back in the middle) and pictured them all on Sundays listening as Canon Brian Christopherson, Jack’s father, delivered his weekly sermon in a Lancashire accent.9 I watched ghosts of the family, Brian, Caroline, and the seven children enjoying the roast beef dinner later that day at the rectory. Brian would be serving up the roast beef while Caroline watched for elbows on the table and other cardinal sins. I imagined the children earlier, before they escaped south, living in a dank and gloomy boarding school in Newcastle-upon-Tyne where the Reverend Brian was headmaster. I could shut my eyes and smell the wretched food—the boiled cabbage, the ubiquitous brown Windsor soup. I recalled from my own boarding-school experience the bitter cold and the misery of chilblains—but at least girls were spared the thrashings routinely meted out in boys’ schools. Christopherson’s background was one of discipline; his headmaster father had seen to that. His mother, Caroline Christopherson (née Denton), was a social climber and a stickler for correctness—not unusual traits for the times. The family had known trouble at the school in the north where both the headmaster’s character and the reputation of

8 Susan Kenyon, The Smallpox Outbreak of 1903: Disease and Disorder in Colonial Sudan. Unpublished paper. 11 October, 1999. 9 Canon Brian Christopherson was born in rural north Lancashire, now Cumbria.

4

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the school had been called into question on the subject of some overenthusiastic disciplining of two boarders. Shortly after this matter was settled, in May of 1879 there befell a tragedy. Two of his younger sons, Denton and Claude, age four and five, died of scarlet fever within days of each other. ‘In convulsions, father present at death’ the death certificates read. The family soldiered on. It was said that Caroline could no longer bear to speak their names. As a schoolboy in Newcastle young Jack would have been aware of the gossip surrounding the discipline inquiry from the other boys. This background may have encouraged the traits he became known for— stubbornness and a sense of ‘being right.’ It is clear from his letters to his wife, and from the comments of his colleagues, that Christopherson, although kind and compassionate, could be rashly outspoken.10 There were times when he seemed to enjoy a good fight. Research to learn more, not only about Christopherson, but about the lives of his colleagues, at this remove, both geographic and temporal, has taken eight years. After exhausting the public archives, I moved to obituaries, from thence to wills, and from there to names in those wills. There were disappointments and some surprising results; sometimes uncle so-and-so, who looks so jolly in his photo, was remembered by his nephews as a miserable martinet and a bully. A good example of a search with surprising results is that of the search for Dr. E.S. Crispin, an early adversary of Christopherson in Sudan. I read all I could about Crispin, his obituary and notes held at the Sudan archive in Durham. He had died at sea and there was no mention of a wife or children in the newspaper report. I ordered a copy of his will—no spouse or child were mentioned there either. I began to think that perhaps he had been one of those loners who go out to Africa or India and become affected by the loneliness, or perhaps he had been homosexual, and given the taboos of the time, unmentionable as such. Crispin’s will featured one heart-stopping item. An unpublished manuscript, a memoir, left to a ‘friend,’ who turned out to be a relative, in the hope that she might find a publisher. The friend is long dead, and the memoir remains unpublished. After four months of investigation

10 Over two hundred of JBC’s letters were kindly given to me by Joyce Christopherson’s nephew, Dr. T. Peter Ormerod. These will later be turned over to the Sudan Archive, Durham University, UK.

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using more wills, the internet, various public libraries, and finally an advertisement in a local British paper, I unearthed the Crispin family. From them I learned that “uncle Ted Crispin” had married not once but three times and his only child and its mother died in Sudan! Unfortunately, although a number of his family recalled having read his manuscript, no one could find it. After all, some of my conclusions will be conjecture and stated as such. Nevertheless, through Christopherson’s writings and any of his colleagues’ that I could locate, his personality has emerged quite clearly. His hopes—both achieved and dashed—have come into focus in the context of the Sudan Medical Department, in Africa, in the early twentieth century. The trajectory of his career, as described in his obituary in The Times of London, and from the various appreciations in the press, showed a life of challenge and success: service in both the Boer War, in the First World War, and in two decades in Sudan. All was crowned with his astonishing discovery in 1917 for the use of antimony (tartar emetic), an ancient poison, as the successful treatment and cure for bilharzia (schistosomiasis): one of the first chemotherapies and a potential life-saver for the millions suffering and dying of this tropical scourge. That was one version. The material I unearthed revealed a more complicated story. In over six years of research, assisted by dozens of enthusiastic friends, colleagues and archivists, I felt at times elated, at others simply bewildered. The devil was, in fact, in the details.

The Development of Tropical Medicine as a Discipline The term ‘Tropical Medicine’ came into use formally in October 1899 with the opening of the London School of Tropical Medicine (LSTM) adjacent to its clinical adjunct, the Albert Dock Hospital. Patrick Manson (1884–1922) founded the LSTM despite considerable opposition from those who felt that the Royal Victoria Hospital, Netley, servicing patients from India and China, was sufficient.11 Sir Patrick, as he later became, is generally acknowledged as the ‘Father of Tropical Medicine’ and there is a handsome plaque to his memory in the new school

11 The Royal Victoria Hospital, Netley was near the port of Southampton. Here were trained those enlisting in the Indian Medical Service (IMS).

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building on Keppel Street, opened in 1929 as the London School for Hygiene and Tropical Medicine (LSHTM). Manson cemented his name in history not only by founding the school, but also by publishing Tropical Diseases: A Manual of the Diseases of Warm Climates, in 1898.12 This became the standard for decades and ran to sixteen editions, the last, in 1966, edited by his faithful son-in-law Philip Manson-Bahr.13 Manson’s interest in tropical medicine sprang from his work in China and his discovery of the filiaris worm responsible for the hideously deforming disease, elephantiasis. It was years later, in 1925, that the hard-driving Andrew Balfour, by then Director of the LSHTM, (and at one time an adversary of Christopherson) stated that it was “. . . quite wrong to speak of Patrick Manson as the ‘Father of Tropical Medicine.’ He was the Father, most undoubtedly, of modern Tropical Medicine, but behind him stood a long line of British and American pioneers.”14 Surely this is, one way or another, the route for almost any scientific or medical achievement? Of course tropical medicine had been practiced, just not so-named, wherever disease and illness, either in the tropics or thought to come from the tropics, was experienced. Sadly, without specialist training and with very little notion of how to diagnose, let alone how to treat, young physicians travelling to torrid climates at the end of the nineteenth century and in the first years of the twentieth century were often both inexperienced and ill-equipped. Given that their reputations amongst indigenous peoples often depended completely on the outcome of their first case, their future careers in the colonies might well be doomed from the very beginning. This much Christopherson and some of his colleagues knew well and even wrote about. What drew young men to the colonies? Were they hoping to find challenges in tropical medicine and positions of responsibility they could not have held at home? Were the stated politics of the British

12 Manson, Patrick. Tropical Diseases: A Manual of the Diseases of Warm Climates (London: Cassells, 1898). 13 Patrick Manson’s daughter married Philip Bahr who took his father-in-law’s name. The explanation for this was kindly furnished by his great grandson, Mark M.-B. “Sir Philip Bahr was a German and England in the 1880s / 1890s was a nationalistic place with a war looming with Germany. In order to alleviate prejudice issues they joined their names.” E-mail to the author 26 November, 2008. Philip M.-B. was a great friend and champion of J.B. Christopherson. 14 David Arnold, Ed. Warm Climates and Western Medicine: The Emergence of Tropical Medicine 1500–1900 (Amsterdam: Rodopi, 1996), p. 2.

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at variance with the ideals of some individuals? Did these men (there were no women) believe that their primary work was to build pillars of Empire and civilize natives? In the case of the first few physicians, those arriving before 1904, no matter what life they may have envisioned before they set sail, they found few trappings of empire to enjoy. Their daily life played out in the heat and dust of a landscape of shifting sand and shifting loyalties. For each of them work in the first decade was a daily battle of fighting disease amidst a lack of clean water and sanitation in excessive heat and smothering sandstorms. There were few basic necessities to support a tolerable life. In the effort to succeed each of them had to learn enough Arabic to get by, all the while leaning heavily on local Sudanese and Egyptian or Syrian assistants for advice, advice reputed to have been given cheerfully. For British young men, at any rate, there were several enticements. There was adventure: they had all read the stories of General Gordon, the British hero at the siege of Khartoum, and the lengthy adventures of Burton and Speke searching for the source of the Nile, and of course, the legendary Dr. Livingstone. These tales had glamour. There was sport: hunting big game or even smaller game was a big draw, and trophies such as elephant-leg umbrella stands or tiger-skin (in India) or leopardskin rugs were eye-catching. One historian noted that employment for physicians at home during the late Victorian and Edwardian eras was becoming more difficult as the profession became crowded. There was professional success: a young man could make a position for himself in the colonies with experience and responsibilities he could not possibly attain in England. On the negative side there was loneliness, and at times serious health risks.15 As Anna Crozier documents, many were invalided home, some even died on the job.16 The Foreign Office appointments required only an interview, essentially to see if the candidate were European and ‘top drawer’ i.e. spoke the ‘King’s English’ and had been to the ‘right schools.’ Unlike the Indian Medical Service, or the Indian Civil Service, there were no exams. With the expansion of many empires, not just the British Empire, but also all those other active and rapacious colonizers, expertise in ‘medicine for the warmer climates’ was needed. Without healthy armies

15 Anna Crozier, Practising Colonial Medicine: The Colonial Medical Service in British East Africa (London: I.B. Tauris), p. 47. 16 Ibid., p. 95.

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conquerors could not take and hold the land; without healthy administrators they could not run government departments; without healthy indigenous labour, they could not carry out schemes of expansion or exploration, for example, for mineral wealth or agriculture. British efforts to grow cotton to feed the Lancashire cotton mills had, if not unforeseen consequences, at least initially neglected consequences. The irrigation channels in the cotton growing areas offered a new water-highway for the schistosomiasis-infected snail. “British irrigation projects made bilharzia the number one health hazard in Egypt” wrote the author of a book on the medical profession in Egypt.17 Sheldon Watts described a remarkably similar, but in reverse, irrigation problem in India instigated by over-enthusiastic British engineers “. . . who [neglected the building of] . . . a parallel system of drainage to rid fields of surplus water . . .”18 In this case the result was a breeding place for the anopheles mosquito and its consequence, malaria. Colonization, had anyone stopped long enough to consider this, spread channels for disease as fast as it spread medicine. European-built access, railways and roads, across the desert exacerbated the problem. It was not only the African continent that suffered these unintended consequences of the improvements by the enthusiastic colonizers. Historian Mark Harrison wrote: “British rule in India had created as many medical problems as it had resolved.”19 The biggest medical success on both continents was in preventive medicine, specifically smallpox vaccination. Perhaps this was due, not just to the coercive methods of the medical staff but to the sheer terror felt by the indigenous population at the thought of contracting this disfiguring disease and, as likely as not, dying of it. Disease in the tropics was not limited to people. Cattle died from rinderpest. Donkeys, the mainstay of local transport for Europeans getting about Khartoum in the early 1900s, could sicken and die from sleeping sickness carried by the tsetse fly. The Germans in East Africa in the First World War, led by the brilliant General Von Lettow Vorbeck, used the tsetse fly to advantage by enticing British mounted battalions 17 Amira el-Azhary Sonbol, The Creation of a Medical Profession in Egypt, 1800–1922 (Syracuse: Syracuse University Press, 1991), p. 123. 18 Sheldon Watts, British Development Policies and Malaria in India 1897–c. 1929 (Past & Present: Nov. 1999: No. 165), p. 142. 19 Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914. Cambridge History of Medicine (Cambridge: Cambridge U. Press, 1994), p. 227.

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through tse-tse infested areas, while keeping their own animals safely grazing elsewhere.20 Both European and indigenous populations ran the risk of yellow fever, cholera (understood as water-borne, in the late 1850s, but often not believed as such), kala-azar (visceral leishmaniasis), leprosy, yaws (often thought by prurient missionaries to be syphilis contracted by ‘promiscuous natives’), Chagas’ disease, typhus, typhoid, (the last two sometimes confused), and hook-worm (ankylostomiasis), to name a few. Smallpox, perhaps more dreaded than any, swept through central Africa in waves. One outbreak challenged Christopherson at the very beginning of his time in Sudan. It is worth noting that although malaria, (from ‘mal’aria’, Italian for ‘bad air’) is considered a tropical disease, it was prevalent in large parts of Europe, in the Fens of England, and in parts of the Niagara Peninsula, Ontario, Canada, until the late nineteenth century. Malaria, then as it does now, killed and debilitated many. It was more usually referred to in history as ‘the ague’ and is found so described in many old homeremedy books. The saviour from this misery was quinine, made from the pulverized bark of the Cinchona tree and taken as an infusion. It was imported from Peru to France in the early seventeenth century and remained the accepted treatment for centuries. My grandfather, a surgeon in the IMS in East Africa in the First World War, complained that he had drunk enough quinine to float a ship. And yet, it must be said, he suffered many bouts of malaria during his four years there. Tonic water was flavoured with quinine giving it the bitter taste so popular with the British colonials as a gin-and-tonic ‘sundowner.’ Fortunately, most host organisms are geographically limited, requiring warmer weather than exists in northern Europe. For example, the intermediate host snail of schistosomiasis lives in warm, fresh, slowmoving water, so re-infection in England was most unlikely to occur.21 The helminth (worm) continued to affect mostly soldiers and sailors and the fellaheen—Egyptian labourers—some of whom harboured them for years, spreading the disease unknowingly. As for the teenage boys in Africa who saw urinating blood, a symptom of schistosomiasis, as

20

See A. Crichton-Harris. Seventeen Letters to Tatham: A WWI Surgeon in East Africa (Keneggy West: Maine, USA, 2001). 21 The advent of global warming may, in time, encourage the snail hosts to infect England.

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a rite of passage, I can only quote Robert Desowitz: “If you are never well, you may not know that you are sick.”22

The Race to Discover, Name, Treat and Cure in This Living Laboratory In the race to colonize the colonizers encountered a universe of opportunity and a myriad of questions waiting to be answered. Tropical medicine and colonization went hand in glove and geography mattered enormously. Skin colour, tribe, race, indigenous medicine, all would play a part in the new exciting world waiting to be understood, and perhaps conquered to bring glory to the mother country. Did racial difference influence disease? Were some races more susceptible to a particular disease than others? Did some carry a natural immunity? Would mixed marriages increase or decrease the innate susceptibility to certain diseases? If, as the graveyards testify, Europeans were at greater risk of dying in Africa, the Philippines, India and Malaysia, exactly why was this and what could be done about it? Were European men and women affected differently by local disease and if so how? Would the ‘miracles’ of western medicine succeed as a tool to pacify the ‘uncivilized’? Stories about doctors in the jungles of ‘darkest Africa’, or in India with their colourfully turbaned servants discreetly and humbly waiting on them, gave a glamour to the job and photographed well. It was the Indian Mutiny of 1857 that finally led some to question the status quo but few questioned the belief that Europeans were superior to any indigenous population with a different skin colour. It was a brave, or perhaps foolhardy, man or woman who fraternized with locals outside office hours, despite the fact that it was local men who assisted, advised, translated both language and customs, and generally kept the early Europeans out of trouble. Their reward? To be kept ‘in their place.’ As Hubert Lyautey so famously said “La seule excuse de la colonisation, c’est la Médecine.”23 No matter how well disguised with elegant phrases, colonization is about what you can get out of a land over and above what you put in.

22

Robert Desowitz, Tropical Diseases (London: Harper Collins, 1997), p. 164. Hubert Lyautey (1854–1934) quoted in Roy Porter’s The Greatest Benefit to Mankind, p. 463. 23

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Were some ‘natives’ really lazy, or were they so loaded with parasites sapping their strength that they were not fit for work? Christopherson believed the latter. He wrote of the Egyptian fellaheen that they were ‘saturated’ with bilharzia and other debilitating parasites, sometimes as many as six different types at once. For this reason, he argued, the Army and the Administration in need of manpower should put money and effort into freeing these people from their parasites. The British could do well by doing good. Most cases of tropical disease in England itself had been brought in by soldiers or sailors. These were the patients seen by Christopherson when, back in 1899, he worked at the Albert Dock Hospital, London, where ex-members of the merchant navy were cared for. This hospital would see more cases of disease found in tropical countries and have given Christopherson an introduction to the same sort of work he later found in Africa. These were some of the cases that presented, in even greater variety, at his hospital every day in Sudan. These were what challenged and intrigued him and gave him the opportunity to use his microscope. It is recorded that he had great sympathy for his patients, but at the same time, once in Sudan, he recorded his fury at sloppiness, poor time-keeping, and anything that did not reasonably, come up to the standard of his old hospital, St. Bartholomew’s (Barts), in London. Tropical medicine (medicine in the warm climates), was geographically spread wide. In India most would subscribe to the Indian Medical Gazette; this also circulated outside India—Christopherson read this journal in Sudan. The Lancet and the British Medical Journal (BMJ) were two standard publications, important forums on the cutting edge of information and intellectual debate. The Society of Tropical Medicine and Hygiene, founded by Sir James Cantlie and George C. Low in 1907, spawned its own journal of the same name the following year.24 These four were among the most influential and useful for a physician in the tropics in the first decades of the twentieth century. There were others: (dates of first publication in parentheses): Tropical Diseases Bulletin (1906), Annals of Tropical Medicine and Parasitology (1906),

24 James Cantlie wrote to Christopherson asking for his interest and that of his colleagues in such a project. Christopherson thought his other European doctors should be notified but wondered how useful it would be for Syrian doctors to belong to a society based in England. Perhaps he had not considered the all-important journal at this time. 18 December, 1906. JBC to Cantlie. Khartoum [WTI/RST/AL]

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Journal of The Royal Society of Medicine (1907), Journal of Pathology and Bacteriology (1895), Journal of the Royal Army Medical Corps (1854), Journal of Parasitology (1894). Competition for priority, whether admitted or not, was hampered by the time required to transmit information. Physicians working in the mother country had the advantage. Those working in the colonies might wait six weeks or more for a paper to reach an editor in Europe or for a professional journal to arrive from England. As Mark Harrison wrote: “. . . controversies over priority for ‘discoveries’ in the emergent discipline of tropical medicine had distinctly nationalistic overtones.”25 He cites the priority fight conducted by Ronald Ross and the Italian, Batista Grassi, over malaria, and the lamentations of others distressed that medical textbooks were being imported from France and Germany. There was a British desire that England, ruling the biggest empire, should lead the way in colonial medicine. There was concern that other nations might be gaining momentum in this race.

British and French Colonial Medicine in Africa. How Did They Compare? The French Algerian colonial project, ‘La Mission Civilisatrice,’ was France’s gift of civilization, with medicine as a significant element, to the people of Algeria.26 The idea, if not the catch-phrase, is not dissimilar to the comment of General Sir Reginald Wingate, the Sirdar of Sudan, about using medicine to pacify the natives. Medicine throughout the colonial period, if only in retrospect, is generally acknowledged as an important ‘tool of Empire,’ a pax medicinae. While the French, British and others were colonizing parts of Africa, Britain had acquired Sudan, the largest country in Africa, almost by default when she took over Egypt. In designating Sudan the Anglo-Egyptian Condominium, it became ‘not quite a colony’ as I explain in detail

25 Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914 (Cambridge: Cambridge History of Medicine. Cambridge U. Press, 1994), p. 151. 26 “Algeria was a constituent component of the French interior . . . Tunisia and Morocco . . . were protectorates under the rubric of France’s Ministry of Foreign Affairs.” These were ruled much like any other colony despite their titles. Keller, R.C. Pinel in the Maghreb: Liberation, Confinement, and Psychiatric reform in French North Africa (Bulletin of the History of Medicine, Fall 2005, Vol. 79, No. 3), p. 465.

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elsewhere. The difference: British living and working in Sudan might neither acquire land nor settle in Sudan, both of which were permitted in Kenya, for instance. Using Sudan, its people, and its wealth, for the ‘benefit’ of the empire, was of course, constructively rationalized. For physicians working in the two colonial systems, there was more similarity than discrepancy, particularly with regard to the negative aspects. No matter how much inspiration, good-will, energy and highlevel training entered into the original plan, budget constraints and plain old human behaviour of the less charitable nature (with an emphasis on bigotry), managed to hamper the grander ideas. Both administrations, French and British, were rife with personal tensions and disagreements, usually beginning with the first jostling for rank in a newly formed system. Everyone experienced the stress of long working hours in stifling heat and generally miserable conditions. In Sudan both Andrew Balfour, and Major P.R. Phipps, Governor Wingate’s right-hand man, found their health seriously affected. Europeans did not suffer the humiliations encountered by five Algerian-born doctors described by William Gallois. Those physicians, working in the French colonial medical service, expressed, in their many letters, a depressingly sad tale of disillusion and sickness. Three of the five died on the job as a direct result of their perilous working conditions in the outposts of the colony. All were hired under a banner of medical imperialism and all felt betrayed.27 According to N.E. Gallagher, author of Medicine and Power in Tunisia, early in the century French settler-doctors felt threatened by Algerian-born Muslim doctors. These European doctors had to “stay on good terms with the Muslim chief of physicians to practice European medicine without difficulties.”28 By the end of the century the situation had completely reversed. High-ranking Muslim doctors were treated as second class and barely tolerated to practice. Gallagher sees this as a result of the colonists’ pervasive push to use medicine as a tool. This emphasis encouraged dependency, not only in medicine, but also in politics. A hundred years made an enormous difference. It was ‘a camel in the tent’ situation with the Europeans as the ‘camels’ easing their way in. Gallagher posits that Algerian elites chose Europeans doctors 27

William Gallois, Local Responses to French Medical Imperialism in Late NineteenthCentury Algeria (Social History of Medicine, Vol. 20, No. 2), pp. 315–331. 28 N.E. Gallagher, Medicine and Power in Tunisia, 1780–1900 (Cambridge: Cambridge U. Press, 1983), p. 1.

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in their belief that by doing so they could obtain special diplomatic services. The shift in confidence to the European physicians (and to European authority in general) was also encouraged by effective quarantine requirements in the case of epidemics, and the use of quinine and mercury as demonstrably successful drugs in use by the Europeans.29 Louis Pasteur (1822–1895), the great French microbiologist, generated an enormous legacy with a major impact on colonial medicine. His experiments supported the germ theory of disease and created the first vaccine for rabies. The list of his accomplishments is too long to list here; it is enough to say that his fame led to the establishment of the Pasteur Institute in Paris in 1888. This in turn, attracted many physicians inspired by the ’master’ and by the idea of microbe-oriented medicine. From Pasteur’s Institute grew “. . . an international network of associated Pasteur Institutes and Laboratories established in the five continents, 17 . . . founded by physicians of the [French] Colonial Health Service, 15 in the ancient colonies and 2 in Iran and China.”30 As Myron Echenberg wrote: “The Pasteur tradition did lead to much more applied research in colonial Africa, and achievements in dealing with sleeping sickness and yellow fever were great . . .”31 It also led some disciples of Pasteur to become giants in original achievement: Alexandre Yersin who isolated the microbial agent for plague in 1894 (in Hong Kong), followed by P.L. Simond who identified the carrier of the disease, the flea, and G. Girard and J. Robic who developed a vaccine in Madagascar in 1933. G. Martin became known for his work on sleeping sickness and for establishing a great centre for trypanosomiasis, a Pasteur Institute in Brazzaville, capital of the Congo. The list is long. The French medical footprint in West Africa started with French navy physicians stationed in the region at the end of the nineteenth century and grew to the establishment of the French army medical corps in 1903, partly as a result of finding a lack of interest in the work amongst civilian doctors.32 In Sudan there were tensions between civil and military doctors. They competed for rank (or assimilated rank), with pay and opportunity to

29

Ibid., p. 100. The Humanitarian Work of the French Colonial Health Service: 1890–1968. Introduced by the Naval and Overseas Health Association. (ASNOM) www.asnom .org Nov. 2008. 31 Myron Echenberg. E-mail to author 19 November, 2008. 32 (ASNOM), Op. cit., Nov. 2008. 30

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match, but the military were promoted faster. My own reading about non-European physicians in Sudan at that time has not found the severe or humiliating experiences endured by the Algerian doctors. Christopherson cheerfully accepted and learned from his particular friend Dr. Zeki, and from others whose collaboration he acknowledged in his published papers whenever appropriate. This is not to say that racial discrimination did not occur or that stratification was not adhered to; it was, at work and in the clubs. In 1924, some years after Christopherson had left Sudan, the first nationalist uprising took place in Cairo, and Governor-General Sir Lee Stack was murdered. This did not involve the medical profession directly although doubtless some Sudanese, Syrian and Egyptian physicians felt resentment about their poor chances of promotion. The British Administration had to face the fact that as they were now educating young Sudanese and Egyptians, they were simultaneously enabling them to challenge the status quo. There were unintended consequences. These bright young men didn’t want to hold lower-rank desk jobs; they wanted a say in running their country. In comparing French and British colonial medicine on the subject of mental illness I could not find any information in British texts, either for hospitalization of such patients or for their treatment. Either such patients were kept by their families and treated by the local medicine man, or perhaps the British found it convenient to ignore them. The French, on the other hand, particularly in the Maghreb area, took a great deal of interest in mental illness cases, how to treat, and how to keep locked up or restrained. Were patients in hospitals or ‘prisons’?33 That question is particularly brought to the fore here by the writing of, and about, Dr. Franz Fanon (1925–1961), a psychiatrist-philosopher who raised the issue of the psychopathology of colonization based on his work in hospices for the insane. No one of Fanon’s stature in this specialty has surfaced in the British African colonial medical system.

33 For an in-depth discussion of this question see: Richard C. Keller, Pinel in the Maghreb: Confinement, and Psychiatric Reform in French North Africa (Bull, Hist Med., Vol. 79, 2005), pp. 459–499.

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The British Pharmaceutical Industry: A Place in Colonial Medicine? At the beginning of the twentieth century “the general practitioner had an armoury of only four specific disease-fighting drugs: digitalis for certain heart conditions; quinine for malaria: pecacuanha [sic] for dysentery; mercury for the treatment of syphilis.”34 The race for Empire therefore offered the opportunity, indeed the necessity, to compete for more and better medicines. Britain produced a number of major pharmaceutical industries: Glaxo, Allen & Hanburys, Boots for example. For the purpose of this biography, the company of Burroughs Wellcome Co. is the most important. Henry Wellcome and his partner Silas Burroughs (both originally Americans) were highly successful manufacturers and entrepreneurs. Burroughs was an energetic salesman who liked to travel the world drumming up new markets using aggressive marketing tactics. Wellcome, probably with some justification, felt that Burroughs tended to appoint people to do unsupervised work without checking their career history satisfactorily. Wellcome’s attitude, occasionally verging on the paranoid, probably worked to his detriment at times. Certainly it did in the case of the travelling pathologist Dr. Neave, as I document later in chapter six. In any event, Burroughs Wellcome & Co. were well aware of the burgeoning prospects in the Far East, India and Africa. They had already experienced some disappointment in Europe. France had forbidden imports of foreign pharmaceuticals in an effort to protect her own industry. Germany and Spain also made problems in various ways. The tropics looked more positive. They were, but there were different obstacles here—climate for one. Drugs had to travel great distances in excessive heat without mechanical cooling. Vaccine in particular did not travel well across the desert on a journey from Cairo to Khartoum. Secondly, staff running a satellite facility thousands of miles away from the parent plant could not be satisfactorily monitored. The importation of pharmaceuticals to Sudan was dominated by one company—Morhig’s, the Lebanese Christian family of George N. Morhig.35 This company had what amounted to a monopoly on the

34

James Taggart, The World Pharmaceutical Industry (New York: Routledge, 1993),

p. 1. 35 Pharmaceuticals for the military were ordered direct from England or tendered from Cairo where the Anglo-German pharmacy was successful in 1905. See Wingate letter. SAD 277/5/39.

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sale of pharmaceuticals in Sudan. In the early years, as will be seen, this created a conflict of interest between the Morhig’s commercial Khartoum pharmacy and the Civil Hospital pharmacy. Morhig ran his import-export business so successfully that its quarters grew to cover the length of a city block. The company dealt not only in pharmaceuticals, they were also the sole agents for importing upmarket food, (something akin to the prestigious Fortnum and Mason in London) and whisky and gin, drinks so dear to the club life in the colonies. They dealt with big names like Colgate and Gillette, as well as the major pharmaceutical manufacturers: Burroughs Wellcome & Co., Parke Davis, Allen & Hanburys, Glaxo, and so on. Morhig’s were wholesalers and distributors importing from France, Germany and the USA as well as Great Britain. Their success, as George Morhig’s son and daughter-in-law, Alfred and Madeleine, were anxious to tell me, “brought a lot of jealousy”.36 Undoubtedly it did. This magnificent pillar of commercial success ended at the muzzle of an AK-47 in the coup of 1970. Burroughs Wellcome & Co. are probably pictorially memorialized by their trade-mark, ‘Tabloid,’ as the name for their compressed tablets. Their revolutionary American machine could compress medication and produce hundreds of tablets quickly and accurately. The term ‘Tabloid’ was also used to include first-aid kits and by 1884 Tabloid medicine chests and cases with varied contents to suit the situation and climate were on the market and in use by missionaries and explorers, most notably by newspaper reporter, Henry Morton Stanley, the man who found Dr. Livingstone.37 Allen & Hanburys, founded in 1715, is one of the oldest pharmaceutical companies and is famous for its baby foods and invalid foods. The firm had successful overseas subsidiaries as early as 1902 in Canada, then South Africa, South America and Russia in 1913. Geoffrey Tweedale’s history of this company notes: “The firm made energetic efforts to open up the Far Eastern trade. In 1894 a branch business was established in India . . .” with a salesman whose territory covered India, Burma, Ceylon, Malaya and Siam and all stocks shipped directly from

36

Alfred and Madeleine Morhig, telephone conversation with the author, 9 November, 2008. 37 Roy Church, & E.M. Tansey, Burroughs Wellcome & Co. (Lancaster: Crucible Books, 2007), p. 46.

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England.38 The firm found, as did others, that it was expensive running overseas operations but eventually they learned there was more profit in supplying not just drugs but operating theatre equipment and surgical instruments during the war.39 For a third example: Glaxo, a trade-mark name invented for the purpose, began with a New Zealand family interested in dairy products and evolved into a British-based company of major importance particularly for baby food and dried (powdered) milk in the early 1900s. Glaxo continues to enjoy world-wide importance into the twentieth century. As Davenport-Hines and Slinn, the historians of Glaxo, report, there was a good market for their products in India, particularly between the wars, even though hindered from time to time by problems of quality.40 Later on Glaxo established subsidiary companies and laboratories in India and Pakistan, the former to avoid possible trouble with the rise of nationalism under Gandhi’s Quit India campaign. In French West Africa countries, Burkino Faso, Côte D’Ivoire, Mali (formerly French Sudan), Mauritania, Senegal, Guinea, there exists still a “complex pharmacopoeia developed by trial and error over hundreds of years, probably the first example of medical research in West Africa” according to Dr. Brian Greenwood of the LSHTM. He continued reminding his readers that the “. . . two most effective antimalarial drugs in use today (quinine and artemether) are both based on traditional remedies and are both still prepared from plant extracts.”41 However, direct colonial rule was short-lived in West Africa and the number of physicians was small. Their impact in the nineteenth century, before independence, was somewhat effective only in the urban centres which enjoyed hospitals.

38 Geoffrey Tweedale, At the Sign of the Plough: Allen & Hanburys and the British Pharmaceutical Industry 1715–1990 (London: John Murray, 1990), p. 108. 39 Ibid. p. 116. 40 R.P.T. Davenport-Hines, & Judy Slinn. Glaxo: A History to 1962 (Cambridge: Cambridge U. Press, 1992), p. 121. 41 Brian Greenwood, Traditional medicine to DNA vaccines: the advance of medical research in West Africa (Tropical Medicine and International Health, Vol. 3, No. 3), p. 167.

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Dr. Christopherson’s Achievement Christopherson had been in Sudan since early 1902 when, in the summer of 1917, in the men’s ward of Khartoum Civil Hospital, he performed a significant experiment of injecting tartar emetic (antimony) into the vein of a bilharzia patient and made a landmark observation. He examined the urine of this patient and recognized that the eggs of the bilharzia helminth (worm) were dead or dying. He concluded that this was probably as a result of the tartar emetic he had injected experimentally.42 He didn’t just wait for the patient‘s outcome, he searched for mechanism, i.e., how did this happen? How many doses would he have to administer before all the shriveled and dead bilharzia ova would be excreted? He had some idea of dosage for such a dangerous drug (antimony is a well known poison) because he had read, in The Indian Gazette, of Dr. Leonard Rogers’ recent work using tartar emetic for kala-azar, and had been similarly successful using this treatment himself. Following the first injection, he began to administer a graduated series of injections of tartar emetic. He would shortly proclaim this to be both treatment and cure for the debilitating parasitic illness, bilharziasis (now known as schistosomiasis).43 Refining the treatment became the central theme of his life-work. Defending his claim to priority was a battle fought, in part, through the pages of the British Medical Journal (BMJ) and The Lancet. John Brian Christopherson thus discovered and promulgated the first effective drug treatment for bilharzia, one of the great endemic diseases of the tropics and subtopics. Although he published his work copiously in major medical journals, he received surprisingly little credit for his discovery. The story of his discovery, given that millions of people world-wide continue to suffer from bilharzia, always elicits the question: if the treatment and cure was discovered in 1917 why is it still a major, yet little publicized, problem? The short answer is, lack of money, which leads immediately to a second short answer, lack of political will. In countries such as China, Egypt and Brazil, where formerly schistosomiasis was a major problem, its public health importance has

42 Tartar emetic is a synonym for Potassium Antimony Tartrate. Stedman’s Medical Dictionary (27th Ed.), p. 1787. 43 Alternatively written ‘bilharziosis’ in The Lancet on occasion.

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been greatly reduced, but in sub-Saharan Africa, where little control has been achieved, the disease remains a major problem.44 In the following chapters I discuss the troubled waters of early colonial medicine in Sudan in the 1900s, and disclose reasons for the public neglect of Christopherson’s accomplishments. I follow his progress from his secure and comfortable life in London to a much more difficult existence in the sand-blown, stifling heat of sub-Saharan Africa in the period following the monumental events of the Mahdi, General Gordon and Lord Kitchener. On one hand the doctor’s nineteen years in Sudan were dogged by professional jealousies, accusations, interdepartmental wrangling and at times, arguments ad hominem. On the other hand he enjoyed friendships with local colleagues, he possessed a surgical expertise second to none in Sudan, and his marriage—he married in 1912 at the age of forty-four—was known to be a happy one. His medical breakthrough was the high point of his career yet in spite of this, ‘a veil was drawn over his name.’45 With bad luck, even a Nobel nominee, as he was in 1922, can sink from history’s view. Malaria, whose vector (the Anopheles mosquito) seeks out its victim, is difficult to avoid. In the case of bilharzia the infective cercaria larvae of schistosomes are produced by freshwater snails, so that infection can be avoided but only by not walking or bathing in slow-moving fresh water.46 Unfortunately this simple advice is not an option for the poor in countries like Egypt and Sudan where the daily lives of fishermen and women doing laundry, necessitate their working in rivers or lakes. By 1917 Christopherson believed he had found the cure to this serious parasitic disease. The question remains, why did the administration not champion Christopherson’s work? Surely it would have been a feather in the cap of the Sudan Medical Department to acknowledge and celebrate this success under their administration? What was it about Christopherson’s character that led him to cross swords with a number of people along his career path, in particular, Major P.R. Phipps, the man closest to Wingate, but also with Andrew

44

There has been a resurgence of the disease in China, as will be discussed. Susan Kenyon, The Smallpox Outbreak of 1903: Disease and Disorder in Colonial Sudan. Unpublished manuscript. 10 November, 1999. 46 Cercariae—free swimming trematode larvae that emerge from the host snail. Stedman’s Medical Dictionary 27th ed. 45

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Balfour, director of the prestigious Wellcome Laboratory on the Nile?47 My challenge was to get to the bottom of this. Why should a brilliant surgeon, for years holding higher academic degrees than any other physician in Sudan, find himself the subject of a court of enquiry and why have the documents from the enquiry vanished? Where are the private papers of those who sat on that enquiry? Was Christopherson a troublesome man or, was he a target and simply defending himself? What was it that rubbed the Wingate’s private secretary, Phipps, the wrong way? Could it have been Christopherson’s collegial friendship with the native doctors and his disregard for military rank that so irritated Phipps? That there were tensions between military and civilians over both pay and position has been well documented by historian Martin Daly and others.48 Battle lines were drawn and cliques formed. On 3 November, 1903, twenty months after his arrival, Christopherson wrote home to his mother: “I am climbing not without opposition I can tell you, it is a fight for places between the Military and the Civil the military being in occupation of the places to be fought for now.” There were expectations of public reward. There were moral dilemmas: Europeans versus locals (natives), the ‘haves’ versus the ‘have-nots.’ There were problems with the administration of the Sudan Medical Department pharmacy and the public pharmacy, and a question of who was on the take. Early in the history of the Anglo-Egyptian Condominium, Governor General Sir Reginald Wingate stated: “I believe that the pacification and contentment of these primitive people can be obtained more effectively by medical aid than by any other means.”49 Christopherson was first and foremost a physician so it is unlikely that he thought in these terms. Another physician, the much younger Andrew Balfour, director of the well-equipped Wellcome Laboratory in Khartoum, was similarly too absorbed in the work at hand, building and running a state-ofthe-art laboratory and in making Khartoum a mosquito-free town to be thinking about pacifying locals.50 Later Balfour and Christopherson

47

Major Pownall Ramsay Phipps (1865–1932). Martin Daly, Empire on the Nile: The Anglo-Egyptian Sudan 1898–1934 (Cambridge: Cambridge University Press, 1986). 49 Leonard Bousfield, Sudan Doctor (London: Christopher Johnson, 1954), p. 70. 50 Balfour, picked for the job by the wealthy donor, Henry Wellcome, was twentynine when he went out to Sudan. 48

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would become seriously at odds with one another over the naming of the local parasite for relapsing fever. From my reading of many private papers, I conclude that Christopherson, rigorous Edwardian that he was in terms of correctness in manners and in dress, had a particular personality trait that bedeviled those in power in early-twentieth-century Khartoum. He believed in appointing the best man for the job regardless of race. His friend, Gwynne, noted that Christopherson had little time for socializing at the Sudan Club (the club for British staff of the Colonial Office). His friendships with non-Europeans ran counter to the British notion of a gentleman’s conduct.51 Christopherson was a man of education, intellect and skill. He was a man whose star shone brilliantly in 1902 and 1903 when he spectacularly arrested an epidemic of smallpox. Yet, here was a man who, despite his medical breakthrough in 1917, vanished into the dustbin of history. This story focuses on events in the Sudan Medical Department, incidents fomented by the vagaries of Wingate’s administration and the rivalries and loyalties of those inhabiting that out-post of Empire.

The British in Sudan—What Were They Doing There? What were the English doing in Sudan in the first place, and who was really benefiting and how? The question “when is a colony not a colony?” might well have been asked. Lord Cromer, the British Agent in Cairo and responsible for Sudan, was adamant that once conquered Sudan would not be called a colony but would receive a title he concocted—The Anglo-Egyptian Condominium—and would be under two flags. As it turned out ‘Egyptian’ was just window-dressing; the British had the upper hand. Sudan is a vast sub-Saharan country and the setting for several chapters of the Christopherson story. Its 2.5 million square kilometers make it the largest country in Africa. On the east it is bordered by the Red Sea (and using the names as they were at the time) lie Egypt and Eritrea. The Central African Republic, Chad, the Congo, Libya, Uganda, Kenya and Ethiopia are also its neighbours. In the north is the Libyan

51 Personal correspondence from Prof. Yusuf Fadl Hasan, of Khartoum U., 19 August, 2007.

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desert and in the west the Sahara runs the length of the country. The River Nile is the lifeline, not only for Sudan but also for its northern neighbour, Egypt. The White Nile flows through the centre of Sudan, the Blue Nile, flowing from the mountains of Ethiopia, joins the White Nile at Khartoum whence they flow together as one in a huge S-curve to enter Egypt north of Wadi Halfa. Sudan and Egypt had long been under the heel of the Ottoman empire; for decades Egypt paid an annual tribute to the Ottoman Sultan. Egypt had conquered Sudan in 1820 and Britain, in its turn, having more recently occupied Egypt was, by 1884, hoping to extricate itself from the additional burden of Sudan. In the late-nineteenth century an extraordinary event took place that would shortly change the lives of the people of Sudan. A charismatic figure of humble origins, Mohammed Ahmed, became a dervish and proclaimed himself Al-Mahdi (the Messiah). Becoming a dervish entailed, in part, studying the mystical Sufi doctrine and taking a vow of poverty. The timing was accidental but was crucial to his acceptance as the saviour of the Sudanese. The Mahdi, as he became known, dictated reform in clothing and designed a ‘uniform,’ a patched shirt-style garment, for his men. The square patches, whether needed or not, were symbols of poverty. “[He] forbade smoking, drinking, fine clothes, jewellery, music, dancing, feasts, the use of abusive language, and even the practice of buying brides.”52 In June of 1881 the Mahdi proclaimed a rebellion against Egyptian rule and invited all the important sheikhs in Sudan to assemble and join him. Naturally, when news of this reached the Egyptian GovernorGeneral, a small force was sent to capture the Mahdi and his followers and put an end to any possible uprising. As with so many military engagements, luck had much to do with the outcome. The Egyptian force, despite its superior weapons, walked into an ambush of men armed with no more than stones and spears, and were defeated. In December of 1881 a second attempt against the Mahdi and his evergrowing army of dervishes also failed, and while news of this religious reformer’s success spread like wildfire.53 The reputation of the new messiah and his followers added fuel to the movement to expel all foreign

52

Byron Farwell, Prisoners of the Mahdi (New York: W.W. Norton, 1989), p. 19. Dervish—originally a Moslem friar vowed to poverty and austerity. From the Persian darvesh poor. OED. 53

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forces; his success was in sharp contrast to the dismal performance of the British-led Egyptian army. The administration in Cairo realized that the Mahdi’s influence was becoming a serious threat. The British had underestimated the strength of native opposition. One by one, towns garrisoned by Anglo-Egyptian forces were falling. In September 1882 the Mahdi’s army laid siege to the well-fortified town of El Obeid with a force of 30,000. Initially beaten back and under fire from the parapets of the fortifications and taking serious losses, the Mahdi retreated and elected to starve out the town rather than attack. Attempts to relieve the town from outside were bloodily savaged and the remaining starved citizens surrendered in January of 1883. In November of that year a regrettably ill-prepared British-Egyptian force under General William Hicks Pasha was sent to the province of Kordofan then occupied by the Mahdi. Hicks was beheaded. The force was annihilated. Historian Byron Farwell described the larger picture: The timing of the Mahdi’s revolt was, quite accidentally, perfect. While the Sudanese were trying to throw out the foreigners, meaning the Egyptians, the Egyptians themselves were also trying to throw out the foreigners, meaning the French and British. In 1879 when Ismail, the Khedive of Egypt, was replaced by the young and inexperienced Tewfik, the country was bankrupt, officials and soldiers were unpaid, and the morale of the country as a whole was low. In debt to England and France, the Khedive had to submit to two controllers-general, one from each country, whose task was to reform the administration and establish financial stability.54

Lord Cromer had become the British Agent headquartered in Cairo by the time the inevitable collision with the Mahdi presented itself. The Mahdi had turned towards Khartoum, the most important town in Sudan, situated across the river Nile from the older city of Omdurman. By now the British government was seriously alarmed at the situation. Discussion centred around the idea of sending the popular antislavery hero, General Charles (Chinese) Gordon to Africa, initially to report on the situation. Gordon, a flashy energetic character, had many plans for the future of the area, too many perhaps, and were the cause of considerable consternation in Cairo, the centre of British Egyptian operations. As the Mahdi’s dervishes continued with small successes,

54

Byron Farwell, Prisoners of the Mahdi (London: W.W. Norton, 1989), p. 25.

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Gordon, holding a letter appointing him Governor-General of Sudan and a set of somewhat conflicting orders from Britain and Cairo, headed out for Sudan. On 18 February 1884, Gordon arrived in Khartoum and settled in to hold rather than to evacuate the town, a large city by local standards of 25,000 civilians and 8,000 soldiers. A month later, in mid-March, he found himself besieged. Despite Queen Victoria’s concern over the predicament of Gordon, a man she admired, the British Government wavered over the idea of a relief expedition until August of 1884. The months then ground by. There were more delays. The siege of Khartoum had lasted almost eleven months when the relief force finally arrived, two days too late. Khartoum had been sacked and Gordon beheaded. There are a number of dramatic descriptions of the death of Gordon, and of the relief boats rounding a bend of the Nile to be met by the sight of smoke from the ruined city.55 A few Europeans inevitably remained as prisoners at the Mahdi’s headquarters in the neighbouring town of Omdurman, and after the Mahdi’s death (due to illness), were held by his successor the Khalifa. The most famous of these prisoners was Rudolph Slatin, an Austrian whose earlier role in the new Sudan had been as governor of the province of Darfur. Slatin’s extraordinary life in captivity and the tale of his terrifying ten-day escape over the desert, described in his book Fire and Sword, made him an international hero. Slatin (later Sir Rudolph von Slatin Pasha) would feature not just in schoolboy stories as the man held, often in chains, for more than eleven years, but much later and somewhat less dramatically, in the life of Dr. Christopherson.56 Christopherson and Slatin, as is evidenced by their letters many years later (although curiously not from any earlier documents or biographies) had become good friends in their Khartoum days. One consequence was the assistance Slatin gave to repatriate Christopherson, who as part of the privately funded James Berry Red Cross unit, was captured in Serbia in the First World War. Knowing that her husband would be out of touch for virtually the whole of his service in Serbia, Slatin took the trouble to write reassuring letters to Christopherson’s wife, Joyce, whom he nick-named affectionately ‘Little Diavoletta.’ 55

Not often mentioned is the fact that Canadian voyageurs and Mohawk Indians, strong men who knew how to paddle for hours on end, were sent to help in that expedition. 56 Pasha is a high ranking title from the Ottoman Turkish, equivalent to Sir.

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By the early 1900s the extraordinary story of the Mahdist regime, the sack of Khartoum, and the murder of General Gordon was known to every English schoolboy. It had all the ingredients for a great novel: murderous fanatical dervishes, an inhospitable country to test one’s stamina and courage, a brave and romantic Englishman besieged, a dangerous rescue attempt, Europeans held in chains for years, and finally, the possibility of revenge. At least this was how the British Imperialists and the press saw the story. The move to avenge the death of Gordon was led by Lord Kitchener. On 2 September 1898, the decisive and bloody battle of Omdurman took place. The British, who had the advantage of using their efficient Maxim guns, mowed down ten thousand dervish tribesmen. “It was not a battle, but an execution” commented one war correspondent, adding, “. . . but the Dervishes were superb . . .”57 It was the romantic notion of the sight of all those sabres glinting in the sun and the noise of the war cries that added to the glory. However, Omdurman was pillaged; the sand ran red with blood; the city was levelled in much the same manner as Khartoum had been by the Mahdi’s followers earlier. This epic battle is remembered accurately if unkindly by Hillaire Belloc: ‘Whatever happens / we have got / the Maxim gun / and they have not’. In some respects Sudan has long been divided both geographically and culturally. The British, as a result of their earlier policies are sometimes blamed for tacitly encouraging this situation. The people in the north are predominantly Muslim. At the beginning of the Condominium, in order to avoid a head-on confrontation that might ignite another uprising, the administration enacted a policy of leaving the Muslims in the north to practice their faith undisturbed. The Sudanese in the south are African and, since the arrival of European missionaries in the late nineteenth century, predominately Christian. Even the energetic Gwynne, friend of both Wingate and Christopherson, was unsuccessful in pressing his cause for missionary

57

Byron Farwell, Prisoners of the Mahdi (London: W.W. Norton, 1989), p. 309.

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work in the north, although in 1912, he succeeded in building a cathedral in Khartoum.58 By 1900 the British found themselves in control of a huge area, one tenth of Africa, a country that had been fought over and pillaged, a country with no public works or public sanitation, a country that was mostly desert and largely populated by nomadic tribes. The Egyptians were soon to discover who had the upper hand in the Anglo-Egyptian agreement, and that the inequitable sharing of power was greatly to their disadvantage. Now, at the beginning of the twenty-first century, Sudan has endured a civil war that raged for almost two decades and has brought even more desperate poverty to parts of the country and a seemingly endless crisis in the region of Darfur.

The First British Pioneers, Both Political and Medical Various engineers and civil servants headed out to Sudan to serve under the wing of the Egyptian military; their job was to make order out of chaos and bring civilization—as they saw it—to the Sudan. The British doctors who went out initially to care for the troops and establish hospitals and dispensaries for this purpose, soon found their job enlarged to care for the needs of the local inhabitants. In the past, roughly every five years, serious outbreaks of smallpox and cholera had occurred; malaria and sleeping sickness had also taken an enormous toll. In this manner, in the early years, medicine became the tool used by the British to balance the other necessary ingredients of rule, the military and the law. At first “All medical treatment, drugs and dressings, were free in order to accustom the people to Western doctoring . . .” and fees were required only from the occasional western visitor. Education, for the males of the society, began as soon as schools could be built.59 In 1902 there were six British doctors J.B. Christopherson, E.S. Crispin, V.S. Hodson, N.E. Waterfield, A. Balfour and R.G. Archibald. Shortly thereafter Leonard Bousfield arrived in Khartoum. In his

58 Khartoum Cathedral is now (no longer with its spire), the Republican Palace Museum housing a collection of colonial artefacts in dusty cases and cared for by a couple of cheerful Sudanese lounging around in armchairs watching television. This is probably a fair and rightful indication of concern for the colonial past. 59 Bousfield, Op. cit., p. 74.

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entertaining book about his experiences there he wrote that in those early years “we worked together in a spirit of peculiar intimacy. We felt that we had high standards and did our best to maintain them.”60 They were undoubtedly encouraged by the need for mutual support in the suffocating heat and Spartan conditions. Summer temperatures in 1902 soared to 113° F in June and dropped back to a high of 106.7° F in July.61 The living arrangements as remembered by Dr. Bousfield are recalled as: . . . no piped water supply. Lighting was by means of candles or lamp. Sanitation relied upon the dry earth bucket system. Ice was unobtainable. There was no decent furniture except in the Palace and in a few of the official’s houses. The rest of us had furniture made from packing case wood, painted or unpainted.62

The palace was built as a place of grandeur, a place to entertain, a place from where an aura of rule, even omnipotence, emanated. No effort was spared to demonstrate what the British were all about, namely power. From here Wingate hoped to bring order out of chaos and rule benignly but firmly.63 From the palace Wingate’s entourage rode out in full glittering military regalia for the morning parade leaving no chance for misunderstanding. Heather Sharkey, in her book Living with Colonialism, suggests that the British were “dependent more on the spectacle of power than on its performance,” and “were not entirely secure in their positions.”64 As for the British being not entirely secure in their positions no invading army—and recently Afghanistan and Iraq bear this out—can feel secure. Sudan was not a particularly safe place in 1902 and 1903. Not generally mentioned in books on the history of the first years of the condominium are the little ‘side shows’ where both indigenous peoples and invaders lost their lives in skirmishes. The Anglo-Egyptian Sudan: A Compendium Prepared by Officers of the Sudan Government in 1905

60

Ibid., p. 64. Gleichen, Lt.Col. Count. The Anglo-Egyptian Sudan: A Compendium Prepared by Officers of the Sudan Government. Vol. I (London: Harrison and Sons, 1905), p. 12. 62 Ibid., p. 66. 63 In fact years later Christopherson felt comfortable, in a talk to the Medical Society, in London in 1920 saying: In countries such as the Sudan, where the government is paternal and respected . . . 64 Heather Sharkey, Living with Colonialism: Nationalism and Culture in the AngloEgyptian Sudan (Berkeley: U of California Press, 2003), p. 100. 61

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with a foreword by Wingate, is unusual in this respect; it brought the challenges into relief.65 This compendium is essentially a collection of surveys contributed by officers of the Administration, each from his own district reporting on the general terrain, rivers and villages. In other words ‘Geographical, Descriptive and Historical’ as it says in the front of the book. These pages also include an alarming list of encounters with tribesmen who refuse to pay tribute, who engage in slave trading and who, unsurprisingly, are reluctant to give this up. There are also details of the death of a British officer “treacherously assassinated on the banks of the Naam river” and of the punitive expedition quickly organized to avenge this. The army was kept very busy quelling all these incidents, and although none are mentioned as taking place in or near Khartoum or Omdurman where substantial barracks were manned, it is not a pretty picture of life under the British in central Africa. Neither the word ‘tribute’ nor the phrase ‘treacherously assassinated’ raised an eyebrow then but are seen in a very different context now, and not just by anthropologists. Heat and dust are givens in northern Sudan. The famous haboobs (dust storms) can spring up suddenly and cloud the sky in a thick, almost suffocating, brown veil. These are remembered by my friend René Malouf chiefly for the eerie silence that preceded the phenomenon.66 In the first decade of the twentieth century there were no fans to stir the stifling air, yet Christopherson’s many letters contain no complaints about his living conditions. Few of the published reminiscences of men out there contain complaints. They rose to the challenges and felt all the better for it, although it was mandatory for Europeans to take their three-month home leave in the summer to recover health and sanity. To those early pioneers in Wingate’s empire, working in and for Sudan was a mission. All the reminiscences extant hark back to this belief: they believed they were there to work for the empire and to make Sudan a better place for its people. This may not have been seen as such by those tribesmen at the wrong end of a gun, but from contemporary accounts, it is certainly what those first idealistic Europeans believed. There were a few British men, and among the early physicians Christopherson can be documented as one, who had considerable regard for

65

Gleichen, Op. cit., Vol. I, pp. 276–280. Son of Dr. Nikola Malouf, a Lebanese Christian doctor who worked closely with Christopherson. 66

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his native colleagues and who, as will be seen later, worked well with them and publicly gave them their due. Later this acted to the detriment of his own career, although in his case it may say more about the British class system and the spitefulness of the civil secretary, P.R. Phipps, who took pains to make Christopherson’s life difficult. In the early 1900s, the grab for Africa was in full swing and colonialism was not yet a dirty word. For the control of Sudan, the hypothetical question might be: “If not the British, who? King Leopold of the Belgians, the Egyptians again, the French, the Italians, the Turks?” There is no doubt that someone would have moved to fill in the perceived vacuum, which may not now be considered a good enough reason for occupation.

CHAPTER ONE

WORMS AND DEAD EGGS IN THE LONG HOT SUMMER

When Katharine Hepburn was preparing to make “The African Queen” her physician father sent her to see a Dr. Macdonald at the London Hospital for Tropical Diseases.1 “I went to see him in his office before I set out for Africa. He hardly looked up from the paper he was working on. ‘Don’t go into the water, Katharine. Don’t go into the water anywhere . . . This Bilharzia is a most unpleasant disease—used to be fatal. Is hard to cure. Sort of large boils in the urinary tract—kidneys, etc. Don’t go into the water.’ ‘I won’t, sir.’ I didn’t. No one did.” —The Making of the African Queen

The First Story: What Exactly Happened That Day in May 1917? In the large high-ceilinged office-cum-laboratory of Khartoum Civil Hospital, Dr. Christopherson took off his light jacket, and bent over his gleaming brass microscope. It was the end of May 1917 and already the heat was suffocating. This particular hospital had been opened in 1909. It stands today, a fine example of British architecture, solid, with cream-coloured stone walls and tall archways. The entrance is a wider and taller archway leading to a generous hall and then a large courtyard. From here a staircase winds upward to the women’s ward and a wide balcony overlooking the courtyard. The balcony gives some shade to the windows of the men’s ward directly below, although in reality little relief from the heat. Khartoum is a cauldron in summer. The tropics were the new world of opportunity, especially medical and scientific opportunity. It was the spirit, the zeitgeist, of the era that brought parasitology and bacteriology and the necessity of using a microscope into the clinical practice of the physician. Christopherson had experience from his time at the Seamen’s Hospital, (The Albert

1 Probably Dr. George Macdonald (1903–1967) Professor of Tropical Hygiene and Director of the Ross Institute.

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Dock Hospital) Greenwich, London where he had had opportunity to see some of the more unusual diseases. Even so, in 1902 many illnesses had no known genesis, or cure. This was what offered such opportunity and the chance to test one’s mettle far away from the security of large teaching hospitals and a temperate comfortable climate. The riddle of malaria was partially solved by Ronald Ross in August 1897, when Christopherson was still training, walking the wards at Barts Hospital. It was the era when Manson founded the School of Tropical Medicine in London, in 1899, and this was followed shortly after by the Liverpool School. One can say that medicine for warm climates was legitimized and came of age at the beginning of the twentieth century. The challenge now moved from water and air-borne diseases to more complicated illnesses utilizing vectors and intermediate hosts. Many of these challenges flourished under the umbrella of British imperialism. Jack Christopherson, son of the rector of Falmouth church and considered the intellectual star of his family, was one of that special breed drawn to the tropics, where he could direct his energies towards an uncharted and exciting future and perhaps a spectacular career. That day in the early summer of 1917 Christopherson’s patients in the men’s ward, those afflicted with the parasitic illness kala-azar, were undergoing a new and special treatment.2 They were being injected with tartar emetic (antimony), a particularly toxic drug.3 Injections of tartar emetic were found to be successful for treating kala-azar which, when left untreated, (particularly in cases of espundia one of the many varieties of this illness), caused ulcerating and hideous facial disfigurement. By 1915, and after twenty years’ work in India, Dr. (later Sir) Leonard Rogers, a pioneer in this field and friend of Christopherson, had succeeded in finding the treatment and cure, and now Christopherson was using tartar emetic for his kala-azar patients in Khartoum. The word ‘emetic’ alone indicates an association with vomiting; the history of antimony records that it was used specifically as a purgative over the centuries. It is also a highly lethal poison.

2 Visceral leishmaniasis “. . . a condition due to infection of reticulo-endothelial cells throughout the body with the protozoan parasite, the most fully studied being L. donovani. The infection is conveyed from man to man by the bites of certain sandflies (Phlebotomus spp. Maegraith, B.G. 4th ed. Clinical Tropical Diseases (Blackwell Scientific Publications, Oxford 1966), p. 153. 3 A treatment piloted by G. Vianna in 1912 and shortly after by the British doctor, Leonard Rogers, who had worked independently, unaware of Vianna’s work.

worms and dead eggs in the long hot summer

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As he routinely examined the urine specimens from these kala-azar patients, a sample from one man who was infected with both kala-azar and bilharzia (if we believe the story as told by his friend Manson-Bahr) exhibited something different.)4 When I review, in a later chapter, Christopherson’s later letters on his 1917 work, I find serious questions with the accuracy of Manson-Bahr’s story. Curiously, Christopherson, in his first papers on the antimony treatment, did not actually lay claim to such a patient, one who suffered two diseases simultaneously, but both cured with the same drug. Nor could I locate the name of such a patient. It is only through deduction, by studying what he wrote then and later, and noting when he was actually in Khartoum, that I could conclude that the first use of tartar emetic for schistosomiasis had to be May 1917. I now believe that the first patient named on the list published in his second paper (that of the 15 July, 1919), the longer and more detailed paper using seventy patients, indeed suffered from at least schistosoma haematobium—the species most commonly found in Egypt and Sudan.5 This usually causes the passing of blood, can be very painful yet sometimes goes on for years before becoming really serious. Knowing what he would expect to see in the urine and faeces as a result of the bilharzia disease, namely live eggs from the schistosoma (bilharzia worm), he was surprised to see these eggs shriveling and turning dark; in other words the schistosome eggs present were also either dead or dying. It was then that he must have experienced an ‘aha’ moment of recognition. It is hard to imagine exactly what he said out loud. Perhaps nothing, until he could confirm his suspicions. In the hospital setting he was a careful and meticulous man. It unlikely he said anything as flowery as Sir Ronald Ross, the identifier of the mosquito as the carrier of the plasmodium, the protozoa causing malaria, who claims to have crowed at his ‘aha’ moment of discovery: “Dame Nature, you are a sorceress . . . ”6

4 P. Manson-Bahr, History of the School of Tropical Medicine in London (1899–1949) (London: H.K. Lewis & Co Ltd. 1956), p. 203. 5 This patient was also first on his list of thirteen patients published in The Lancet, 7 Sept. 1918, later subsumed in to the list in the longer paper published in the J. Tropical Med., 15 July, 1919. 6 Roy Porter, The Greatest Benefit to Mankind. (London: W.W. Norton & Co. 1997), p. 470. It was Alphonse Laveran who in 1880, in French Algeria, identified the plasmodia as the causal agent of malaria.

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Christopherson must have sat back for a minute and thought about some of the implications and the complications of what he had just seen. There were enormous possibilities. Standing on the edge of a medical breakthrough requires both dedication and opportunity to carry the research forward. Right now the timing, early summer 1917, was a problem. He had requested leave to help with the war in Europe. Doctors were leaving Sudan as fast as they could, not wanting to be left out of the general war effort. No matter how much he trusted his co-workers, there could be no guarantee his work could be supervised to his standards in his absence. The timing was unfortunate. Did he take a deep breath and start right in testing others? Who would or could he tell about this? These were early days; one success is only the suggestion of possibility. Perhaps he went back to his villa to have a stiff drink and think it over. His life so far in Sudan, although beginning well, had, off and on, been fraught with personal and professional stumbling blocks. What Christopherson needed to find out was ‘is the tartar emetic treatment really as effective for bilharzia as it is for leishmaniasis?’ What should the dosage be? How well is it tolerated when increased? There were no institutional review boards then. He resolved to try tartar emetic on patients who suffered solely from schistosomiasis. It was the recognition of this observation and its consequential success that focused Christopherson’s professional life from that time forward. Although during his professional career what is now known as schistosomiasis was called ‘bilharzia’ (even as late as 1962), for the purposes of this biography, I will continue the use the term ‘bilharzia’ unless quoting a modern text.7 His first patient, named and used in his first publication, was an Egyptian, Mohammed Atyieh Shabini, who was admitted suffering from both rectal and bladder bilharzia.8 Christopherson and his pathological assistant,9 J.R. Newlove, took careful notes of these patients and published their first successes with a list of thirteen patients, in The

7 No doubt parasitologists and other medical professionals will prefer the modern term, but it is clumsy to write one term, or quote one term as used by those physicians in the early twentieth century, then parenthesize the second constantly. I have simply tried to use my judgment in each circumstance. 8 This soldier was discharged as improved but suffered a relapse the following month. See chapter 12 for details of many of these patients. 9 Christopherson used the term ‘pathological assistant,’ we would be more likely to say, ‘pathology assistant.’

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Lancet on 7 September, 1918.10 A paper based on a much larger sample (seventy cases) was also published in The Lancet, a year later in July 1919. In chapter eleven I examine these cases in detail. See Appendix A for a re-analysis of Christopherson’s data using statistical methods not all available to him in the early twentieth century. Now he knew he had found a treatment and perhaps a cure for bilharzia, and by extension, the key to personal success. Once his observation had been repeated many times he went on to refine the dosages, methods of administration of the drug and to control, as far as possible, for the serious toxicity of tartar emetic. Christopherson’s discovery had come by chance. The important point here is that he understood the exciting possibility that fate had presented. He took the potential of that unexpected outcome and ran with it. Alexander Fleming did the same with his discovery of penicillin in 1929, and was rewarded with a knighthood and a Nobel prize for medicine. In 1907 Paul Ehrlich, after a particular arsenical drug had been tested hundreds of times against other illnesses, suggested it be tried on rabbits infected with syphilis. His colleague, Sahachiro Hata, noticed that drug, numbered 606, showed such excellent results that he and Ehrlich continued with this compound and within a few weeks they achieved complete cures. Number 606 was soon given the name Salvarsan. This treatment was referred to by Ehrlich as ‘chemotherapy’ and became the cure for syphilis. In 1908 Ehrlich was also recognized with the Nobel prize for medicine. In Christopherson’s case, he learned that even such an important achievement as an effective chemotherapy for this endemic disease, bilharzia (endemic in Egypt and soon to spread to Sudan) would not be greeted with unequivocal enthusiasm and public applause. Successful tartar emetic treatment required adherence to strict conditions; patients had to be willing to stay the course, an injection every second day for the better part of a month: they had to be in fair physical shape; pneumonia cases were a particularly bad risk.11 They had to be willing to return to the clinic and to continue even though they

10 J.R. Newlove took a good deal of responsibility as Christopherson was away in France for the next six months. 11 J.B. Christopherson, Notes on a case of espundia (naso-oral Leishmaniasis) and three cases of Kala-Azar in the Sudan treated by the intravenous injection of Antimonium Tartaratum. J. of Trop. Med. & H. No. 20, Vol. XX, (15 Oct. 1917), pp. 229–36.

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might feel much better, or might experience some nasty side effects, such as coughing, vomiting, giddiness, delirium, diarrhoea, cramp in the calves. Tartar emetic was no magic one-time bullet nor, in reality, was Salvarsan which also required multiple doses. Further, in using a poisonous drug, the administering physician had to pay attention to the therapeutic range, i.e., the correct dosage so that it would be strong enough to kill the schistosoma adults as well as the eggs, but not the patient. Christopherson spent many years refining this, and most of his papers on bilharzia and tartar emetic (he published more than twenty-five papers and letters on the subject in standard medical journals) include warnings about possible dangers and the necessity for skilful administration. A few patients died while being given this treatment and from time to time he noted some of these failures in his published papers.12 The tartar emetic discovery in the early summer of 1917 came after Christopherson had spent the better part of sixteen years in Sudan working for the Anglo-Egyptian Condominium, in effect for the British Empire. For Christopherson these were years of considerable personal upheaval; sometimes he found himself fighting to retain his professional reputation in an atmosphere of difficult interpersonal relationships and petty jealousies. The small European community on the Nile, with the exclusive Sudan Club, the Wellcome Laboratory on the Nile, the grand Palace with the Sirdar (Governor-General) in residence, and the hospitals and law court buildings, showed a serene public façade of power and authority which masked the day-to-day trials of the medical department and administration. The Palace sat four-square on the banks of the Nile occupying a large footprint and surrounded by English gardens. The British made the point that they were here to stay.

The Second Story: Exactly What Happened on That Day in May 1917? It took a lot of reflection and double-checking of Christopherson’s papers to convince me that things may not have taken place exactly as I perceived at first. Of course, perhaps he did have a patient who suffered from both kala-azar and bilharzia, it is certainly likely but he

12

Ibid., p. 232.

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does not actually say so. He names only the first patients he treated, those who suffered from the one illness, bilharzia. In other words, it was probably a myth, a plausible myth, that presents his story of the patient suffering from both bilharzia and kala-azar. I had bought into this myth of the patient with both diseases, not only because someone knowledgeable had told me this story but also because Christopherson often describes the Egyptian fellahin as being riddled with many different parasites. Also Christopherson’s friend MansonBahr said as much in his History of the School of Tropical Medicine in London, written when Christopherson was alive and checked by him. The several obituaries Manson-Bahr wrote after his friend died also support this view: in the British Medical Journal, for example: . . . Christopherson . . . had several cases of kala-azar under his care which were also infected with schistosomiasis (Schistosoma haematobium). He observed with astonishment that not only did the former disease respond to the antimony injections but that also the schistosome eggs disappeared gradually from the urine . . . .13

and Nature, where he wrote similarly, adding “. . . until the cases were cured of both diseases.”14 What seems much more likely now is a slightly different scenario—that Christopherson’s comment to Manson-Bahr in his letter 12 January, 1954, “I have always believed that the clinical work I was doing at that time on Leishmaniasis was what chiefly gave me the idea which finally led to the discovery of the Antimony cure for Bilharzia . . .” allowed Manson-Bahr to embellish a little and detail exactly what he imagined had happened. Surely these two men who, according to Manson-Bahr, met once in while in London after 1919, would have discussed the story and the details of that moment would have been retold.15 It does not seem likely that such an important and pivotal moment in Christopherson’s professional life would have been remembered merely as ‘the idea’ or, that the name of that most important first patient, remain unrecorded. Was the Egyptian Mohammed Atyieh Shabini the first bilharzia patient to receive tartar emetic from Christopherson? And was bilharzia all he suffered from?

13

BMJ, (30 July, 1955), p. 327. Nature, No. 4478 (27 August, 1955), pp. 377–378. 15 They met in Khartoum in 1919 and in his BMJ obituary M-B wrote; ‘from this time [1919] on was to see a great deal of Christo.’ 14

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Manson-Bahr attributes an appreciation of a serendipitous observations. Christopherson attributes a confirmation of a rational hypothesis based on Roger’s work using antimony (tartar emetic) for leishmaniasis. After his initial discovery, he had waited some months before he published. There was more than one reason for this. He was absent from Sudan, having left Khartoum on 26th July 1917 to take a position as Secretary to the Commission on Medical Establishments in France. His colleague, Dr. V.S. Hodson, “. . . very kindly continued the treatment of bilharzia cases . . . during my absence . . . and afterwards at Atbara, carried on a series of trials quite independently . . .” His pathology assistant, Mr. John R. Newlove, and Dr. Mustafa Izzedin carried on treating patients and keeping records for him. In any case he needed more data—carefully and rigorously accumulated data—to feel confident enough to tell the world his findings. On 7th September 1918 he published in The Lancet. Within the week his claim was challenged.

Medical Reporting circa 1905 To someone looking back from the twenty-first century the style of medical reporting that was accepted without comment in major medicals journals—everything from publishing patients’ names, using patients in ‘experiments’ without consent, to making extremely personal and racial statements—seems cavalier, even shocking. Christopherson appears to admire the Egyptian fellah [peasant ] as ‘a man of good physique,’ he also describes these fellaheen afflicted with bilharzia as having: . . . a somewhat hang-dog expression of countenance, pale, sallow, muddy complexion, not over-clean in his habits and not too tidy in his dress, his feet naked, his wardrobe limited to three cotton garments, soiled and humble in the extreme. He has as little thought for others as he has for himself: he is said to be of a cruel disposition, unreliable, impulsive, emotional, fatalistic, fanatical, easily influenced to criminal acts . . .16

All this was published in the Proceedings of the Royal Society of Medicine. Even worse, it was his presidential speech, yet it caused not a ripple. This was not the only time Christopherson’s pen managed to run away with

16 J.B. Christopherson, A National Outlook on Tropical Medicine. President’s Address. R. Soc. of Medicine Proceedings. Vol. 22 pt. 1. (1928–29), p. 2.

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him; his maxim seems to be ‘why use one adjective when ten will do?’ We are left wondering if eradicating bilharzia from Egypt could influence the unreliable mental disposition of the fellaheen as he described him. No one appeared to question such outrageous statements. Candid comments viva voce of a racial nature were a fact of life, and if one Englishman wanted to insult another he need do no more than cast doubt on the other man’s ancestry. Christopherson was not the only man who found himself thus targeted later when he ran into trouble. In Khartoum Christopherson had sick patients in front of him every day; it is unlikely he gave a second thought about wasting time with too many constraints. The hospital was short of staff, and particularly of competent staff. He was often writing to the tight-fisted Financial Secretary for funds to fulfill basic needs; he had the same problems that modern hospitals have; nosocomial infections (although he does not appear to have used the word, he does speak of battling the unclean conditions) and iatrogenic illness, the latter in particular as a result of antimonial injections. At the time of his discovery he was the director of the civil hospitals in the two major cities of Sudan; he had authority and he just got on with the job. Despite his demonstrated competence, there were times when the Sudan administration considered him so controversial they would have given a collective sigh of relief to see him sail home. He was a stubborn individual with a strong belief both in his God and in his role as a physician who knew best. In spite of, or perhaps in consequence of, these beliefs his tenure in Sudan was turbulent.

The Fly in the Ointment—McDonagh’s Bid for Priority The week following Christopherson’s initial ground-breaking paper, his priority was challenged. The challenger, Dr. J.E.R. McDonagh (1881–1965), remained an irritant to Christopherson for years. McDonagh, resident in London, had immediate access to The Lancet and had hurried into print immediately upon reading Christopherson’s paper. September 14, 1918 saw McDonagh’s letter to the editor: “I can fully confirm Dr. J.B. Christopherson’s results given in this paper in your issue of Sept. 7th. I began to use antimony in bilharziosis in 1912 . . . and have treated 23 cases with a disappearance of ova in the

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urine . . .”17 McDonagh went on to say he had published this in his book on venereal disease. Christopherson must have been stunned. His major paper, his discovery that held the seeds of a possible illustrious future, had been trumped. Given that it took several weeks for journals to travel from London to Khartoum, it was a while before his riposte came into print. By that time, and not yet hearing about McDonagh, he had sent a second bilharzia paper to The Lancet, “Intravenous Injections of Antimonium Tartaratum in Bilharziosis.”18 His riposte, once The Lancet of September reached him in Khartoum, was published 11 January, 1919 and is worth quoting in full: Sir,—I have read Mr. J.E.R. MacDonagh’s [sic] note in The Lancet of Sept. 14th. Nothing is new in medicine and I dare say that tartar emetic (antimony tartrate) has been used many times for bilharzia, especially in days gone by before tartar emetic fell into disrepute. I have not seen Mr. McDonagh’s book. In May, 1917, after making a trial of antimony tartrate by intravenous injection for leishmaniasis (kala-azar, espundia, tropical sore, all of which are found in the Sudan), and finding it, as other workers had found before, a specific, I began to try it for the Schistosomum haematobium (Bilharz). And found it equally successful, and we have since used it as routine treatment and have still the treatment under trial at the Khartoum Civil Hospital. I hold the same opinion about it as I did at first—that it is a specific cure for bilharziosis. My work was original, and has been independent of anyone else’s work and quite spontaneous, and I had never read of, or heard of, or dreamt of any other worker having before tried antimony for bilharzia. Although I had written my paper considerably before I dispatched it to The Lancet on June 2nd, it was published on Sept. 7th 1918. I have now had one and a half years’ experience of cases under the treatment, and think it will prove a great benefit to the people of Egypt. If they can get rid of the scourge of bilharziosis the Egyptians will become a clearcomplexioned, rosy-faced race. One of the most striking features of the treatment is the change from the muddy, sallow face to a healthy, pink, clear complexion. I intend to publish more observations on the treatment shortly, but there is no hurry. I may say that antimony tartrate for bilharziosis is under trial at the Egyptian army Military Hospital, Khartoum and I hope that Major Innes, R.A.M.C. (T.) who is interested in the treatment, and who is carrying it out with the caution and patience and with all the splendid critical quali-

17

J.E.R. McDonagh, Antimony in Bilharziosis. The Lancet. (14 Sept. 1918), p. 371. J.B. Christopherson, Intravenous Injections of Antimonium Tartaratum in Bilharziosis. (The Lancet. 14 December, 1918), p. 652. 18

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ties of the Scottish race which have made its scientific work so valuable, will have something favourable to put on paper soon. I am Sir etc.

Christopherson had good reason to feel fury and resentment. McDonagh had unwittingly deprived him of the prestige for being first to find the cure for a tropical scourge, something that had ruined and curtailed the lives of millions as far back as the pharaohs. Until the antimony cure, nothing, although much was tried, had any lasting effect on bilharzia. McDonagh’s book on venereal disease was a very curious place to publish what surely would have been seen as a new and important treatment in the field of tropical medicine. Under a subheading of Antimony, McDonagh had written two and a quarter lines, and these lines turn up in both editions of his book, (1915 and 1920), unchanged: Although not a venereal disease, I should like to mention here that I have had great success in treating cases of bilharzia with intravenous injections of antimony.19

McDonagh offered nothing about number of patients and not a word about dosage. The fact that he wrote ‘I should like to mention’ in such an off-hand way, only serves to underline the lack of importance he accorded it. His was a weak case indeed. Nevertheless he certainly felt it to be a bona fide priority. Almost surely realizing he had not made enough of his original work, McDonagh wrote again, this time to The Journal of Tropical Medicine and Hygiene 1 July, 1920, explaining: My original reason for using antimony in bilharziasis was because I found this metal to succeed in three cases of sleeping sickness I was treating in 1910 and 1911, when it was not practicable to prescribe further injections of arseno-benzene, and because I had found arseno-benzene to be useless in two cases of bilharziasis. I treated my first case of bilharziasis with intravenous injections of tartar emetic in 1911 . . .20

He mentioned three different preparations of antimony used with varying success among twenty-two patients. Meanwhile, Christopherson had been continuing his work on antimony for bilharzia and publishing copiously. It was almost three years 19

J.E.R. McDonagh, Venereal Diseases: Their Clinical Aspect and Treatment (London: Heineman. 1920), p. 214. 20 J.E.R. McDonagh, The Treatment of Bilharziasis with Antimony. J. of Trop. Med. & H. No. 13. Vol. XXIII (1 July, 1920), p. 164.

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before McDonagh wrote again on the subject, but mainly one suspects to complain as the last peevish paragraph demonstrates: In conclusion, I may perhaps be permitted to remind the reader that the antimony treatment of bilharziasis was first introduced and published by me before any other observer, though apparently this fact has escaped the notice of some recent writers on this disease. The first mention of this method of treatment appeared in my “Biology and Treatment of Venereal Disease,” which was published in 1915.21

Christopherson was not long getting back at this. 15 June of that same year saw his response under “Original Communications.” The cases do not appear to have been followed up or the subject pursued. The treatment was not recorded in any work on tropical diseases or in any of the medical periodical publications which are the usual means of communicating new facts to colleagues interested. . . . Mr. MacDonagh’s [sic] information . . . bore not fruit . . . If Mr. MacDonagh had been sufficiently confident and had published particulars of cases and had worked out details of treatment, he would have been well advised to have published the facts in one of the well-known medical periodicals, or to have communicated the same to his friends who were actively engaged with a malady then incurable in countries where the disease is prevalent. I met Mr. MacDonagh as late as 1917 in France, but he did not speak to me of a cure for bilharzia, although he was aware that I was working in the Sudan at the time . . . . We made due acknowledgement at the time to all from whom we had gained assistance, but we owe to Mr. MacDonagh nothing, . . . He could not have pigeon-holed an important communication to tropical medicine more effectually than by recording it in a work dealing solely with the biology and treatment of venereal disease.22

This letter in the priority war seems to have silenced McDonagh for while but as Christopherson and others learned to their cost, the ghost of the priority fighter was always there, waiting to jump out and ruin a wonderfully productive day. It is also worth noting that when Christopherson complains that McDonagh said not a word when they met in France, Christopherson also said not a word, surely because it was premature to mention something undergoing trials and still in relative secrecy?

21

J.E.R. McDonagh, The Treatment of Bilharziasis with Antimony, J. of Trop. Med. & H. No. 8. Vol. XXVI (16 April, 1923), p. 119. 22 J.B. Christopherson, The Treatment of Bilharziasis with Antimony. J. of Trop. Med. & H. No. 12. Vol. XXVI (15 June, 1923), p. 210.

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Leonard Rogers and Priority—What Happened Here? Christopherson’s friend, Leonard Rogers, also ran into a priority issue but curiously this one didn’t cause much of a ripple. The two men had much in common. Both were born in 1868. Rogers was a Cornishman; Christopherson’s father, although from Lancashire, was Rector of a major Cornish church for thirty years. They were both steeped in the Anglican faith which remained a strong influence through all their lives. Rogers’ successful use of tartar emetic for kala-azar (leishmaniasis) had come to fruition in May of 1915 in Calcutta; but just when he felt the elation of success, he received word in June of that year that someone had got there first. His feelings are recorded in his autobiography: My disappointment may be imagined when news reached India in June 1915 that my independent discovery had been anticipated by two Italian doctors in the case of the closely allied infantile kala-azar in Scily, [sic] and published by them in February 1915.23

In this same autobiography he proffered a nod to Christopherson’s work, using the old story that Christopherson’s patient had both diseases: In 1918 my friend, J.B. Christopherson, while treating a Sudan case of kala-azar with tartar emetic, made the important observation that the drug had also cured the patient of a coincident attack of endemic haematuria, due to a schistosome worm in the portal veins of the abdomen.24

Christopherson—A True Edwardian, Warts and All25 Christopherson was a man of his times—a solid Edwardian, God fearing, ‘right thinking’ son of the empire. He had one particular flaw, as perceived by the political wing of the administration (and a number of others were pointed out over the years): he supported his Egyptian, Sudanese, Syrian, and other local colleagues, and formed friendships with some. He also spent very little time in the Sudan Club, the centre 23 Leonard Rogers, Happy Toil: Fifty-five Years of Tropical Medicine. (London: Frederick Muller Ltd. 1950) p. 115. N.B. To be precise, Rogers was off by one year. JBC’s discovery was in 1917, he published in 1918. 24 Ibid. p. 118. 25 He actually lived through several reigns, Victoria, Edward VII, George V and George VI.

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of Britishness in Khartoum. All this added to the exclusionary politics of his being ‘not one of us’ that surfaced from time to time to his disadvantage. He seemed not to see race as a bar to promotion and recognition. He had been in Sudan eighteen years when in 1919 he dashed off a statement so typical of his opinionated writing that, imagining his pen moving furiously across the paper as he wrote these phrases, one can sense the heat of his concern: “Bilharzia probably is accountable more than anything else for the indolence of spirit, want of character, and the backward condition of development of the Egyptian peasant (fellah), and, as he as a class includes 90 per cent of the population, one might almost venture to say, the Egyptian nation.”26 This was not the sort of statement that would fly in The Lancet or the British Medical Journal today, but it easily passed muster with the editor in 1919. Tropical medicine, although not a new field, was certainly coming into its own at the beginning of the twentieth century, pioneered by Patrick Manson. Manson’s Tropical Diseases: A Manual of the Diseases of Warm Climates (1898) would have been carried under the arm of every physician heading out to the tropics in the early 1900s. Christopherson may have felt he had a sort of blessing from above when his priority claim was robustly endorsed by Manson’s son-in-law, the well respected Sir Philip Manson-Bahr. Africa, with its many different peoples, intimidating climate and landscape, and plethora of ‘biters,’ as Christopherson referred to the insects, was a laboratory waiting to be studied. With his beloved microscope he embraced the challenge and, like many others, hoped to make a name for himself—doing well by doing good. This was how ‘colonization’ of Sudan, was seen through western eyes; a potential triumph of noble beneficence, and nobody asked the conquered.

Bilharzia (Schistosomiasis) in Sudan—An Overview When Christopherson first went to Sudan in early 1902, bilharzia was not regarded as a major problem even though it was endemic in

26 J.B. Christopherson & J.R. Newlove. Laboratory and Other Notes on Seventy Cases of Bilharzia Treated at the Khartoum Civil Hospital by Intravenous Injection of Antimony Tartrate. J. of Trop. Med. & H. (15 July, 1919), p. 141.

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neighbouring Egypt. Regrettably, in time, the British were responsible for inadvertently spreading the disease south into Sudan. This occurred when the snails (the intermediate hosts of the bilharzia parasite) migrated via the new irrigation canals dug for the growing of cotton in the Gezira area. How much did the British know of the risk? Did they weigh the risk of infecting thousands of their workers against the financial gain of income from the Lancashire cotton mills? Did they believe they would be able to control the snail, somehow? Some discussion on this subject is found in a later chapter. Egyptian cotton is some of the finest cotton produced anywhere but it was grown at the cost of the health of the Fellaheen (Egyptian labourers) who year after year were required, bare-legged and bare-armed, to dredge out and clear the irrigation canals. Great efforts were made to kill the snail, to educate the people, to treat the sufferers—but the disease persisted. Farley suggests that “the British army lost interest in the disease once they learned of the life-cycle . . . it was a black man’s disease . . . ”27 Unlike the malaria vector—the anopheles mosquito, which inflicts itself upon the traveller who neglects to cover up at sundown—the bilharzia cercariae find those either ignorant or deliberately foolish enough to be tempted, in those swelteringly hot African days, to risk a swim.28 Even now the waters of the Nile, and other bodies of fresh water in many tropical countries, continue to be polluted by the carelessness or ignorance of those already carrying the disease and who urinate and defecate into the water, and the cycle continues.29 A recent (2004) story, of a student who probably thought: ‘it can’t happen to me’ showed up in The New York Times Magazine recently. She was a twenty-one year old female who contracted the parasite while on a university trip in Tanzania. The symptoms, evident only when she returned to the United States, were “abdominal pain that made even standing difficult. And she had terrible diarrhoea. She had a temperature of 102°. Her blood pressure was low, and her heart was beating fast and hard.”30 Shortly the patient became seriously ill and a tropical medicine specialist was called in. Once diagnosis was made she was treated with the modern drug Praziquantel and recovered in four

27 28 29 30

John Farley, Personal communication. 7/12/2003. Free swimming trematode larva from the host snail. It also infects mammals other than man. Dr. Lisa Sanders. New York Times Magazine, (6 November, 2004), p. 23.

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days. My letter to the author asking about what preventive measures had been taken in Tanzania elicited further information: I didn’t get into this but the patient was warned about bathing in the river and had protective gear available but didn’t use it. She didn’t think it was schistosomiasis though, she actually thought it was malaria because she had a reaction to the prophylactic medicine she had been taking and had to stop it. Actually she was only the first of several students to come down with the disease from this trip. The university has since reinforced the need to use prophylactic medicines and equipment on these excursions as a result of her illness.31

Africa is not the only continent infected—Brazil and China are also sources of the disease. In the region of China near Dongting Lake in Hunan province, the unavoidable mundane tasks of daily life, fishing, washing and so forth in the snail-infested lake, have contributed to an epidemic of schistosomiasis. “Almost everybody has snail fever . . . some get treated and feel better. Some do not get better” said the man who ran the local clinic. This sad story was reported in the International Herald Tribune on 23 February, 2005.

Bilharz and Leiper: They Solved the First Two Parts of the Three-Part Problem The scientific solution of the mystery of this illness came in three steps, effected by three individuals. In 1851 Theodor Bilharz (1825–1862) discovered the white parasitic worm responsible for the disease. Originally he mistakenly placed the worm in the genus Distoma “. . . a broad genus that was soon abandoned as more types of parasitic worms were discovered.32 There was considerable controversy over the naming of this parasite as at first it seemed reasonable to name it and the disease after the discoverer of the worm. Finally, in 1922, after considerable discussion, the International Commission of Zoological Nomenclature placed Schistosoma on the official list of generic names and wrote that the disease must

31

E-mail from Dr. L. Sanders 8 November, 2004. NB there is to date NO prophylactic medicine to prevent infection with schistosomiasis. 32 J. Farley. Bilharzia: A History of Imperial Tropical Medicine. Cambridge: Cambridge History of Medicine. (1991), p. 5.

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be schistosomiasis.33 Yet the two names, bilharzia and schistosomiasis, depending on circumstance, have become almost interchangeable. People tend to say one, and then, almost apologetically in case you haven’t caught on, say the other. It was helminthologist R.T. Leiper (1881–1969) who solved the middle problem of the bilharzia conundrum by examination of the snail, the intermediate host, Bulinus contortus, whose habitat is the reeded areas of fresh water along the banks of rivers in the tropics. This is exactly the place where fishermen, children, and women doing laundry, tend to congregate and are inevitably at risk. Leiper, perhaps helped towards the right path by reading that the Japanese had already determined the intermediate host, a snail, for their version of schistosomiasis, began his work in London. The advent of the 1914 war and the urgent need for an answer to the disease that affected so many soldiers at Gallipoli and other middle-east venues of battle, gave the impetus for a bilharzia mission to be established at the Cairo Medical School, Egypt. It was here, in 1915, that Leiper confirmed that this mollusc was the host and therefore a part of the life-cycle of the bilharzia parasite.34 Leiper’s success was not without controversy. For instance, Arthur Looss (1861–1923) held the theory of the direct entry of the miracidium by way of the skin. As Lise Wilkinson remarked, Looss was a “German professor of the old school . . . and . . . [held] intractable, but erroneous, views on almost every aspect of schistosomiasis.”35

Christopherson and the Third Part of the Bilharzia Problem—A Cure As Dr. H.C. Squires, physician and historian, wrote in 1958 of Christopherson’s published treatment for bilharzia: “This was probably the most significant contribution to medicine made by a member of the Sudan Medical Service.”36 Impressive words, but this was posthumous

33 David I. Grove. A History of Human Helminthology. Oxford: C.A.B. International. (1990), p. 197. 34 R.T. Leiper, Report on the bilharzia mission, Part IV. Egyptian mollusca. J. of the Royal Army Med. Corps 27 (1916), pp. 175–177. 35 L. Wilkinson, and A. Hardy. Prevention and Cure: The London School of Hygiene & Tropical Medicine. A 20th Century Quest for Global Public Health. (London: Kegan Paul. 2001), p. 36. 36 H.C. Squires, The Sudan Medical Service: An Experiment in Social Medicine. (London: Heinemann. 1958), p. 96.

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approbation. His path to success and recognition from the ‘aha’ moment when he understood the importance of what he saw in his microscope that day in May 1917, was strewn with impediments, professional jealousies and the usual ‘who published first’ squabbles. Christopherson was forty-nine that year and had been working in Sudan since January 1902. His life up to this point had been full of challenge and adventure: the building of hospitals and clinics, and the publication of investigations into the various medical oddities that crossed his path and his ongoing battle with the ever-present parasites. Like many who found their way to distant corners of the Empire, Christopherson rose to the occasion, uncomplaining of his physical circumstances and proud to be accomplishing so much.

CHAPTER TWO

THREE GENERATIONS OF CHRISTOPHERSONS: TANNER TO CLERGYMAN TO PHYSICIAN

The Taint of the Tannery Years ago in England, anxious to visit one cradle of Christopherson family history, a cousin and I motored up the M6 to Colton in Cumbria. Our inent was to visit Colton House and look for the local church. It was spring; the countryside shone with that bright emerald green one associates more with Ireland. Sheep were everywhere and cars were few. Colton House is now a rest home, smelling of boiled cabbage and bringing back memories of boarding school dinners. It had not always been a Christopherson home. Grandfather Christopherson (born in 1811), a tanner, had lived in a nearby hamlet in much humbler circumstances. Colton House came into the family later when the tanner’s educated brother, Rev. Arthur Christopherson, later Vicar of Caton in Lancashire, bought it for his retirement. This grey stone house sits in a pretty oneacre garden protected from the wicked Cumbrian wind by mature trees surrounding the perimeter. A stone’s throw away on the hill behind stands Colton church, begun in the late fifteenth century. It cannot be said to be attractive. The exterior is stuccoed with some dark material that becomes even gloomier when the rain hits, which is frequently. Yet here they all worshipped on Sundays (and were sometimes fined for non-attendance) and here in this churchyard many Christophersons are buried.

Family Origins The Christopherson name surfaces frequently in North Lancashire. It is said to come from Scandinavia in the year 900 when a wave of Norsemen invaded England. The Christophersons are certainly well documented by the early sixteenth century. The people living in this bulge of land

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in north-west Lancashire,1 around Ulverston and Furness, were cut off for generations from mainstream England by virtue of poor roads. The intrepid traveller and journalist, Celia Fiennes, who made what was termed the Great Journey of 1689, passed through the town of Kendal and on to Penrith, a little east of Colton, where Brian the tanner lived 120 years later. Not much escaped her critical eye. “. . . its a goode tradeing town mostly famed for the cottons: . . . and a great deale of leather tann’d here and all sorts of commoditiyes . . .”2 she said of Kendal. A bit farther north and certainly near the well-known Lake District, Celia Fiennes took pains to note the poverty: “Here I came to villages of sad little hutts made up of drye walls, only stones piled together and the roofs of same slatt; . . . I tooke them at first sight for a sort of houses or barns to fodder cattle in, noting them to be dwelling houses, . . . it must needs be very cold dwellings but it shews something of the lazyness of the people . . .”3 The Irish Sea is to the west, and to the south the dangerous shifting quicksands and tides of Morecambe Bay where a guide, a man on the white horse, could be seen guiding the peasants and merchants to safety at low tide.4 In the north, towards Scotland, marauding bands of various troublemakers and ruffians were known to come tearing over the border to disturb and wreak havoc. The only way in from the main body of England, other than by sea, was via narrow, flint-stone roads. It was around 1840 that Wordsworth immortalized the lakes a few miles north of the Christophersons’ home and deplored the coming of the railway in the 1850s that would bring tourists destined to spoil the wild beauty. The people worked the land and kept sheep; some were charcoal burners. The early Christophersons were blacksmiths, tanners and small farmers, but we know of one, Bryan Christopherson of nearby Penny Bridge, who was involved in the slave trade in 1752.5 Tanner Brian (b. 1811) was second in a family of twelve. When he married Mary High of nearby Walney Island, two sons, Thomas (b. 1835) and Brian

1

The counties were re-figured in 1974. North Lancashire is now in Cumbria. Celia Fiennes. Christopherson Morris, ed. The Journey of Celia Fiennes. (London: The Cresset Press. 1947), p. 191. 3 Ibid. p. 196. 4 In February 2004 nineteen Chinese cockle pickers drowned, surprised by the fast moving tide in Morecambe Bay. 5 Transactions of the Cumberland and Westmorland Antiquarian and Archaeological Society. Vol. IX (1960), p. 124. 2

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(b. 1837) were all that they could achieve.6 This was unusual because in a world without contraception, most people either had the bad luck not to have any or had a dozen.7 Brian’s tannery was in Oxen Park, a hamlet in the parish of Colton. His elder son, Thomas, followed rural tradition and apprenticed to a coach-builder in nearby Ulverston, married his master’s daughter, moved to Windermere and produced ten children. This coach-builder, later a pub owner, appears not be mentioned by the younger brother Brian, or his upwardly mobile side of the family, and the curtain was rung down on this country bumpkin. An elderly Christopherson cousin recalled for me an incident from her childhood: “when staying in Windermere with cousin Nellie I espied a very large house with Christopherson in big letters on the front. Mother and Cousin Nellie made no comment when I showed some excitement seeing my name. When I got home I told Dad’s sister Aunt Mary Margaret what I had seen and she said: ‘Yes my dear, but you just look on the other side of the road.’”8 The particulars of this building remained obscure, although one may imagine it was a pub. The general idea was clear: we don’t associate with that branch of the Christophersons. Brian junior’s life would be very different. Somehow the hand of fate intervened and forged a new and prosperous path for this youngster. He must have been a likely lad, good at reading and with a curiosity about the world. His chance to make something of himself intellectually came when he was taken under the wing of his uncle, the Rev. Arthur Christopherson and his wife Mary, who were childless. Arthur was vicar of Caton, near the town of Lancaster, home to one of the best grammar schools in England. Young Brian lived at the Rectory as the son of the vicar and his wife. They all had the same surname so the school might be forgiven for believing Brian was in fact their child, and perhaps Arthur and Mary were pleased at the thought. Here, the tanner’s son had the chance to escape from smelly, rural tannery, to gradually ascend into the ranks of the gentry.

6 Walney Island, long thin island, about eighty miles by five at its broadest, lashed by the Atlantic. 7 “One child families were not that unusual because puerperal sepsis, if it did not kill, left the woman unable to conceive. ‘Two child sterility’ was less common because the first child being the most difficult delivery, was more liable to give rise to interference by a septic midwife, but certainly 1, 2 & 3 child sterility did occur.” Dr. W. Ormerod, Letter to author 25 November, 2002. 8 Personal communication from Marie Christopherson. 24 March, 1997.

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The story moves quickly as opportunity developed and young Brian received a solid education at Lancaster Grammar School.

Cambridge and Academic Success Brian would have spoken with a north-country Lancashire accent, but doubtless his grammar and manners would have been polished and improved by his uncle and aunt. He was their protégé and they must have been proud of him. He did well in school, won a scholarship to St. John’s College, Cambridge, where he was awarded his BA in the Mathematical Tripos in 1863 and his MA two years later.9 At the same time he ‘took Holy Orders,’ i.e., became a member of the clergy, and found employment as curate in the parish of Thorne with an annual stipend of ten pounds. Thorne is a small market town in West Yorkshire 160 miles north of London. “. . . with neat parish church, five meeting houses, and two charity schools . . .”10 Some time during this spell in Yorkshire the Reverend Brian must have met his future wife, Caroline Ord Denton. Upon his resignation from the parish 1866 the congregation gave him a tea-and-coffee service and an illuminated address, perhaps as a wedding present for the marriage a little later that year. Just how Brian’s life-changing opportunity to meet Miss Denton came about is not known, but it had considerable consequences. In 1866 Brian was twenty-nine. His father-in-law, John Punshon Denton, was a town councillor, one time mayor of Hartlepool and partner in the shipbuilding firm of Denton & Gray: a kindly man so they say, he did business on a handshake. The Denton name stood large in Hartlepool. It was a thriving seaport, big enough to return a member of parliament, known for a ship-building industry and coalmining nearby. As the number of Denton children grew to eleven, the family moved to nearby Norton village two miles away, where they leased Norton House, a handsome pile, as befitted their status in the community. Theirs was certainly a name that commanded respect but, like any family, they had their share of misfortune. When John Punshon

9 St. John’s College, Cambridge seems to have been a favourite place for these lakeland men. William Wordsworth went there in 1787. Young Brian’s uncle Arthur Christopherson entered as a Sizar (on reduced funds) in 1831, so it seemed natural that Brian would follow in his uncle’s footsteps. 10 Brooks General Gazetteer. Undated but probably mid-1800s.

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Denton, ‘the governor,’ died in 1870, the business partnership fell into disarray and the concept of trust was abused. After a long court case, Denton versus Gray, with expensive Queen’s Counsel from London by both sides, the Dentons lost. The Gray name is still prominent in Hartlepool, the Denton name now almost buried. But before all this, when the ship-building and ship-owning business flourished, there were seven daughters to be married off. It is not known what Mrs. Denton thought of her Lancashire son-in-law, or of the rural tanner and his wife; they are not noted in the description of the wedding party. Where it was necessary to write the occupation of the groom’s father on the marriage certificate, the word ‘Gentleman’ is inscribed. One can only imagine the consternation and embarrassed discussion caused by the infra-dig word ‘tanner.’ ‘Vexing’ might have been the word used then. Brian’s bride, Caroline Ord Denton, was known as Carrie in the family, and over the succeeding years earned a reputation as a snob and a social climber. Perhaps this was common in others of her class and generation. Brian’s next move was to a teaching job in Batley in Yorkshire and here the first two children were born. Arthur, in 1867, predictably named for the kindly and generous uncle, the vicar of Caton, and in 1868, John Brian, the subject of this biography. Over time the Rev. Brian continued to work his way up until he held the important but onerous job of headmaster of The Royal Grammar School, Newcastleupon-Tyne. It was here that the Christopherson family, pillars of church and society in general, suffered personal tragedy and a serious, if temporary, fall from grace.

Newcastle: Scandal and Tragedy Surmounted In 1876 the Rev. Brian Christopherson, approaching forty, found himself in what might be termed, a spot of bother. This was a man who had already fathered eight children, five boys and three girls, (and there was soon to be a ninth) and had some experience raising children, particularly sons. He was an experienced teacher, yet he seems to have walked into this trouble blindly. That headmaster Brian was a disciplinarian I have no doubt. Boys’ schools, were heavy on corporal punishment. On this occasion it was the headmaster’s turn to learn a few things the hard way. What followed

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was tragic. It seems that the Rev. Brian Christopherson on one side and certain boys’ parents on the other, became caught in a whirlpool of charges and counter-charges. A 1986 history of the Royal Grammar School describes the situation as: “. . . a seedy story involving some of the boarders was given wide and salacious circulation in the local newspapers.” The same author refers to this “tiresome episode” which soon “fizzled out without doing much damage to the School . . .”11 The headmaster’s house was a part of the school so a scandal would have affected at least his older children—Arthur aged nine and John (Jack) aged eight. It is unfortunate that as so often happens, one side in a dispute manages to disseminate information to a salivating press faster than the other can dignify the story with a denial. Headmaster Rev. Christopherson was exonerated a year later, but the aroma lingered on. To the family, to Carrie in particular, this must have been devastating, knowing as she did that the news in the Newcastle papers was readily available to her family, the Dentons, and their friends only thirty-five miles away in Hartlepool. She really had enough to do with eight children, a house full of boarders, servants and nursemaids, never mind keeping up appearances. The ‘scandal’ involved accusations of excessive flogging and insinuations of a dubious moral nature committed, not actually by Rev. Christopherson, but by certain boarders and masters, for whom he was responsible. The situation became so serious that in time the school board and even the local Mayor became involved. Lawyers were hired and innumerable meetings were held, as the headmaster attempted to safeguard his name and the name of the school. Finally, in March 1877, following the publication of a heavily biased thirty-five page tract by the headmaster’s adversaries, Rev. Christopherson, who had been fighting a vigorous rearguard action and adding a few counter-charges of his own, had the sense to write a short, dignified letter to the committee saying: “. . . I have read with utter amazement [the pamphlet]—I trust my not replying publicly to the many mis-statements contained therein will not be considered by you, or any other member of the

11 Brian Mains & Anthony Tuck, Eds. Royal Grammar School, Newcastle upon Tyne. (Oriel Press. 1986).

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Schools and Charities Committee, as the slightest admission on my part of their truth.”12 I felt a sense of relief reading this note, 130 years later, after all the inflammatory writing that had gone before. It is not pertinent here to give a blow-by-blow account for all that went on as detailed in the tract. It is necessary to point out for the benefit of readers in the twenty-first century, that thrashing male boarding-school pupils was an accepted practice, by parents and staff, even fifty years ago. It is also worth noting that the pupils involved in the accusations and counter-accusation were living alongside the boys, Arthur and Jack, dining and studying with them. What effect this had on these Christopherson children we don’t know, but they cannot have escaped the tension at the dinner table, the whispers in the dormitory, and the tight-lipped disapproval of their mother. One year later the Board closed the enquiry by saying: “Headmaster Brian Christopherson was culpable only in the laxity of the supervision exerted over his boarders.”13 Less than two years later, in 1879, a double tragedy struck the Christopherson family. Their little sons, Denton Dockray and Claude born 1873 and 1874 respectively, caught scarlet fever. They died three days apart on 15 and 18th of May 1879. The death certificate for Denton says “convulsions for thirty-six hours, father present at death.” Jack was eleven when these deaths occurred and must have been well aware of the funeral arrangements, the graveside service with the two buried together, and how devastating it was to the parents. A cousin told me that a picture of the two little boys who died hung above the sideboard in the dining room in the rectory at Falmouth and that no one dared speak of them. By late 1880 the family seemed sufficiently recovered from all this to have their photos taken. In one Caroline sits surrounded with the three older boys, Jack kneeling, Arthur and Evelyn beside her.14 Reverend Brian is seated in a second photo with his three daughters, Caroline, Muriel and Eva. Perhaps the parents liked the symmetry.

12 Proceedings of the Newcastle Council March 7 1877. Newcastle Central Library, Local Tracts. D48. No. 26: p. 246. 13 Brian Mains & Anthony Tuck. Eds., Op. cit. 14 The baby, Edward (Ted) Oscar Ord, born 1877, is missing here. He was destined to bring more than a share of misery, shame and trouble on this family in later years.

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2.1. ‘Jack’ Christopherson aged 4. His sister Eva wrote on the back ‘Isn’t he sweet?’

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2.2. Little ‘Ted,’ with Claude and Denton Christopherson.

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2.3. Rev. Brian Christopherson with Caroline, Muriel and Eva.

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2.4. Caroline Christopherson with Jack, Arthur and Evelyn.

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Edward (Ted) Oscar Ord Christopherson, the baby, is not in evidence here. He was to cause his parents much unhappiness years later when he ran away to sea, abandoning his wife and two baby daughters. The desperate mother, finding herself destitute and without help from her mother-in-law, also abandoned them. The little girls were raised in Falmouth by their grandparents on condition that their mother never see them again. This last makes one wonder about the notion of Christian charity at the Falmouth rectory.15 Given the difficulties of the previous few years it is understandable that when Reverend Brian’s brother-in-law, Richard Denton, in 1883, offered him the living of the parish church of Falmouth, Cornwall, he accepted.16 He could not have located farther away from Newcastleupon-Tyne than to the most southwestern tip of Great Britain. Here the family could make a new start, leaving their sadness and the aromas of scandal far behind. It is likely that the Christophersons were desperate to get out of Newcastle and that the Denton family were equally anxious to help their daughter Carrie.

Family Life in Cornwall The church Reverend Brian took over in 1883, King Charles the Martyr, Falmouth, was built between 1662 and 1664. It is a large and important parish and the rector had four curates to help with the work. One of the choirboys, Tom Stroud, remembered his days there and wrote to me: “. . . the three top men were the Mayor, the Rector and the Police Super . . . at that time Falmouth was a Garrison Town & and busy Port.” He went on to say that the rector kept the choirboys under strict control.17 Writing in a history of the Falmouth Parish Church in 1928, John Key Kempthorne observed, “Canon Christopherson was a man of quiet disposition, but strong-willed, hardworking and businesslike.” It would appear that Canon Christopherson (he became an honorary canon of

15 Some time after writing this I received a new version: The Illustrated Police Budget, 17 October, 1903 claimed that the wife was the adulterous offender and titled the piece: A Broken Promise—the Lodger Again! 16 It was actually offered first to Rev. Denton Jones, son of one of Caroline’s sisters, who refused. Falmouth Parish Church, John Key Kempthorne (1928), p. 19. 17 Tom Stroud, Letter to the author, 20 December, 1990.

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Truro cathedral in 1900) had come through his northern ordeal by fire well and, having a second chance, flourished. When he finally retired in 1912 he was awarded the Freedom of the City of Falmouth. The family lived first at No. 2 Witton Villas and in the early 1890s moved to Woodland House in Wood Lane. The seaward side has elegant windows looking over a pretty garden. A Christopherson granddaughter who lived to be more than one hundred, remembers the nursery in the basement ruled by sundry governesses who came and went at short intervals largely due to the whims and manipulations of the small fry.18 Perhaps Jack was too old at fourteen to spend much time with a governess. In September of 1883 he entered Clifton College, Bristol. His younger brother, Evelyn, had entered Clifton in the junior department in 1882, but left after two terms. Boarding school is not for everyone. Clifton, wrote the school archivist: . . . [was] a very exceptional school for science teaching at the time, which may both have inspired and informed him [Jack]. Most scientists went on to the Royal Military Academy at Woolwich which trained the army engineers and gunners . . . We did have a special section of this school, known as the Military section, which specialized in maths and physics and was aimed at the Woolwich exam, but boys who opted for that had to drop Greek, and so could not to into the VI form or go to Oxford and Cambridge. It may be that Christopherson did this, as he left from the Vth form not the VI. The surprising thing is that he was then accepted at Caius College, Cambridge, and did both an MA and an MD . . . there.19

Presumably he had enough Latin and Greek, probably tutored by his father, along with an excellent grounding in science, to satisfy Cambridge.

Cambridge: Gonville and Caius College—October 1887 Jack continued to follow in his father’s footsteps with a first-class Cambridge university education. His was a well-rounded science and medical degree, pre-clinical only, as Cambridge at that time had no clinical courses. The archives at Cambridge furnished the following for the degree of M.B. where Jack’s name appeared on various exams lists

18

The late Ena Edwards, daughter of Edward Oscar Ord (Ted) Christopherson. Personal correspondence from Richard Bland, Clifton College Archivist. E-mail 30 January, 2002. 19

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between 1888 and 1893: Chemistry and Physics and part II Biology. Part I Pharmaceutical Chemistry. In the Michaelmas Term of 1890 he passed the exam Medical and Surgical degrees: Part II Human Anatomy and Physiology and the third examination for medical and surgical degrees in the Michaelmas Term of 1892 part I. In the Easter Term of 1893 he passed Part II of the Medical and Surgical degrees. Although the subject of epidemiology had been an acknowledged field for some time, courses so named do not appear while Jack was at Cambridge.20 He probably took an exam in state medicine and sanitary science but information is sketchy. He certainly developed an interest in the subject, most likely from force of circumstance, while working at the Albert Dock Hospital, London at the turn of the century. No personal letters have surfaced from his Cambridge days, so all that can be said about how he spent some of his free time there was that in 1891/2 he rowed number three in the second college boat weighing in at 9 stone 13 lbs, and that the crew won blades in the Lent races.21 He must have been in excellent physical shape in those years; physical stamina was something that counted a good deal for those being chosen for a posting to Sudan. Gonville and Caius was the college known for science and medicine. There were more students reading medicine than at any other college. Many well-known names in medicine got their start there, including the great William Harvey (1578–1657), who discovered the circulation of the blood and then, like Christopherson, continued his education at St. Bartholomew’s Hospital.

Walking the Wards at St. Bartholomew’s Hospital (Barts) In 1898 Christopherson found lodgings at 5 Staple Inn, Holborn, and began the clinical part of his training at Barts Hospital. Once again, epidemiology, something that was to interest him in 1903 in Sudan, was not so-named as a course at Barts. There were: . . . weekly lectures on Public Health, and these included teaching on subjects such as Contagion, Vehicles of Infection—e.g. Water, milk, clothing, air. Measures for staying the spread of infection: isolation, disinfection,

20 21

The Society for Epidemiology was founded in 1850. Lent term—the January term.

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vaccination, quarantine, the Etiology of specific Fevers and communicable diseases, and Methods of reasoning and the nature of proof required in sanitary investigations. This series of lectures was given by W.H. Hamer, fellow of the Royal College of Physicians.22

Although I have discovered no mention that the famous epidemiological study of the cholera outbreak by Dr. John Snow was taught at Barts, certainly every medical student, then as now, would have heard the tale. The devastating cholera outbreak in 1854 in Soho, London, became the focus of Snow’s meticulous investigation that finally resulted in acceptance of the water-borne theory of cholera. Years later, when Christopherson was faced with an outbreak of smallpox in Omdurman in 1903, he made a similar study, albeit on a much smaller scale, tracing the incidence of smallpox to its source and creating a map documenting each infected house. Christopherson is recorded as House Physician and House Surgeon at Barts and is noted in the register as Assistant Demonstrator of Practical Anatomy for the sessions 1898/99 and 1900/01. Demonstrators attended the department of Anatomy from 10 a.m. until 4 p.m. to direct students in their dissections and to give demonstrations in classes. At the same time he is noted as being Senior Resident Medical Officer, Evelina Hospital for Children. His nephew, Dr. Peter Ormerod, remembers his uncle’s mentioning his work at the children’s hospital, suggesting he worked there during the summer. Barts held another significance for Christopherson. More than a decade later he married the daughter of Dr. Joseph Arderne Ormerod, a senior consultant at Barts, under whom he had earlier worked. Discipline at Barts in Christopherson’s time was strict; nurses and students were not allowed to mix. “A rigid hierarchy was also maintained. Senior staff treated their juniors in a formidable manner, and all staff had to wear frock-coats and top hats.”23 Fortunately it seems that the young Dr. Christopherson, son of a reputable cleric, was invited to form a social relationship with the Ormerod family away from the hospital. They lived at 25 Upper Wimpole Street, where the doctor had his consulting rooms. They were

22

E-mail from Marion Rea, Archivist, St. Bartholomew’s Hospital. 17 December, 2002. 23 Waddington, Kier. Medical Education at St. Bartholomew’s Hospital 1123–1995: Suffolk, UK. The Boydell Press. 2003. p. 145.

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2.5. JBC in his Barts Hospital days.

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close-knit and gregarious family and there were a number of daughters of marriageable age. At the turn of the century Barts was on the cusp of a new direction in teaching. Medicine was moving into the realm of science as opposed to empirical art. “. . . physiology, chemistry and pathology . . .” 24 were added to the syllabus. Christopherson took tremendous pride in ‘his hospital.’ His association with Barts hospital and Barts-trained staff amounted to bonding in much the same way that soldiers bond in their regiment. In 1910 he wrote a paper, published in the hospital’s journal, examining the question: Which of the various St. Bartholomews gave his name to the famous London hospital?25 When he was in the Boer War he took a number of photographs of nursing staff and on the back of these snapshots, beneath their names, he wrote ‘(Barts)’ where applicable. Much later when trying to procure nurses for his local hospital in Gloucestershire he argued enthusiastically for the hiring of a Barts’ nurse. For example, in 1939, in a letter to Joyce, he wrote of recommending a career for a friend: “I would be pleased if I knew she had made up her mind to do something which in life would be useful to her fellow creatures and I think she would herself be happier—in fact quite happy, if she seriously decided to do a career of nursing at St. Barts or Thomas where she would find the nurses were of her own social standing, all emancipated [author’s emphasis] and keen and happy.”26 With respect to women and people of other races, Christopherson was a man ahead of his times. In the case of the latter, as will be seen, this did not always sit well with his superiors. In 2003 I visited Barts, the oldest hospital in England, intent on seeing their archive. The hospital is an enormous sprawl of a place sitting on a large triangle of land near Smithfield Market. On my way in I found St. Bartholomew’s the Less, a lovely, peaceful chapel for the use of both patients and staff.27 I sat for a while thinking that Christopherson, a deeply religious man, must have come here often. By the time he left Barts, Christopherson was in possession of some of the finest medical training in the world. He had a close acquaintance

24

Ibid. p. 145. St. Bartholomew’s Hospital Journal (March 1910), p. 83. 26 Letter to Joyce 14 August, 1939. 27 St. Bartholomew’s the Less is actually the parish church for Barts Hospital—a most unusual arrangement! Peter Ormerod 2005. 25

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with a senior consultant, Dr. J.A. Ormerod, whose home and office was one of the best addresses in London, and of course he had the approval, pride and blessing of his family, now happily ensconced on the Cornish Riviera. Thus it was that the Lancashire tanner’s grandson, John Brian, known as Jack in the family, and the subject of this biography, lived and worked in much more prestigious, even exotic, circumstances than either his father or his grandfather. It was a major step, in three generations, from the a tannery in rural north Lancashire to life in the drawing rooms of the gentry of Newcastle, Hartlepool and London. John Brian, son of the Rev. Brian, graduate of Cambridge, became a fully fledged physician by ‘walking the wards,’ at St. Bartholomew's Hospital, London. From there he moved to the best-equipped field hospital in the Boer War, then spent two decades as director of the civil hospitals in Khartoum, (with a short stint in Serbia and France for wartime duty), and finally, in his own elegant consulting rooms near Harley Street in London. Along this seemingly smooth trajectory of advancement lay a number of obstacles; some might call them battlefields.

CHAPTER THREE

THE BOER WAR EXPERIENCE: THE IMPERIAL YEOMANRY HOSPITAL—A PALACE IN THE DESERT

The train from Johannesburg to Cape Town was not the famous tourist ‘Blue Train,’ its dining car kitted out with starched white table-cloths and little curtains in the windows. Ours was a regular get-from-hereto-there train with overnight berths. We booked first class as suggested but although clean, there was nothing elegant about it. No smiling porter to help with the luggage, just get on and shift for yourself. The dining car had oilcloth on the tables and the food was a local version of McDonald’s. My cousins in Cape Town were appalled when they met us, they had somehow not expected us to emerge from a local train. I didn’t mind. I had a mission to accomplish. This train was scheduled to pass through De Aar, the junction adjacent to the site—at Deelfontein—of the most luxurious hospital camp ever seen in the Boer War. Privately funded and palatial, it had sprung up almost overnight in the veldt and, as I knew from my research, had vanished just about as fast three years later. Nevertheless, in 1900 Christopherson spent many months there, so the site warranted a look.

One Niggling Issue In research, re-reading your collected data after a period of time pays dividends. Not only do you see things you skipped through as a result of being distracted or generally naïve the first time, but sometimes later, with better hindsight, new details jump out. In this case, a letter written in November of 1908 by Sir Reginald Wingate, Governor General of Sudan, [and here I am jumping ahead of the chronology] gives a whiff of trouble erupting as early as 1900. It surprised me. There had been no word of anything like this up until now. . . . I think C.[hristopherson] has many excellent qualities, [but] there can be no doubt that he has altogether failed to obtain the friendship or confidence of any of his profession, including even those actually in his own Department. I suppose it is a peculiarity of his nature and I am

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What ‘want of success’ in the Boer War? And what other places—Barts hospital? The Albert Dock Hospital, London? Is this fact, or simply fiction dreamed up by his adversaries who had the ear of Wingate? I made a valiant effort to find something that would either substantiate or negate Wingate’s words. But first, some background to the South African story.

The Call for Medics In 1899 the British War Office called for volunteers for active service in South Africa. Medical staff were also urgently needed so it is hardly surprising that Jack Christopherson, thirty-two and unmarried, signed up. The abnormal demand for medics, in particular by the Royal Army Medical Corps (RAMC), meant that many civilian physicians and surgeons worked as attached to the RAMC. It also explains why Christopherson, in his portrait of that time, is wearing a uniform (in order to give him some authority) but no badges although he is designated in The Times as ‘RAMC—Civil Surgeon J.B. Christopherson.’2

Background on the War The ‘scramble for Africa,’ as it was known, had been in process since the 1870s, with Britain, France, Belgium, Italy, Portugal, and later Germany, all trying to grab a piece of the pie. The Boer War, often referred to as the South African war, was about greed. It was also about British arrogance, and the belief in the need to expand the empire and to maintain naval bases and ports along the shipping lanes to India. It was about outlawing slavery, a trade the British had enjoyed for years and only abolished in 1834 and that the Boer

1

Wingate to Acland. 29 November, 1908. SAD 284/3/68. “. . . the important point is that he is not wearing any badges of rank, or a capbadge. RAMC uniform was exactly the same as the rest of the army except that they had crimson embellishments instead of the army’s scarlet (stripes down trousers, facings on tunics etc.) Personal correspondence to author from Colonel Iain Swinnerton, 13 March, 2003”. 2

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3.1. JBC in his Boer War uniform.

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farmers, who resented the Imperial interference, planned to continue. It was also about the new-found wealth—diamonds and gold. The Cape and Natal were already British colonies. North of the Orange River sat two independent Boer republics, the Orange Free State and the Transvaal. The proposal by Lord Carnarvon, British Colonial Secretary, for a federation of South African states, led to the annexation of the Transvaal and the determination of the British to hold on to it. The joining of these two Afrikana (Boer) republics to fight for their independence led, twelve years later, to the outbreak of a fullscale war in 1899 as British imperialism clashed with Afrikaner/Boer nationalism.3 Britain was determined to maintain a united South Africa and towards the latter part of 1899, began shipping more troops out to the Cape. This the Boers watched with alarm and finally issued an ultimatum on 9th October demanding two things: that points of mutual difference between Britain and the Transvaal be settled by an arbitrator and, that British troops, already en route to the Cape, not be landed. Ultimatums usually stir action and this was no exception. The deadline passed and on October 11th Britain was officially at war. This brought with it the major complications of moving troops, horses and supplies over a three-week sea voyage. Initially things did not go well for the British. In October they suffered 1764 casualties at Modderspruit. Soon the towns of Ladysmith, Kimberley and Mafeking were besieged. In December of 1899 they suffered terrible reverses at Stormberg, Magersfontein and Colenso. The situation was becoming serious. All of Britain became caught up in the fever of the war and the government’s call for volunteers successfully attracted more than 10.000 men, often recruited direct from civilian life, to serve in a Yeomanry specifically for the Boer War. Christopherson’s service was part of this patriotic fervour.

3

The Boers were the “poorest and most independent of the [Afrikaans], the wandering farmers whose search for new grazing lands brought them progressively deeper into African territory.” Thomas Pakenham, The Boer War (London: Wiedenfeld & Nicholson. 1979), p. xxi.

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Noblesse Oblige and Fundraising In London, two wealthy women—Lady Chesham and Lady Georgiana Curzon—had an urge to do something that would make a difference. They called on the general public for funds to build and equip a hospital specifically for the Imperial Yeomanry serving in South Africa.4 I had wondered, when I first learned of the work of these ladies, why they had picked the Yeomanry. I had assumed they had sons or at least relatives involved in some way. In the end I learned that their reasoning was more to do with noblesse oblige. Lady Georgiana, as editor of the three-volume history of the Imperial Yeomanry Hospital (IYH), explained their choice: Although the life of the regular soldier is as valuable as the life of the yeoman, the former contemplates war and its accompanying perils and hardships as the natural corollary of his profession, while the latter could never anticipate that this would be his lot, yet the yeoman, whether farmer or landowner, was ready, without a moment’s hesitation, to leave his farm or his country seat, and exchange his peaceful but useful career in life in order to take his share in the great national effort stirring the British Empire to its very depths. From the highest in the land—many owning great historic names—to the humbler farmer, vast numbers had volunteered to fight for the freedom of their fellow-countrymen in South Africa. The value of the lives of these men, representatives of every class, seemed to us of such vast importance that we believed no better outlet could be found for generous enthusiasm than by setting before the people of the United Kingdom a scheme by which all could give expression to, and practical proof of, their desire to assist their Queen and country.’5

Before Christmas 1899, the letter of appeal for funds was published in major London newspapers. The response was termed “enthusiastic . . . sufficient to equip and remunerate the personnel for four hospitals . . . a convalescent home, a field hospital and a bearer company.”6 In fact these two ladies in their centre of operation, the elegant Number 20 Curzon Street, London, certainly knew a good deal about what would now be called networking and public relations. They were, of course, well placed 4 As military specialist Colonel Iain S. Swinnerton pointed out, “Yeomanry was just a name, nothing like the ordinary county Yeomanry. The great majority of the IY were ordinary working men.” Personal communication 17 April, 2005. 5 Countess Howe. Ed. The Imperial Yeomanry Hospitals in South Africa 1900–1902. Vol. I (London: Arthur L. Humphreys 1902), pp. 13–14. 6 S.A. Watt, Deelfontein: A hospital in the Karoo During the Anglo-Boer War, a cemetery today. In S.A. Military History Journal. Vol. 7 No. 4 (Dec. 1987), p. 151.

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in society and even caught the interest of the Queen and her family who donated enough money to equip several beds. With this blessing the new committee went from strength to strength. Many of their meetings were noted in The Times, always with the heading IMPERIAL YEOMANRY HOSPITAL. Any group raising enough money to equip a bed could name that bed; for example, The Exmoor was so named by The Devon and Somerset Staghounds hunt. One manufacturing company gave a complete plant capable of making 350 dozen bottles of mineral water per day; the ladies of Yorkshire sewed nightshirts and hemmed sheets for the Yeomanry. In three days there were over 300 subscribers, and the Prince of Wales presented a flag. Groups all over the country raised money for the IYH, as it was known, and various companies contributed glass, china, 7 wine and other commodities. Later, when the Royal Commission on hospitals in the war interviewed patients and visitors there, one visitor, Murray Guthrie M.P., had this to say: [IYH is] the finest hospital in South Africa. One was almost shocked at the money that was spent there. The wine glasses had the Prince of Wales’ feathers in gold engraved on them, and all the basins had the same, and the jugs, and everything. That is a small matter, but the thing was absolutely perfect; it was just like Guy’s Hospital put down in the middle of the veldt.8

The staff were being appointed as fast as possible. The Times of 24 January, 1900 listed Christopherson, ‘Demonstrator of Anatomy, St. Bartholomew’s Hospital’, along with surgeons and physicians: Mr. William Turner, Mr. Hamilton A. Ballance, Mr. Wallace C.G. Ashdowne, Dr. Andrew Elliot and Dr. H.W. Saunders. By February 5th there was a much longer list including dressers and nurses, all named with their hospital affiliation. Barts and Guy’s hospital sent five nurses and twelve nurses respectively, all of whom belonged to the Army Nursing Reserve. A reading of The Times shipping columns shows dozens of ships leaving every day for South Africa from the three major ports, Liverpool, London and Southampton. One hundred tons of equipment for the

7

The china bears the badge of the IYH—The Prince of Wales’ feathers, by special permission of the Prince. 8 Report of the Royal Commission South African Hospitals. (London: HMO Stationary Office. Section A: 1901).

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3.2. IYH, Hunt ward. Note the names of the donors over the beds.

IYH shipped out on the Canning on 27th January and there was more to follow. Traffic on those sea-lanes was heavy. On 29 January 1900 The Times noted: “. . . Tall, sturdy, intelligent, and active-looking . . . the Imperial Yeomanry looked a splendid force, representative of the best young and seasoned manhood of England, and fit for anything.” On 1 March, The Times again: “The Hon. F.G. Curzon has received from various wine merchants a large quantity of wine for use in the hospital, and four large easy chairs . . . articles most needed are ticking bags . . . blankets, mosquito netting, rolls of flannel, and cholera belts . . . Sufficient cushions and muslin doilies have for the present been received . . . ” Wine for the patients was an important part of medication at that time, and the easy chairs were to relax in after imbibing perhaps? What does seem surprising is the mention of cholera belts. Cholera was known to be water-borne as long ago as 1854, so it should have been well understood that a cholera belt, i.e., a piece of flannel wrapped about

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the midriff, would be useless. In spite of this, as late as 1912, drowned passengers from the Titanic disaster were found floating wearing cholera belts. In fact, the discussion for and against the use of multipurpose flannel belts now ‘for the prevention of bowel complaints’ continued until 1919.9 If one considers that copper bracelets are, in the twentyfirst century, worn by some believing it will relieve arthritis, the use of cholera belts may not seem so ridiculous. The reference to muslin doilies needs a word for those who were born after the second world war. Muslin doilies fringed with beads were used to cover milk jugs and the like to protect against flies where there was no refrigeration. Presumably many women left at home, rather than serving in the ‘only stand-and-wait’ mode, took to doily making.10

A Palace of Luxury “Never, in the history of warfare, has so completely equipped a hospital as that which now finds its home on the veldt at Deelfontein been sent out to administer to the wants of the wounded.”11 Indeed Chaplain Rev. J. Blackbourne when interviewed in August 1900 enthused: “you will find it a palace of luxury . . .”12 The Commander-in-Chief of the British forces in South Africa, Lord Roberts, had chosen the site for the hospital—about forty-five kilometres south of De Aar—the “railway junction linking Bloemfontein and Kimberley with Cape Town and East London and Port Elizabeth with Mafeking.”13 The choice was made particularly because it had a good supply of fresh water. At 1,359 feet above sea level it was a place of sunshine, fresh air and tropical vegetation. So this meant the prospect not only of adventure, but also a welcome change of climate after London’s grey damp winter. It must also have been an excellent training ground for Christopherson’s future work in tropical medicine. The Times on February 5th offered yet another headline for the IYH with a full list of medical officers appointed. Lt.-Col. A.T. Sloggett,

9 E.T. Reybourn, “The History of the Flannel Binder and cholera belt”, in Medical History. Volume 1. No. 3 (July 1957), p. 221. 10 Quote from sonnet no. XIX by John Milton. “they also serve who only stand and wait”. 11 The Graphic. April 28, 1900. 12 Commission on Hospitals in S.A. Section A. 13 Ibid. Section A.

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RAMC was the commandant of the hospital and principal medical officer. I smiled on first reading this name and wondered how much trouble he had suffered as a youngster, at English boarding school, defending this moniker. Christopherson took several photographs of Colonel Sloggett during his stay in South Africa, and although there are no letters extant from him at that time, he and Sloggett must surely have thought well of one another. They were later to serve together on the 1917 hospital commission in France when Christopherson obtained the post of Secretary, a post he would have been unlikely to hold without Sloggett’s endorsement. On January 30, 1900, Lady Georgiana made another coup. Princess Christian, granddaughter of Queen Victoria, attended a meeting at 20 Curzon Street. There is nothing like a nod from royalty to get recognition and newspaper inches. On this January day, sixty nurses were given nursing reserve badges and certificates confirming their appointments to the IYH. At yet another well-publicized Curzon Street meeting The Times reported that enough money had now been collected to equip a field hospital as an extension to the original scheme of the IYH but that this would be subject to military requirements in South Africa.14 For instance “. . . male attendants only can be employed in a field hospital, the committee therefore cannot entertain any applications from female nurses.”15 A week earlier, sixty nurses had been engaged to ship out to South Africa. It should be explained that although they were barred from field hospitals, they were welcome at the base hospitals, stationary hospitals and on hospital trains. It is likely that women were thought to be at too much physical risk in field hospitals, i.e., right behind the front lines.

Embarkation Firemen, St. John ambulance brigade, cooks, a dispenser (pharmacist), a chaplain and others sailed on The Norman having first been paraded and cheered with enthusiasm. The nurses and ward maids were scheduled to sail a week later. No reason is given for shipping the nurses separately

14 15

Although often referred to as a ‘field hospital’ the I.Y.H. was really a base hospital. The Times, 8 Feb. 1900.

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3.3. Col. A.T. Sloggett, commandant of the camp. Taken by JBC 17 June, 1900.

from the doctors, but it looks as though fraternization and shipboard romance were discouraged. On Saturday, 10th February, two days before the Majestic was due to leave Southampton with the medical staff on board, there was an impressive ceremony at the Albany Barracks, in London, to say farewell to the troops. Even at 10.30 a.m. the day was “bitterly cold and the fog was still thick enough to make it difficult to distinguish from one side of the square the roofs powdered with hoar frost which lay on the other.”16 The Yeomanry were drawn up by contingents. Perfection in drill and general assembly was not evident. The Times ‘special correspondent’ wrote, “As for smartness in drill, of this perhaps, the less said the better.” Of the uniforms he remarked, “The legitimate diversity in details of uniform gave a certain picturesque irregularity to the parade: but, serviceable though it may be, the khaki cloak worn by the officers too closely resembles a Jaeger dressing-gown . . .”

16

The Times, 10 Feb. 1900.

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At 11 o’clock the Prince of Wales arrived with a coterie of Lord this and Colonel that; here he inspected the troops and wished them well. The send-off for Christopherson and the rest of the medics was no less splendid and took place that afternoon at Devonshire House. The ambulance men were drawn up outside in the cold for inspection while the physicians, nurses and others moved inside. The nurses are noted as resplendent in their blue cloaks and scarlet hoods, presenting “a very businesslike and military aspect.” Once again the Prince of Wales made appropriate remarks and greeted each member of the medical staff in turn. Col. Sloggett called for three cheers for the Prince and, formalities over, departures to the docks commenced.

The Camp in the Veldt Takes Shape When the group arrived at Cape Town on 3 March, they proceeded to entrain to Deelfontein, a journey of forty hours over 471 miles. Col. Sloggett wrote to Lady Chesham of the “difficulties owing to the congested state of the railway traffic which delayed the arrival of much of the equipment,” the work entailed being enormous; at the same time he praised the men “who behaved splendidly.” By 17 March when the hospital was opened, tents were already erected, huts built and stores and equipment carried from the railway station, 400 metres distant from the site. The entire staff consisted of 21 doctors (including surgeons, physicians, an ophthalmologist and a dentist) 10 surgical dressers, 40 nursing sisters, 10 ward maids, 76 men from the St. John Ambulance and 110 orderlies, making a total of 191 persons. Prior to its opening, the military authorities completed a railway siding in front of the hospital in order to facilitate the removal of patients brought by rail. Water had been laid on by means of piping it from a tank at the foot of the hill behind. Flowing under the force of gravity it was easily distributed throughout the camp. Pathways, lined with stones painted white, gave the camp the appearance of a small town. On 19 March the first ambulance train with 101 ill and wounded men arrived . . . and at the end of the month some 300 had been accommodated . . . .In mid May Lady Chesham and her daughter arrived . . . bearing gifts of newspapers and books as well as luxury items, including tobacco. . . . 17

17 S.A. Watt, Deelfontein: A hospital in the Karoo during the Anglo-Boer War, a cemetery today) Military History Journal—Vol. 7 No. 4. The South African Military History Society, p. 151.

3.4. Camp, with IYH carved into the hill behind.

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On 10 April Deelfontein was treating 402 men. By mid-June 1900, and at an astoundingly fast pace, provision had been made for nearly eight hundred patients. “The hospital complex eventually contained fifteen buildings used as wards . . .” Names of donors, private and public, were inscribed over doors and on beds. In addition there were seventy-seven tents and marquees for use as wards, dining rooms, recreation rooms, warehouses and kitchens. “A composite building contained an operating theatre and an X-ray room, and a dispensary . . . the dairy . . . laundry . . . steam plant for disinfecting . . . a fire station, a carpenter’s shop, the Commandants office, toilets, a pack store, linen store . . . a Russian bath.”18 It was, in a very short time, a small town and photographs soon arrived home as a testament to the money being well spent. All this is so detailed that I can imagine Christopherson, this stocky energetic man, dashing around helping to erect tents for the first night and later organizing equipment for the operating theatre. He relished a challenge. As the unnamed ‘medical correspondent’ in The Graphic of April 1900 wrote: “The whole of the staff, medical officers included, have worked with an amount of energy which would have gladdened the hearts of those at home, who may be inclined to think that a medical man is never in his element unless he is clothed in the regulation frock coat and top hat.”

After Mafeking The besieged town of Mafeking, which lies about 360 miles north of Deelfontein, was relieved on 18 May that summer of 1900. The very first train to reach Mafeking, on 22 May, once the line was restored, came from Bulawayo. Prof. John Chiene, a Scottish surgeon, was informed that he was the first man in from the south when he arrived there on 1 June.19 The railway from De Aar to Mafeking was not usable until

18

Ibid. p. 153. Professor John Chiene was one of the surgeons paid £5000 per annum by the Government when he went to S. Africa. He was not in Mafeking during the siege and I believe he worked in the Army General hospitals that were out there. E-mail from Peter Prime to author 23 June, 2007. 19

3.5. Operating theatre, IYH camp.

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12 June when finally a train chugged up the line to collect the wounded. It is likely that Christopherson was on this train and that this is where he and Dr. Chiene met. A Mauser bullet still testifies to their friendship.20 It had been cut in half lengthwise, joined end to end and inscribed: Mafeking 1900 Prof. St Chiene to JBC Boer Mauser Bullet fired during siege.

As further mark of Christopherson’s visit to Mafeking see the photograph below. Here the doctor is standing in front of St. Joseph’s convent, the damage done by 100 lb Boer shells clearly visible. He is accompanied by Sister Mary Patrick, the acting Mother superior and, some postulants who, as he noted on the back in his usual meticulous fashion, were ‘not there during the siege.’ The sisters’ tireless and brave efforts in nursing the wounded through the long days of the siege were recognized when the Mother Superior, Mother Teresa, later received the Royal Red Cross from Queen Victoria. The families home in England read a glowing report of the IYH camp diet featured in The Graphic dated September 22, 1900. The following is one soldier’s story: . . . they packed some dozen or so [of us] down here to Deelfontein, much to our delight. This camp and hospital, you must understand, is organized especially for the Yeomanry, and splendidly it has been carried out, everything is tip top, the grub particularly. My diet sheet for to-day consists of:—Breakfast: Porridge, coffee, bread, butter, and jam. Lunch: Mellin’s food or Benger’s food21, and 4 oz of port wine. Dinner: Chicken (tinned), potatoes, rice pudding, bread. At 4: Extras, beef tea, milk pudding. Tea: tea, toast, butter, and jam. Supper: Soup mince, arrowroot, and milk pudding. Besides which we have a big jug of fresh milk, a can of condensed milk, a tin of cocoa and another of Benger’s food, together with soda water and lime juice, given out to the tent daily. Every tent is supplied with a small oil stove on which we cook our extras. Lady Chesham comes round every other day with tobacco, cigarettes, cigars, (all good quality), daily papers, note-paper, &c. For recreation there is a well-stocked library, cricket, football, concerts. Every evening church service.22

20

In the possession of the author. These were foods for babies or invalids, generally powdered versions that could be mixed with milk and fortified with vitamins. 22 The Graphic. September 22, 1900. 21

3.6. JBC at the convent, Mafeking. Note damage by a 100 lb Boer shell.

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Despite the soldier’s enthusiasm, to someone looking back from the twenty-first century one glaring omission strikes immediately—there was neither fruit nor vegetables. This was explained to me later upon reading in Guy’s Hospital Gazette that “Fruit and fresh vegetables except potatoes and onions, are absolutely unobtainable.”23 The lime-juice is a mere nod in that direction and probably helped prevent scurvy, yet the young soldier who wrote this piece seems more than happy with his lot.

The Royal Commission In 1901 the Report of the Royal Commission was published24 with its: Appendix to the Minutes of Evidence taken before the Royal Commission appointed to consider and report upon the Care and Treatment of the Sick and Wounded during the South African Campaign 1901.

The six inspectors had interviewed several hundred men and women each with some involvement with the South African hospitals. Physicians, orderlies, nurses, patients and even visitors were questioned in detail and each question and answer was transcribed for the report. Letters of complaint were examined and the writers or recipients interviewed. The committee chased down what might now be referred to as urban myths to discover any possible validity. Eventually they pronounced the medical establishments, although certainly having some problems, as having done an excellent job. Their insights and recommendations would serve, they hoped, for the future. The hospital at Deelfontein, enjoying as it did a budget far in excess of any other hospital, had not a single complaint. Typical responses consisted of “Splendid” and “A palace.” Christopherson was not among those questioned when the Commission arrived at Deelfontein on 30 August, 1900. He was there though, taking snapshots with his Kodak box camera. A photo of five members of the Commission shows Col. Sloggett, commandant of this hospital,

23 Letter from Dr. Alfred Fripp in Guy’s Hospital Gazette, 23 June 1900 p. 304. Courtesy Peter Prime. 24 Report of Commission, Op. Cit.

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on the left. Most figures in the snap-shots are identified on the back—a Mr. Cummings was carefully noted on the back as ‘not there.’ The most interesting photo shows a patient being interviewed, in bed out in the open, probably so he could answer privately and candidly. Sir David Richmond is at the bedside sporting the requisite grey top hat.25 Presumably no one thought it a trifle ridiculous to see a senior physician wear a grey top hat, something more usually seen at weddings and funerals, and sitting on a small bentwood chair in the middle of the South African veldt. This photo is annotated in detail on the back. Cruickshank. ILH [Imperial Light Horse] being examined by Insp. Commissioners (Dr. Church on left), Sir David Richmond on Rt. and reporter taking notes on left. Cruickshank, a patient of mine was at Eland slaagte [sic]26 And thro the siege of Ladysmith and was wounded through knee at relief of Mafeking. JBC.

Cruickshank, having complained of his earlier treatment at Mafeking, says of the treatment at the IYH: “The medical treatment has been splendid, and we have been nursed splendidly. It could not have been better.”27 The photo taken of the Commission interviewing the patient turned out to be a portent of the future when Christopherson himself would be doing the same job—Secretary to The Commission on Medical Establishments in France in the First World War. The South African Commission had five stenographers; in 1917 Christopherson was not so fortunate and had a frustrating time trying to obtain stenographic help as will be seen from the story of his experiences in Chapter ten. The Camp Commandant, Colonel Sloggett, was also questioned by the Commission; he gave a thoughtful, but guarded account of the needs of physicians and patients. Naturally he thought that doctors serving in the field or at stationary hospitals should have better pay

25

Ex. Lord Provost of Glasgow and Deputy Lieutenant of the County. Elandslaagte “normally written as one word but he has written it as two. The action was fought on 21 October, 1899 to clear the Boers (Kock’s Commando) out of the station which they [were] occupying and where they had cut the railway and telegraph lines. We won but suffered heavy casualties and shortly afterwards withdrew into Ladysmith.” Note from Colonel Iain Swinnerton to author. 17 February, 2005. 27 Commission Report Section B. 26

3.7. Patient Cruickshank being questioned by the Commission.

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and more chance to spend time at home for advanced medical study. He also suggested a need for more nursing personnel. Two other names among the dozen or so interviewed stood out: Dr. John Chiene, already mentioned, and Rudyard Kipling. Dr. Chiene was a distinguished surgeon; his word carried weight although he freely admitted this was the first war situation he had ever been in.28 In general he thought that the hospitals and ambulances were well run. He had concerns that the ambulance trains had too few medical staff and that critically ill men were often transported without food for many hours. He felt that food at the stations was not to be trusted and suggested that small stoves for making beef tea should be procured and put on the trains.

Rudyard Kipling Is Interviewed Although he had not visited Deelfontein, Rudyard Kipling, poet and patriotic voice of the British colonials, had a great deal to say about hospitals in general and offered his own frank opinions. For instance, he said that he had asked the doctors what they needed and was informed that the hospitals at that time were not full and that they had everything needed. He then asked the nurses, and a different story emerged. ‘We want pyjamas very badly, only do not bring them to the Store Issue Department because they’ll never come out. Bring them to the back door.’ So on one particular occasion I got 98 pairs of pyjamas, loaded them onto a Cape cart and went to the back entrance of the hospital and gave them over quietly to the nurses and they were all taken. Then I went to another hospital, and asked the same question, and received practically the same answer, that it was not any good taking them to the officials, but that, if I would quietly bring them to the back door they could take them—pyjamas and pillow-slips—because the nurses said there was a difficulty in getting either pillow-slips or pyjamas. I also put the same question and received the same answer from the nurses of the hospital train, and I sent down a lot of pyjamas to them. Those were the hospitals in February, before there was any strain, [overload of patients and work]

28 Chiene, John, C.B. 1900: LL.D. D.Bc. M.D., F.R.C.S., F.R.S. (Edin.): Consulting Surgeon to H.M.’s Forces in South Africa 1900. Prof. of Surgery, Edinburgh University. 1882–1909. b 1843. d. 1923.

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and the doctors gave me to understand that there was nothing that they needed at all. They were exceedingly well pleased with themselves.29

Kipling also learned that there was a shortage of various drugs. He made arrangements for these to be bought and delivered explaining: This was around February or early in March . . . They were willing to take things privately. I also sent privately: there was no acknowledgment and none was desired, of course. The general impression was that things were better managed if they were given privately to the people who would distribute them.30

To the question: “If you had given the things openly into the stores what would have happened?” He replied: “I should have got the people into trouble, I think.” Kipling did have praise for the ambulance trains and many of the medical staff but he described the hospital at Woodstock, with two words: ‘it stank.’ As usual, bureaucratic red tape and a reluctance to admit inefficiency were major problems and questions were asked in parliament. The IYH emerged the preferred hospital.

Christopherson’s Year at the Camp Christopherson is listed in The Times as leaving South Africa on 31 October, 1900 on The Scot bound for Southampton. His contract, unless terminated early and nothing has surfaced that would suggest this, was therefore for about nine months. Some hospital staff came to the end of their contracts with Lady Chesham’s committee by April of the following year, 1901, when they returned to Britain. About this time the hospital became known as No. 21 General Hospital with Colonel Sloggett remaining in charge.31 If photographs are any indication, Christopherson does seem to have enjoyed his time at the IYH. His nephew owned a china dinner plate with the Imperial Yeomanry badge and the words “The Deelfontein Plate, Aug. 22nd 1900. Winner ‘The Widow’ ridden by J.B.

29 Appendix to the Minutes of Evidence taken before the Royal Commission appointed to consider and report upon the Care and Treatment of the Sick and Wounded during the South African Campaign 1901: p. 121. 30 Ibid. p. 121. 31 Sloggett, Lt. Col. Arthur Thomas. (1857–1929)

3.8. The ‘Deelfontein Plate’.

3.9. JBC on the winning horse, ‘The Widow’.

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Christopherson.” The ‘Deelfontein Plate’ so called, was presumably a little joke.32 He did mention on the back of a group photo taken at a concert in August, that he was not present due to his ‘accident.’ Perhaps this was a riding accident right at the end of August? There are a few snapshots, some taken by him and others showing him on a horse, probably taken by his groom. This camp was a magical place, resplendent with more than the comforts of most homes. Few of the patients would have lived at home using monogrammed glass and china. Further, had they been in England from October to March they would have endured the early darkness of dank, rainy evenings. South Africa in October enjoyed a glorious spring with flowers cloaking the veldt. War was not entirely hell—at least at the IYH. In contrast, elsewhere in South Africa the British were instituting the first well-documented concentration camps and a scorched-earth policy against the Boers. Thousands of women and children died of starvation and of epidemic typhoid in these camps. The British efforts to paint the map with more and more splodges of red, singing such stirring and jingoistic hymns as “Land of hope and glory, mother of the free . . .” while trampling over the ‘natives,’ was not seen as ridiculous or hypocritical in Victoria’s reign. In the Deelfontein village-like camp the staff tents had their inhabitant’s names carefully painted on boards out front. Christopherson took a snapshot of surgeon Ballance sitting in front of his, as he cured a springbok skin; another skin hangs on a line in the background so certainly riding and shooting were recreations when time permitted.33 One fine posed photo “my Typhoid convalescents, Sept. 1, 1900”— shows patients and staff in front of their hut; a list of names is on the back.

X-Ray Stories Two more photos in Christopherson’s collection now in my possession appear to have been professionally taken—the X-ray (Röentgen) room

32

This plate was generously given to me by Dr. T. Peter Ormerod. Mr. Hamilton A. Ballance, [later Sir] Assistant Surgeon to the Norfolk and Norwich Hospital. 33

3.10. JBC on R & Surgeon Ballance.

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3.11. JBC’s convalescent Typhoid patients.

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and the operating theatre. Recently I learned more about the camp’s X-ray equipment. Dr. John F. Hall-Edwards, the radiologist, published a paper in The Lancet in June of 1901. “. . . I had already formed some ideas to the extent to which my specialty might be of service, but my wildest anticipations were exceeded . . .”34 He used this paper as a plea for training X-ray physicians as specialists. He warned that laymen were not up to the work, leaving a number of machines idle with no one competent to operate them. “There is no position of the body in which a bullet cannot be found..[the patient] runs no risk of infection from dirty probes and the results are absolute.”35 The Lancet article finishes with a mention that the other surgeons in the camp, Fripp, Johnson, Ballance, Turner and Parker “admit that some of the best surgery was the outcome of work done [in the X-ray department].” Unfortunately the X-ray equipment at the IYH had remained underused until a young English convalescent, Charles Fry, answered the call for an electrical engineer. Fry had qualified as an electrical engineer in England and then enlisted in the Imperial Yeomanry. He had not been injured in battle but as a result of being thrown from his horse in November 1899. He had been puzzled that although the wards were wired for electricity, orderlies lit oil lamps in the camp every night. The X-ray equipment functioned only with batteries which had to be constantly recharged, a time-consuming proposition as they had to be transported to De Aar for this procedure, a train journey of fifty miles down the line from Deelfontein. According to Fry’s daughter who now lives in South Africa. Fry and a friend, Pat Foley, were able not only to restore the electrical system, but also to keep the generator in working order so batteries were no longer required. The day the whole camp burst into light confirmed Fry’s worth. He was promoted by Colonel Sloggett to Chief Electrical Engineer and stayed in that job until 1903. Sadly, in 1901 little was known about the dangers of radiation. Dr. Hall-Edwards suffered such severe radiation burns from the Röntgen rays that after much agonizing pain he agreed to the amputation of

34 Hall-Edwards, J. The Roentgen Rays in South Africa. The Lancet (22 June, 1901), p. 1755. 35 Ibid. p. 1756.

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his right hand.36 Later, upon being invalided home, the fingers of his left hand were also amputated. In fact his right hand remains in a jar in a laboratory in Birmingham!37 As recounted much later: “By sheer good fortune Charles Fry was not exposed to the deadly rays, [he had spent most of his time in the dark room developing the plates] and lived on into his nineties, his career as an engineer greatly aided by the testimonial Colonel Sloggett gave him when he left Deelfontein.’38

The Curzon Legacy in Print Lady Georgiana’s editing of the three-volume history of her hospital, with excellent photographs, all attest to the glory of this wonderland in the veldt. The books themselves, quarto in size are beautifully bound and embossed in gold with the Prince of Wales’s three feathers on the red and purple covers. She was meticulous, and doubtless also believed a picture to be worth at least a thousand words as it is well illustrated. Inside one volume is a handsome portrait of the author, Lady Curzon, with her tiny, corseted waist and pearl choker necklace, looking for all the world like England’s future Queen Alexandra. Many of those who had been on-site wrote impressively detailed reports. Operations are written up. Many of the surgical cases arose from wounds caused by Mauser bullets, like the one that Prof. Chiene gave Christopherson. The bearers are listed by name along with the dates they arrived and left. Tables and appendices abound, enough for any medical statistician to do substantial analyses.

A Conclusion in Spite of the Original Question Why did Christopherson leave at the end of October 1900 having served only nine months? Did he have a contract for this specified period? Had he promised to go back and fulfill an obligation at the Seamen’s

36 Dr. Hall Edwards also served as camp censor, censoring mail leaving South Africa. Information courtesy of Peter Prime, 17 June, 2007. 37 Dr. Robert Arnott, Sub-Dean of Medicine, University of Birmingham UK. Letter to the author 24 Feb. 2005. 38 T & D. Shearing, The Brave Boer Boy and other stories. Cape Commando Series No. 4. S. A. 2002.

3.12. IYH. X-Ray Room.

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hospital. These details have not come to light. His leaving for England was just prior to a hectic and dangerous time at the camp although no one could have known it. In December 1900 the Cape Colony was invaded by the Boers and “. . . Deelfontein hospital became the centre of hostilities. Many sick and wounded (including a number of surgical cases) were received from the columns operating in the surrounding district.”39 Christopherson’s family must have been relieved he was not there at the time. He is listed in The Times as sailing for home on The Scot arriving at Southampton on 16 November. All efforts to unearth letters or stories that might mention Christopherson during his training or his year in South Africa have drawn a blank. Names of other surgeons, of Colonel Sloggett himself, have been searched for papers that would shed light, but without success. Exhaustive efforts have failed to find Lady Curzon’s (later Countess Howe) diaries, letters, or hospital notes. Nothing has been found to explain Sir Reginald Wingate’s troubling line written seven years later, in 1908 when Christopherson had already been in Sudan for seven years. From the many letters Christopherson wrote later, we know him to be sincerely religious, not that this quality ever stopped someone from behaving inconsiderately, but in his case there are hundreds of letters demonstrating his concern for others—his family and his patients. His letters reveal him to be impatient with those he perceives as foolish or not living up to his standards but nevertheless generous of heart when help or praise was indicated. None of these point to serious misdeeds. I conclude that academic gossip or colonial spite was at the root of these negative allegations which did not surface until eight years had passed.

And Now . . . In 2003 I rode the train from Johannesburg to Cape Town with the idea of seeing the land and in particular the junction at De Aar and the area at Deelfontein, a few miles south of the hospital site. Regrettably I learned too late that the train, on both north and south journeys passes through this area around midnight. There was nothing to see but a brilliantly clear, star-studded sky. By day the veldt, known as the Karoo,

39

Watt, Op. cit., p. 153.

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showed itself, as the train rattled on for twenty-four hours, through a great desert of rock and sparse vegetation, although everyone said “Ah but wait until spring!” South Africans tell me that this is a great sheep-ranching country but I could count any animals seen from the train on the fingers of one hand. After the long twenty-four hour journey I was not much the wiser about the setting of this huge military camp hospital so I must rely on historian Steven Watt, who has written extensively on the Boer War hospitals, going back to visit this particular site in 1999. He found the buildings gone, the cemetery only occasionally looked after by the local Rotary Club. Thousands of people had lived and worked there. Some died there. Arriving in 1900 and disappearing less than three years later, were tents, wooden huts, water and sewage systems and roads. In 1999, a few sheep grazing on the veldt remained the only visible living creatures. Above and behind the old campsite, Watt could just make out large letters carved into the hillside—I Y H.

CHAPTER FOUR

SUDAN 1902–3: SMALLPOX DELIVERS BOTH FEAR AND OPPORTUNITY

After a two-week incubation period, smallpox racked the body with high fever, headache, backache, and nausea, and then peppered the face, trunk, limbs, mouth, and throat with hideous, pus-filled boils. Patients with the infection were in agony—their skin felt as if it was being consumed by fire, and although they were tormented by thirst, lesions in the mouth and throat made it excruciating to swallow.1 So wrote Jonathan Tucker in his book Scourge—a description both alarming and nauseating.

Khartoum in Early 1902 January 1902 found Christopherson in Sudan. It is not known whether he volunteered to go there or was invited. Doubtless he saw the opportunity to work in Africa as exciting and a chance really to make a difference, to help ‘civilize’ the indigenous population, and to enhance the Empire. For physicians there was even more; there was a host of possibilities in ‘new’ diseases and their vectors to be conquered, and there were reputations to be made. In 1902 Dr. J.B. Christopherson was a mature man of thirty-four and single, as were most of the first men to go out.2 He would have known about Jenner’s work on smallpox and that variolation (The obsolete process of inoculating a susceptible person with material from a vesicle of a patient with smallpox)3 was considered dangerous. He already had some experience of tropical medicine and of surgery from his years at the Seamen’s Hospital, and from his service in the Boer War. As is noted in a number of texts

1 Jonathan B. Tucker. Scourge: The Once and Future Threat of Smallpox. (New York. Atlantic Monthly Press. 2001), p. 2. 2 In fact marriage was forbidden for the first five years of service. 3 Stedman’s Medical Dictionary (27th Ed.), 1931.

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he was the first, and for some time the only, fully qualified surgeon in Sudan with FRCP and FRCS after his name.4 The Anglo-Egyptian Condominium felt fortunate to have such a man, and Christopherson, in spite of the difficult and often Spartan conditions, enthusiastically enjoyed his work. In the first years of British rule, the need to get the job done meant that protocol and hierarchy were not as rigidly enforced as they would be later.5 The immediate circumstances of everyday living, complicated with obstacles of language, religion, climate, and customs, were first to be addressed. As a later Governor-General of Sudan wrote: “Among the British, every one in the country knew the idiosyncrasies of every one else. Conflicts of individual opinions and partisanship let to occasional bickering, which were kept inside the ‘family circle’ and mitigated by a sense of common endeavour.”6 Khartoum, as described by Edward Fothergill, who went out in 1901 as a soldier with the Egyptian army, was not much of a place. His book, Five Years in the Sudan,7 documents his hunting exploits (he seems to have shot, then photographed every creature that moved), but he writes of Khartoum and Omdurman much as Christopherson would have found them a few months later. . . . as far as I could see the town [Khartoum] consisted of a large white, and somewhat lonely-looking palace; the famous Gordon College, [under construction] then a few feet above the ground, and a dingy block of buildings standing some way back from the river in an evidently unfinished condition. . . . To my north there spread a limitless sea of sand, the shining lines of steel which marked the track of the railway, and the telegraph poles running at its side alone hinting at the presence of western civilization . . . Omdurman, on the other hand . . . was infinitely more interesting, by reason of the teeming native element which thronged its streets and markets.8

4

FRCP—Fellow of the Royal College of Physicians; FRCS—Fellow of the Royal College of Surgeons. 5 This fact has been noted by many historians. It was the same in India. During the eighteenth century British men often adopted local costume, married Indian women, sired children and remembered them in their wills. Some even embraced the Muslim faith. It was only when British women started going out that the colour bar came seriously into play. 6 Sir Stewart Symes, Governor-General of Sudan. (1934–40) Tour of Duty. (London: Collins. 1946), p. 14. 7 Edward Fothergill. Five Years in the Sudan. (London: Hurst and Blackett. 1910), p. 1. 8 Ibid., p. 4.

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It was in Omdurman in January of 1902 that Christopherson lived in the old Abdin mess, formerly the house of the late Khalifa’s son, near the military hospital.9

Hospital Work in Early 1903 Christopherson’s two diaries from those first months—his only diaries found—show how he and others spent their long days in the Khartoum Civil Hospital, a very primitive, thirty-bed mud-brick building. Here they undertook both medical and surgical work coping with a particularly makeshift situation: “All cases after dressing wrapped in towel in order to keep wound off dirty sheets and blankets.”10 In January he wrote of getting permission to draw the sum of five pounds for a door to the operating theatre, windows with glass for the door, and methylated spirit and gauze which could be bought in the Souk (market). His diary for January 20th has one page with the following: This is my routine. 7.– 8.15 a.m. Civil Hosp. Dressings 9.15 – 11 or 11.30 a.m. Military Hosp. 11.30 – 1 Civil Hosp. Seeing new cases. Doing any business. Mondays, Thursdays 2–3 p.m. Operations at Civil. After Dinner Evening round at Civil: Visit Military at odd times for ops and serious cases.11

He turned his hand to anything and everything. In his diary he noted that he had written to the friends of one patient to say the man was seriously ill and had diarrhoea. Then he notes: “He is a black prisoner

9 In August 1915 Christopherson wrote a letter to Wingate telling him of the death of George W. Anderson who had been Director of Stores, Egyptian Army. “I send you these details because although unimportant in themselves, I think you will like to hear them from a friend who was with him to within a short time of his death and I know that you always had great regard for Anderson and will probably miss him very much. Of course he was older than most people out here, 60 or thereabouts, and he had lately been suffering from symptoms of arterial degeneration, attacks of headache and high tensioned vessels. I do not think that anybody ever crowded more work into 60 years than he did and I suppose a good deal of the work of his younger days involved the machine in much ware and tare [sic]. Personally I am very, very sorry to lose him as a friend—he was one of the first men I knew when I came out over 13 years ago, we both lived in the old Abdin Mess then.” SAD 15/7/121. 10 SAD 400/5/18. 11 SAD 406/5/209.

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whom I removed from the prison into a comfortable bed and sheets. He was lying on a hard cement floor with only a blanket under him.” Later he added: “the patient died a month later.” On 9th February he wrote in his diary: “Balfour [Dr. Andrew Balfour, Director of the newly established Wellcome Laboratory on the Nile] visited and saw me dress cases.” Other notes document a cataract operation, then “a skin graft on large raw surface on outer aspect upper part of Rt. leg of man from whom I had removed Mycetomatous growth.” Next: Woman on whom I was going to do plastic op. on bitten off 1/2 nose was walking to theatre when she saw old lady who had been operated on for cataract lying on stretcher outside theatre, thinking she was dead ran away screaming and wanted to get out of hospital, she was run to earth within hospital hoch [yard] and I found her clinging to M[edical] C[orps] orderly’s leg. Taken back to ward and talked to by Hakeema.12

In early February he wrote to his superiors asking for a small increase of pay for some of his local hospital staff who had had over four years’ service “and on account of the hardness of the work” but this was turned down with only a recommendation that the PMO should consider it in the 1904 budget.13 In mid February he comments on the problem of attending Muslim women. Hassan Bey . . . took his mother from hospital because the mother was wringing her hands all day long. Hassan effendi attends them outside. It is the women who are so prejudiced against the hospital, coming into the hospital is equivalent of stepping into the grave they accompany the patient in in crowds and sit round his bed silently as if to be ready to start lamentations the moment he dies even if he has only lumbago and they never cease wringing their hands & imploring every one to get them out of hospital as if . . . they were in condemned cell under sentence of death.14 There is absolutely no method in the working of the hospital. Men, women and children tumble in at all times, none are examined, no system, all want a drink of medicine, no sofa to see a patient lying down. Quite content with a bottle of medicine. It is waste of medicine and time giving bandages and medicine which . . . cannot be intelligently used. We want

12 13 14

SAD 406/5/28. PMO Principal Medical Officer. SAD 406/5/30.

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a nurse for O.P. [Out Patients] to dress the cases. What is the good of giving lotions for eyes to be used at home?15

The work was becoming more arduous and on 14 March Christopherson wrote in the diary that he had been asking for more orderlies. “I have 37 patients, 5 Wards, Office, Kitchen, Stores, Transport, Khartoum Messenger, Tailor to provide for and only 10 men.” He complained that he wanted hands-on men but was sent two “ugly looking blackguards, useless.” He spent a good deal of time trying to get better food and other items for his hospital. Vegetables have not been considered a priority and he hoped for some variety. Back came a reply “Egyptian officers do not care much about vegetables . . .” His diary records that he operated nearly every day. On 19th February he noted with some pride that Sir Reginald Wingate (the Sirdar), Lady Wingate, Mrs. Balfour and others visited his hospital and were pleased with what they saw. “Sirdar says he has never seen the hospital looking better.”16 Yet it was far from the standards of a British hospital. The mountain of work under trying conditions was making him frustrated and irritable—and then, during that suffocatingly hot summer, something erupted that everyone dreaded and feared: smallpox appeared in the crowded native town of Omdurman. Given that this menace swept through Sudan every few years, it should not have been a surprise but somehow it was always received with shock.

Smallpox—Some Definitions and a Brief History First, some clarifications of words linked to any discussion of smallpox and the various attempts to prevent it: Variola—synonym for human smallpox. Variolation—The obsolete process of inoculating a susceptible person with material from a vesicle of a patient with smallpox.17

15 16 17

SAD 406/5/31 Diary. 10 February, 1903. SAD 406/5/161. Stedman’s Medical Dictionary. (27th Ed.), 1931.

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4.1. Original Hospital, Khartoum, 1905. Dr. Zaki on JBC’s R.

Inoculate—To introduce the agent of a disease into the subcutaneous tissue or a blood vessel, or through an abraded or absorbing surface for preventive, curative, or experimental purposes.18 The word was in common medical use in the 17 th century, almost exclusively employed to describe the procedure associated with Lady Mary Wortley Montagu. This was also called variolation and was a mixed blessing as it involved inoculation with fluid obtained from the pox of someone who had suffered only mild smallpox.19 Many patients, after being infected with a full-blown case of smallpox after inoculation in this manner, died as a result.

18

Ibid., p. 904. Variolation does NOT imply the use of a rag. Note from Prof. P. Mazumdar 2 Oct. 2007. 19

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Vaccination—from vacca the Latin for a cow. Edward Jenner (1749– 1823) is credited with validating the folk belief that people who worked in dairies where cows were infected with cowpox, tended to catch the lesser illness that rendered them immune from smallpox. In 1796 Jenner used a kind of experiment that would never be permitted today. He took the fluid from a pox on the hand of a local milkmaid and scratched it on the arm of his gardener’s son. Later he scratched smallpox matter on the arm of this eight-year-old. The boy proved immune. Naturally this news caused a storm of protest from the variolators who charged good fees for their work. Jenner, treating his patients as experimental subjects, offered his vaccinations for nothing while adding to his successful list of experiments. These he published at his own expense in 1798 as Jenner’s Inquiry. Some have called it “the greatest experiment in the history of medicine.”20 As a consequence, “By 1801 [sixty-seven years before Christopherson was born] 100,000 people had been vaccinated in Britain . . . [and] in 1840 variolation was prohibited by act of parliament.”21

Smallpox in Sudan Africa, and Sudan in particular, had suffered epidemics of smallpox for generations: during the Madiyyah period (1885–1899) there had been five major epidemics, 1885, 1891, 1895 with less severe outbreaks in 1898 and 1900, all facilitated by the trans-desert trade routes and the pilgrimage routes to Mecca. What differentiated a major from a minor outbreak? I found an answer in Bayoumi’s book on the Sudan Medical Service: 1. A Major epidemic is an outbreak in which the number of annual notifications attains a peak of more than 1,000 cases and then returns to previous levels. 2. A minor epidemic is a similar outbreak but with the peak lying between 100 and 1,000 cases.22

20 Malcolm Beeson. “Smallpox—the last word.” In Family Tree Magazine. Vol. 19 No. 8. (June 200), p. 38. 21 Ibid., p. 38. 22 Ahmed Bayoumi, The History of Sudan Health Services. (Nairobi: Kenya Literature Bureau. 1979), p. 195.

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These definitions have many defects, in particular there is no suggestion that the statistics of ‘normal’ variability over the years before and after the identified epidemic are taken into account. Thus it would be possible, if the annual statistics are highly variable, for years or successions of years which meet the definition to be demonstrated equally easily to be random occurrences given the underlying statistics. The number of cases, twenty-three in the 1903 Omdurman outbreak, was so insignificantly small as to account for its not having been noted in print.23 This outbreak goes unmentioned in official histories, even Bell’s book on colonial medicine in Sudan ignores it,24 yet it was, perhaps, the most important of all. It is the first recorded instance, at least in Sudan, in which the likely spread of the disease to epidemic proportions was prevented by timely, intelligent and rigorous control measures.

Smallpox in the Summer of 1903 It was late July 1903 when the first case appeared in Omdurman. As Christopherson wrote in his detailed report “. . . on 30 July one of the learning barbers (sanitary) informed Eff. Zaki that his brother had smallpox.25 Shortly after, two more infected children arrived, and after confirming diagnoses, they were placed in a vacant hosh [courtyard enclosed by a residence].” Christopherson acted promptly. He knew how serious this could be and rose to the occasion. Within hours he had organized an isolation camp, telegraphed for tents and vaccine lymph from Khartoum, and arranged for a team of ghaffiers [guards] to be sent out to check systematically how far the infection had spread. The camp was indicated by yellow quarantine flags and guarded by six ghaffiers and a sheikh. The protocol for his staff was as follows: To see that everyone living in a particular hosh was present or sent for—to inspect every man, woman and child—to examine the arms, and if these were not satisfactorily marked, to have them sent up to the hospital for

23 The U of Durham, UK. Special collections, holds Christopherson’s report to Wingate in unpublished form. 24 Heather Bell. Frontiers of Medicine in the Anglo-Egyptian Sudan 1899–1940. (Oxford: OUP. 1999). 25 Eff. Effendi: formerly an honorific for a professional, an educated man; later, anyone educated.

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vaccination—to inspect the hosh, and burn any worthless rags or anything likely to be infected (destroying as little as possible, however)—to see that the well, earth hole and kitchen were in good order, and to tell the owner to have everything cleaned up and tidied by next day. To see the room lately occupied by the patient taking a rough note of articles left there, and to shut it up at once, and put a seal on it (which latter process was not done in some cases till 2 hours afterwards, in which case a ghaffier was placed on duty to prevent ingress and egress. The sealed-up room was then left to be dealt with later. Two ghaffiers were posted at doors of a hosh to ensure isolation.26

All this was accomplished in the first twenty-four hours. By 31st July more cases arrived and the drill was repeated. Detective work now came into play. Christopherson turned out to be an enthusiastic epidemiologist and he threw himself into this with speed and energy. These situations also depend on luck. Here luck appeared as he described: Just as I started Sheikh Issa said he had found out that a girl had arrived at the Workshops 10 days previously, had been too ill to proceed home to Old Omdurman that night, and had slept at the house of Hass Khater, (whose daughter Minnefalla was one of the cases admitted the day before, with Smallpox) and that he had sent to fetch the girl up to hospital . . . this was a most important capture, and what Sheik Issa said turned out to be true, and it meant that:—1. I know the source, and had secured it in hospital. 2. The smallpox had been imported and only a short time ago, so that it could not have spread much.27

As each new case appeared, the team, including Dr. Hassan Eff. Zaki and Hassan Eff. Lebib, went into action, isolating and cleaning and securing the hoshes.28 Each home's occupants were listed by name. Feeding people in isolation behind locked doors became a problem that had not been considered in that first frantic forty-eight hours. The team, accompanied by a handful of ghaffiers to enforce compliance had done their work and Christopherson wrote: I know because 3 days after when I was riding by I noticed a door opened very cautiously and a pinched, timid face squeezed through as if it expected a severe blow from the ghaffier, and meekly said ‘Doctor, I am hungry’

26

SAD 407/1/3. Ibid., 407/1/3. 28 Dr. Zaki, (sometimes written, Zeki) was an Egyptian-trained physician who became both colleague and friend of Christopherson. Presumably the bond grew as they both battled the same enemy, smallpox. 27

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chapter four and then I realized the necessity of feeding people so isolated—they live from hand to mouth, and have no store at home.29

After a few days, he wrote, “when I was able to feed the people so shut up, dhurra [the local grain] was sent them.”30 Presumably, even after hours on his feet dealing with this potential epidemic, he found time to jot down notes, or perhaps he dictated them to an assistant. His twenty-seven page report complete with detailed map, reminiscent of the work of Dr. John Snow during the cholera epidemic in London in 1854, is a masterpiece of information. This report is not dry clinical information but an evocative piece of history which details the lives of these people in crisis—they have names and personalities. Of one house he says: This hosh [yard] was crowded out with pigeons, animals, and human beings. The infected room was fastened up, and Awad’s father was told to make the hosh clean and tidy. This man also between the shutting up and sealing managed to abstract things from the room, but as he was not meted out divine punishment, when he came to be disinfected the Inspector over-took him with human vengeance by rigorously saturating every possibly infected thing with Jeye’s Fluid—especially the pigeons.31

Co-operation is Required, and Fast Christopherson realized that even more draconian measures were needed given the movement of people, both working men and soldiers. He telegraphed the Senior Medical Officer, [SMO] Khartoum to report that there were now ten cases of smallpox and two suspected cases. He recommended all troops be kept in barracks and Omdurman placed out of bounds for Khartoum troops. Checking on numbers of people crossing to Halfaya, a town on the other side of the Blue Nile, from the infected quarter in Omdurman, he counted thirty-three workers every day and ninety-two on Saturdays. It being important to prevent smallpox invading Halfaya, with its Troops, Customs, Works, Market, and its Railway Station to carry infection North, and its Steamers to carry it along the Blue and White Niles—to say noth-

29 30 31

SAD 407/1/–. Ibid. 407/1/–. JBC’s Smallpox Report SAD 407/1/4.

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ing of its connection with Khartoum, I wrote to the Assistant Director of Steamers & Boats, to ask if he wouldn’t stop this traffic temporarily, and keep his workpeople over in Halfaya (August 4th). He replied that he had not sufficient accommodation nor money to build houses, so he did not see how it was possible to stop the traffic, although he was ready to help in any scheme to prevent the Smallpox spreading. On this I sent over the correspondence to the S.M.O District, who saw its importance, and on representing the matter to H.E. the Governor General the traffic stopped.32

Christopherson then gave the order: everyone who had died must be brought to the hospital so that they would not be buried without the doctor’s knowledge. One boat was found to carry a sailor with smallpox. Immediately the yellow fever flag was hoisted and the boat impounded, the crew remaining on board and with good reason—another sailor came down with smallpox twelve days later. Christopherson’s investigations required considerable questioning of people about where they had been and at what time, and with whom on previous days. Since he was not fluent in Arabic he must have had to go through the tiresome business of using an interpreter, perhaps Dr. Zaki or Dr. Lebib. In many cases clothes were burned, houses torn down, contaminated wells and dirty dung holes filled in. Anyone suspected of being exposed to infection was kept in isolation for a minimum of twelve days. (Osler, in his monumental compendium on the practice of medicine, 8th edition, 1916 recommends a minimum of sixteen days’ isolation). From then on, as the urgency decreased, Christopherson noted every day who was cured, who was out of danger, who had left the hospital, and finally, that the quarantined boat could be freed. In Part II of his report, now that the route of infection was clear, he traced the outbreak case by case in great detail. He summed up by saying: “So that [of] the 21 cases, although at first there seemed no relationship between any of them, all became connected—KANTOUSHA, the original source; MINNEFALLA and the WELL; and BEKHITA and the WEDDING playing important parts in the tragedy.”33

32 Ibid. p. 5. In fact Wingate was on home leave during the hot weather. Acting Gov. Gen. Nason Pasha was in charge. 33 Smallpox Report, Op. cit., p. 15.

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4.2. Smallpox Map drawn for JBC by Sergeant Laurie. (The numbers refer to the list of cases detailed in the full 26 page report held in the Sudan collection at Durham University).

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4.3. Ismail Aly, smallpox victim—a severe case.

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The Report and Reflections on the Summer of 1903 In Part III “General Remarks” Christopherson detailed and listed recommendations for the future. There are strong comments on what kinds of tents not to use, and why. One patient per tent amounted really to two people per tent as each patient required a relative to act as nurse and the bell tents were so small that the air became foul. Sudanese women were reluctant to be seen by unfamiliar men. For a sick female a female ‘nurse,’ preferably one already vaccinated, was seen as a major success factor. He suggested the need for “a separate Permanent Infectious Diseases Hospital for Omdurman in case of Smallpox, Cholera, Plague, or Measles,” and recommended the best place;34 the old 15th Barrack-rooms “just sufficiently far outside the limits of the town in the desert, to the West of the Zaptieh [police station],35 and separated by the prevailing wind . . . from the town. The walls are still standing and in good order, with a good well . . . and it would be capable of holding 30 or 40 patients quite close . . .”36 Others as well as Christopherson have noted that the Sudanese have great faith in the efficacy of vaccination against smallpox.37 Regrettably the earlier use of arm-to-arm inoculation had been popular with the result that many people had inadvertently become infected with syphilis or other pathogens. This, he felt, had accounted for infantile syphilis: “it is the commonest thing in the world to see infants brought up two months or six weeks after vaccination with secondary syphilis.” He finished by writing: There is a rule in the Regulations for the Civil Hospitals that only Medical Officers may select arms for vaccination. This is not observed. . . . whether you vaccinate with vaccinia or inoculate Syphilis or Sepsis, scars are produced, and my point is this—that those cases who took Smallpox and shew “good marks” of “vaccinaton” were really not vaccinated with vaccinia at all.38

34

Ibid., p. 16. Old word for Police station. Personal correspondence—Alsir Sidahmed. April, 2005. 36 SAD 407/1/16. 37 Bell, Op. cit., p. 25. 38 SAD 407/1/19. 35

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It is worth noting that no Europeans were infected in the 1903 outbreak, and few if any in Sudan contracted smallpox after 1903. One of the problems in the medical department was a shortage of reliable staff, as illustrated by a story in the 1903 Report. A ghaffier sent to guard a particular infected house was found to have let two people in who did not belong. This ghaffier had let them in because, he said, “he was only told to ‘let nobody out’.”39 Of concern also was not only a shortage of calf lymph but of the need to keep it in useable condition in the heat. There was no refrigeration at that time. The vaccine had to be imported from Egypt and the train journey across a thousand miles of burning desert meant that not all arrived in a usable state. Sunday had been established as vaccination day in Omdurman and was compulsory. There was good compliance by the people. “As a rule about 30 infants are brought up every week” Christopherson wrote in his Report. Part IV of his Report presented vaccination statistics: a clinical history of each patient, listed by name, and finally a statement of cost, based on twenty cases for sixty days.

And Credit Where Credit Was Due Here was a physician zealous in his work, concerned for his patients as fellow human beings and admiring of his Sudanese and Egyptian co-workers. He wanted to make sure that these men got the recognition they deserved: The Principal Medical Officer’s attention should be particularly drawn to the work of M.A. Hassan Eff. Zaki, and M.A. Hassan Eff. Lebib of the Civil Hospital. Although on paper there does not appear to have been a great amount of extra work, I can only say that there was: and these two Officers were for days on duty all day long, and the M.O. in charge worked them very hard all the time. Sergeant Laurie of the Zaptieh worked very hard indeed to stamp out the Smallpox.40 Whenever it was advisable to do anything, he always knew how it was to be done, and he saw that it was done at once and exactly. He was always there or thereabouts.41

39 40 41

SAD 407/1/8. Sergeant Laurie was responsible for drawing the detailed map on pages 108–09. Smallpox Report, Op. cit., p. 17.

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4.4. Hassan Eff. Zaki vaccinating.

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As a result of working so closely with Drs. Zaki and Lebib and others in such an intense situation a bond developed between Christopherson and his local colleagues. Unfortunately Christopherson’s fraternization with native/local medical men would shortly bring him into conflict with the Administration in Khartoum. Christopherson was justifiably proud of his effort. On 27 October 1903 a copy of the Report was sent to Lord Cromer, the Consul General in Egypt, along with a cover letter from Wingate: Dr. Christopherson’s energy and ability averted what might have been a very serious outbreak and the manner in which he and his small staff worked is deserving of great praise. To have defeated this epidemic at so small a cost and under such adverse circumstances reflect great credit on him. It is very satisfactory to see how fully the natives appreciated his efforts and his success in the present instance will greatly increase their confidence in his methods. If you will allow me I should like to convey to Dr. Christopherson some expression of appreciation of his efforts from you.42

He had earlier written to his mother back home in Falmouth that the Sirdar “thought so well of it that he sent it [the Report] on to Lord Cromer who is practically King of Egypt and Sudan.” The reply from Cromer to Wingate dated 5 February 1904, in the Christopherson file at Durham, is a copy annotated by Christopherson.43 Cromer wrote in old fashioned terms: “Pray thank Dr. Christopherson for his very interesting and valuable report . . . I do not doubt that it was mainly due to his skill and energy that the disease did not spread.” Cromer made three suggestions and against each suggestion was a note jotted in the margin in Christopherson’s hand: “I considered this . . . I suggested this . . . I made some observations on this point.” Whether Christopherson added these notes later, having seen trouble on the horizon and felt the need to ensure his medical reputation, or whether he wanted these for general posterity cannot be determined. It is known that at a later stage of his life he certainly felt beleaguered and likely wished he had kept more detailed notes in order to counter his adversaries’ accusations.

42

Wingate to Lord Cromer 27/10/1903 SAD 407/1/57. It would seem likely that the copy annotated by Christopherson was also a copy typed from the original by Christopherson himself as there are two words crossed out which would hardly be likely in a letter written by a secretary of Lord Cromer. 43

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Thirteen years after Christopherson’s encounter with the smallpox outbreak there was still no treatment, once infection had set in, other than palliative care. The standard medical reference, Osler’s Principles and Practices of Medicine’s smallpox entry read: “We have no specific treatment.” He advocated as an imperative “Segregation in special hospitals . . .” and then made a few suggestions: “There should be abundance of fresh air: the diet should be liquid and large amounts of water and cold drinks given. For vomiting, which is very difficult to check and may be uncontrollable, nothing should be given except a little ice and champagne . . .”44 Presumably this latter advice is aimed at the more affluent patient. In spite of a continued vaccination campaign Sudan suffered devastating epidemics even as recently as the 1950s and 1960s. Gerald Hartwig’s article points out that from 1951 to 1957 there were six epidemics.45 There were, at the low end, 346 cases and at the high end (in 1954/55) 4,200 cases. The mortality rate for these ran between 11.5 and 19.9 percent. In India smallpox was also a menace but western medicine had begun to be introduced, again to benefit the military, as early as 1600. Jennerian vaccination was introduced into India in 1802, almost exactly one hundred years before British doctors arrived and began vaccinating in Sudan.46 At least in Sudan there were not the problems faced by the Indian health authorities. Hindus refused lymph from their sacred cows, and earlier arm-to-arm inoculation across caste boundaries caused even more issues. India suffered from a lack of suitable isolation hospitals, and these were expensive to run; the need for separate blocks for Hindus and Mohammedans, and other accommodation for Europeans complicated plans. “Patients feared the possibility of contacting other disease and of violating a variety of cultural taboos—members of the ‘higher castes’ stood in danger of ‘losing caste’ by coming into contact with

44 William Osler. The Principles and Practices of Medicine 8th Ed. (New York: D. Appleton & Co. 1916), p. 324. 45 Gerald Hartwig, Smallpox in the Sudan. The sources for this Table, he wrote, are the Annual Reports, 1925–1958, of the Sudan Medical Service/Ministry of Health. 46 Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914. (Cambridge: Cambridge U. Press. 1994), p. 82.

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patients of the so-called lower castes.”47 Both Sudan and India ran into problems with the idea of instituting compulsory vaccination. In India, different provinces introduced compulsory vaccination in different years, starting with urban areas. As there was little enforcement, there was little effect, and rural vaccination efforts were hampered by ill-trained, and sometimes bogus, vaccinators. Sudan, at least in urban area of Khartoum and Omdurman (northern Sudan) made Sunday ‘vaccination day,’ given that smallpox was such a reoccurring scourge, the campaign was reasonably successful. Sudan still had issues of vaccination scars turning out to be scars resulting from sepsis as has been mentioned. India was noted in one recent monograph on smallpox in public health as being hampered by: “. . . interdepartmental and intradepartmental, rather than just racial tensions . . . ”48 Sudan, although certainly suffering from departmental quarrelling, was not so affected with regard to the smallpox issue. It is likely that Christopherson’s success had a salutary, temporary, effect on those in the Administration. It was not until May of 1980 that the World Health Organization, after a major effort world-wide, could announce that smallpox was completely eradicated. It is the only communicable disease of which this can be said. Their section on Sudan reads in part: “Sudan launched a WHO-assisted mass vaccination programme in 1962 with freeze-dried vaccine from the USSR . . . ”49 This achieved almost total success in the north and central areas of the country, but due to civil war in the south could not be attempted there. In 1968, the north again suffered from rising incidences of smallpox due to re-infection from the south and from Ethiopia. A break in civil disturbances in the south in 1972 allowed efforts to resume to vaccinate and isolate with the result that outbreaks were reduced to zero in November 1972. In 1981 Hartwig wrote of “a tedious record of repressive but effective quarantine stations and a mixture of useless and useful vaccines; and looming in the background was the basic issue of authority to control people’s lives, whether by vaccination or isolation; when com-

47 S. Bhattacharya, M. Harrison, & M. Worboys. Fractured States: Smallpox, Public Health and Vaccination Policy in British India 1800–1947. (New Delhi: Oriental Longman. 2005), p. 169. 48 Ibid., p. 145. 49 H. Mahler, The Global Eradication of Smallpox. Geneva: World Health Organization. 1980. 9.1.5.2.

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bating smallpox the Medical Service invoked authoritarian rules of warfare.”50 In Sudan, there was a ‘tedious record’ of authoritarian intervention in order to prevent more lives snuffed out by an agonizing and miserable death. Christopherson had anticipated everything Hartwig wrote and had no qualms on this account. Fighting disease is warfare. Fighting a disease that spreads like wildfire requires ‘authoritarian rules of warfare.’ Toronto, Canada discovered this necessity in the SARS episode in 2003. Rules for visiting patients and attending to patients were ‘repressive but effective’ and they were certainly tedious. Eventually the battle in Canada was won and deaths were few.

His Future Seemed Guaranteed Christopherson’s successful management of the outbreak of smallpox in July 1903 and his reputation as clinician and surgeon during these first few months, were noted by Wingate in his 1904 Egypt Report to the British government. Dr. Christopherson, on whom the brunt of the work fell, has written an interesting report on the subject. He commences by saying: ‘It is not an exaggeration to say that a properly vaccinated person cannot contract small-pox.’ . . . Dr. Christopherson then goes on to say that he does not think that ‘the decrease of small-pox in the Soudan during the last few years is to be attributed to vaccination. It is rather to be attributed to the protection afforded by previous outbreaks, the last of which, in 1899, was severe.” And “. . . all the medical authorities are agreed that, in view of the prevalence of communicable disease of various sorts in the Soudan, arm-to-arm vaccination is dangerous. It has, therefore been entirely prohibited.51

What is not noted, and this is curious as surely Christopherson, if not Wingate, must have known, that variolation was banned by an act of parliament in England back in 1840. Apparently this prohibition had not automatically extend to Sudan or other colonies. All this public approbation for the new doctor should have heralded a golden future. As it turned out he was soon to experience problems. 50 51

Hartwig, Op. cit., p. 6. SAD 407/3 pp. 93–94.

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Christopherson was in Sudan for the better part of eighteen years and during that time three major personal conflicts interfered with his career path. As will be seen, early in 1904 the first episode, initially set in motion by circumstances beyond his control, affected not just Christopherson but a number of other prominent people and by association, the entire Sudan Medical Department. Later conflicts during his African tenure can be directly attributed to personality problems, both his and those of some of his senior colleagues. As Wingate once wrote of Christopherson’s character: “I suppose it is a peculiarity of his nature and I am afraid that these defects, or whatever they may be called, had a good deal to say to his want of success . . .”52 In the end, all depends on whose story you choose to believe. How did he manage to the cross the line marking what was considered acceptable behaviour within the social order of the day? His iconoclastic moves (noted later on), using the best man for the job regardless of colour or rank, earned him a furious rebuke from the Sirdar’s secretary. What will be considered is how his occasionally determined personality exacerbated the situations in which he became embroiled. Attributes which might be considered admirable today were considered a betrayal of class in Wingate’s Sudan.

And in 2003 . . . During my brief visit to Khartoum in 2003, I asked for help in finding the descendents of Dr. Zaki. I had no success. Later I thought I had found a descendent of Dr. Ahmed Bayoumi, author of a book about the Sudan Medical Service, right here in a major Toronto hospital, but as usual this was too good to be true. The Toronto Dr. Bayoumi was no relation. Perhaps the name Ahmed Bayoumi is as commonly found in Sudan as the name Ann Harris is in the west.

52

Wingate to Dr. Acland 29 November, 1908. SAD 284/3/68.

CHAPTER FIVE

1904 AND THE APPOINTMENT BLUNDER

First there were the British, then God, then the rest of us. —René Malouf

Living Conditions in the First Few Years Christopherson, like most European doctors working in Sudan, was attached initially to the Egyptian Army where he was given the assimilated rank of Bimbashi, the equivalent of major.1 He worked at both civil hospitals, Omdurman and Khartoum, while living in Omdurman, a town noted by Major Penton, Principal Medical Officer (PMO) of the Egyptian Army Medical Corps (EAMC) in 1900, as ‘unfit for human habitation.’2 The first civil hospital in Khartoum was made of mud bricks and was used until 1909 when a new hospital was opened. This grander and more solid building was handy to a ferry, and later, a bridge across the Nile to Omdurman. Donkeys were for many years the only local transport and the hospital was a short walk or donkey ride to the Wellcome Lab. It must have looked rather odd to see stiffly dressed Englishmen in jackets and ties, astride such a small beast. The first car arrived in Sudan only in 1908 and was for the sole use of the Sirdar. Dr. John Bloss wrote a delightful description of this cumbersome vehicle as it was used for the 1912 royal visit. Their Majesties sat in the back with Lady Wingate, a board was put across their knees on which sat the ladies in waiting. The Sirdar rode on horseback beside the car, and the Admiral of the Fleet brought up the

1

This was the lowest military rank given to any European. Ali Bedri. D. Lavin. Ed. The Creation and Development of the Modern Medical and Health Services in the Sudan, in The Condominium Remembered Vol. 2. (Centre for Middle Eastern & Islamic Studies. 1982). 2

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5.1. JBC on a donkey, 1906.

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rear on a camel. Lord Kitchener was also present but did not join the procession because he refused to ride a donkey.3

In 2001, this car, looking more like a steam roller, could still be seen, parked in the courtyard of the Khalifa’s house in Omdurman, somewhat preserved by the dry desert air.

The First Civil Hospital in Khartoum The first civil hospital in Khartoum was primitive in the extreme and the staff struggled continuously against flies, dust and heat; yet it was all there was until the new building opened in 1909. Back in July of 1904 the Adjutant-General for the Egyptian Army, Sir G.C. Henry wrote to Wingate: Christopherson has written in—saying—(1) he does not think this present civil hospital suitable for following reasons (a) too far from the town to be of use (b) also too far to enable him to supervise properly (c) building not sanitary and not likely to be much so (d) too large for his requirements, he goes on to say that he hears that a sum of £E1000 has been allotted to be spent on this year and thus he feels very strongly that it would be wasted and that he is quite willing to go on as it is until your return . . .4

Getting a new hospital built when funds were short, and they were always short, was a major undertaking. Christopherson was sensibly thinking for the long term, and was more focused on hiring reliable, trained staff, especially nurses; and by nurses he meant trained at Barts or, at the very least, St. Thomas’s Hospital, London.

The Appointment Fiasco Life, despite its physical challenges, was looking up for Christopherson as a result of his success in halting the outbreak of smallpox. He could anticipate a satisfying career ahead. In fact he had written home to his mother about this saying: ‘I have had another little success,’ so that

3 J.F.E. Bloss, The Sudan: A Medical History. Unpublished manuscript c. 1955: 47. SAD 704/4/47. 4 Letter to Wingate from Henry. 15 July, 1904 SAD 275/5/19.

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although we don’t know any details, he obviously had reason to feel upbeat about his work in Khartoum. Unfortunately, in 1904 a bureaucratic blunder came to light, and one with very long-term consequences. What happened was as follows: J.B. Christopherson and Edward S. Crispin5—two eminently qualified physicians, both of whom had been working in Sudan for more than three years—were independently offered the position of Director of the about-to-be-formed, Medical Department of Sudan, and both accepted. How did the administration manage to permit this to occur? The person responsible was never identified but very likely it was Wingate. Both Crispin and Christopherson had had experience in the Boer War. Crispin had been a prisoner of the Boers and it was shortly after his release that he received a cable offering him a post in Sudan. Both arrived in Sudan in early 1902. Both were civilian doctors with assimilated (honorific) ranks in the Egyptian Army. Dr. H.C. Squires, author of, The Sudan Medical Service: An Experiment in Social Medicine, says that “at the same time that Dr. Crispin had been offered an appointment in Sudan through the Principal Medical Officer (P.M.O.) of the Egyptian Army, Dr. Acland had also been asked to select someone for the post.”6 It is likely that Acland, a “lifelong friend of Sir Reginald Wingate,” was asked to find someone and accordingly made the offer to Christopherson whom he knew and liked. If this was the case, and Christopherson was Acland’s chosen man, surely the odds were weighted in Christopherson’s favour from the beginning? It is not hard to picture the situation of these two doctors. Having been offered such an important post, they sent in their acceptances, and doubtless told their families and friends. They would have packed their bags and started turning over in their minds how they would carry out this new responsibility, only to find that there had been a serious error. There must also have been a period of days, perhaps a week or two, when things hung in the balance and the urgency for a final decision and consequent damage control became critical. During this anxious time each would have been in a state of professional limbo, consulting with well-meaning friends, listening to rumours, and waiting.

5

Edward. S. Crispin (1874–1957). Squires, H.C. The Sudan Medical Service: An experiment in Social Medicine. (London: Heinemann. 1958). 6

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On 1st January 1904 the Sudan Gazette announced Christopherson’s proposed appointment, adjusted to read, Senior Medical Inspector, rather that Director. Even so Crispin, reputedly furious, threatened to resign his present position and leave for home. Finally he agreed, under pressure, to be posted to Port Sudan with the lesser title of Medical Inspector. In 1905 Christopherson was appointed Acting Director, and soon, Director of the Sudan Medical Department. Dr. H.C. Squires, in his book, tried to put a good face on the story. Reporting the unvarnished truth had not yet come into vogue and he rightly sought to show the hard-won achievements of the medical personnel in Sudan. Squires, who knew both Christopherson and Crispin and was sympathetic to both, is circumspect.7 He later wrote privately to Dr. Richard Hill, founder of the Sudan archive in Durham University: “. . . I was very anxious that there should be some record of the SMS [Sudan Medical Service, as it was known by 1924] however inadequate and one that I hoped would not be too technical for the average reader. Yet I had, I felt, to skate warily over the trouble between Crispin and Christopherson. They were never reconciled.”8 Dr. John F.E. Bloss, in his unpublished manuscript, was even more careful, and vague: “In 1904 the Governor General formed a civil Sudan Medical Department and Christopherson was made Director. Crispin was persuaded not to resign and posted to Port Sudan . . .”9 This last sentence is one which a careful reader might hesitate over, thinking, ‘. . . why would Crispin resign, there is no reason even hinted at?’ Nevertheless, Bloss’s manuscript remains only a draft and some editor might have caught this before it went to press. Why were these two men at odds with one another, rather than with those who had made the error? Did Christopherson as the new director perhaps not treat Dr. Crispin as an equal? We only know that according to H.C. Squires “they were never reconciled”10 and that Christopherson wrote to his wife, years later: “Crispin was never a good friend.”11

7

Ibid. E-mail from Jane Hogan, 3 May, 2002, archivist for the Sudan Archive, Durham, quoting from Squires’s letter. 9 Bloss, Op. cit., p. 43. 10 Squires letter to Richard Hill 5 January, 1959. SAD files, no reference no. 11 JBC to Joyce C. 9 November, 1917. 8

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In the Foreword to Squires’s book Dr. Ali Bedri, Minister of Health, Khartoum 1948–52 dived right into the initial contretemps as though to clear the way for the rest of the story: . . . there was some confusion with regard to the position of two of the senior members of its staff and we are not quite clear as to how it came about. It is interesting now to read in this book an account of the interchange of posts at Headquarters between Crispin and Christopherson and how each of the two men succeeded to work most suited to him. This rectification resulted in giving the Sudan Medical Service the honour, due to the efforts of Dr. Christopherson in his capacity of a clinician, of introducing an effective treatment for bilharzia.12

Squires does not write about Christopherson’s being difficult. He simply acknowledges: “Almost immediately after my arrival [1908] a drastic reorganization took place within the Department. Colonel [H.B.] Mathias, who had succeeded as P.M.O. of the Egyptian Army, was appointed Director of the Medical Department and Crispin was brought up from Port Sudan to become Assistant Director.”13 As it turned out, the errors of 1904 were not entirely surmounted even by the 1909 shake-up. Resentment remained in the minds of several of the parties affected. The facts are glossed over in Squires’ version as are the consequences reputed to be so far-reaching. Squires writes, and it is possibly an understatement, “This confusion resulted in one of those situations which was destined to create tensions within the civilian medical service in the Sudan when it came to be formed, and which helped to give the other Government staff the impression that doctors found a difficulty in working amicably together.”14 Most published accounts would have one believe that a smooth and accommodating arrangement flowered from the beginning and that nothing more than a gentlemanly ‘after you George’ took place. Christopherson probably realized that from now on, as the victor, he would have to watch his back; people in small communities tend to pick sides with an eye to their own advantage.

12

Squires, Op. cit., p. v. Squires. Op. cit. p. 13. 14 Ali Bedri, foreword to H.C., Squires, The Sudan Medical Service: An Experiment on Social Medicine. (London: Heinemann. 1958), p. v. 13

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As the winner he remained firmly seated in Khartoum and Crispin was in a satellite situation at Port Sudan.15 No matter how important this job was dressed up to look, it must have been clear that this was an inducement to appease Crispin for not getting the position he really wanted. He would have good reason to resent, privately at least, serving under someone who had the job he felt he deserved. According to Martin Daly, appointing Christopherson as personal physician to His Excellency, Governor-General Wingate was a sop—an honorific only. Wingate’s old friend Acland, the physician who had treated him for typhoid back in 1883, was always the man in attendance to the Wingates.16 This notion is bolstered by letters extant in the Sudan archive in Durham showing Wingate addressing Acland as “My dear Theodore” and also the considerable evidence of social visits to one another’s homes in England. There is also documentation to the effect that Acland and Christopherson were on friendly terms, so there was no difficulty there. In March 1904, as the Sudan Medical Department came into being formally, the military administration was gradually being exchanged for a civilian one, although not fast enough for the civilians who frequently complained. Christopherson, proud and enthusiastic about his work and responsibilities, wrote a note to his old hospital, Barts, for inclusion in their journal. At that time Christopherson’s department had consisted of “. . . a St. Bartholomew’s man and Dr. Crispin of King’s College Hospital, nine or ten Egyptian and Syrian doctors, and a rudimentary staff of clerks and lesser employés for nine hospitals scattered about the Sudan.”17 By October of 1905 the department had grown to six British doctors, four of whom were Barts men, and twenty Egyptian and Syrian doctors, three pharmacists, a “headquarter staff of clerks at Khartoum and hospitals and staffs for twelve civil hospitals, “some of them good and some not quite so good, but all of them useful.”18

15 Martin Daly, Empire on the Nile: The Anglo-Egyptian Sudan, 1898–1934. (Cambridge: Cambridge U Press. 1986), p. 260 writes, “Christopherson is usually cited as the first director, but the first official to hold that title was C.D. Hunter Bey, appointed in March 1905.” 16 Ibid., p. 260. 17 J.B. Christopherson, Correspondence in St. Bartholomew’s Hospital Journal (October, 1906), p. 14. 18 JBC Letter to the Editor St. Bartholomew’s Hospital Journal (October 1906), p. 14.

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The following letter is more evidence of the trouble and tensions existing between the military and civil medical departments, trouble that likely simmered for at least three years. But by the summer of 1906, in the department, all appeared, on the surface at least, to be in good order again. On 14 September, 1907, Christopherson wrote to Wingate from 97 Gloucester Place, Portman Square:19 Dear Sir Reginald Wingate, I am sending you a letter underlined to save your time—from Nurse Moore.20 There are several things which will interest you—most of all you will be pleased to see evidence of the entente Cordiale between the two medical departments [Civil and Military]. I am sure that during this last year we have made considerable progress towards a Rapprochement—there are no difficulties in the way which cannot be removed.21

Regrettably the enclosed letter has not surfaced. Its existence would have helped clarify exactly what went wrong.

Administrative Failure Almost every historian writing about the difficult events in Khartoum of 1908–9 during Christopherson’s directorship of the Sudan Medical Department, says that his administrative tenure was a failure. In my first three years of research, I found nothing to explain this except one particularly damning letter, already mentioned, written by Wingate saying that the doctor “altogether failed to obtain the friendship or confidence of any of his Profession, including even . . . in his own Department.”22 This letter is seized upon by others and quoted more than once.23 When a single sentence is taken up and repeated, it is frequently the case that, as historian Linda Proud wrote; “characters are too often and simplistically tarred by traits that may have been

19 The house at 97 Gloucester Place was home to Dr. & Mrs. de Segundo, lifelong friends of the Christophersons. 20 Nurse Maria Pye Moore, first British nurse hired for the Civil Hospital, Khartoum. 21 SAD 281/3/90. 22 Wingate to Acland 29 Nov. 1908 SAD 284/11/2. 23 Bell, ftn. p. 24; Daly, p. 260 and Kenyon-unpublished manuscript, draft. p. 28.

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momentary in their lives . . . . facts should be facts, and not assertions that have gained authenticity by repetition . . .”24 I began to feel that Christopherson must have been unfairly targeted, perhaps as a result of his rather forthright manner of speech. I wondered if he had run a sloppy enterprise, but this notion did not seem to accord with his meticulous methods, such as the way he labelled his microscope with name and address and date of the person who gave it him, or the way so many of his photographs are annotated on the back. It had not occurred to me that the reverse might be closer to the truth and that he might have been seen as demanding and unbending until I read Edward Fothergill’s book Five Years in the Sudan.25 Here is an account of a patient’s experience in early 1910, in the new Khartoum Civil Hospital, a story that gives more than just a hint. Although civil servant Edward Fothergill avoided naming Christopherson, the dates and other details fit so perfectly that there can be no doubt he was writing about Christopherson. There was only one director of Khartoum Civil Hospital when it opened in 1909, he was British of course, and it is noted more than once that he had the best medical credentials of any of the British doctors at the time. This much is correct. He also thought of his hospital in Khartoum as ‘St. Bartholomew the Less,’ as he once wrote. In terms of his old alma mater, St. Bartholomew’s Hospital, London, is one of the oldest and probably the most famous in the world, whose clinical management he tried to emulate, no doubt for all the best reasons. Fothergill set the scene by explaining that one of the first governmental departments handed over to civil control was the medical department. A British doctor was put in charge, he wrote, who was “undoubtedly a very clever man at his work, and had taken the best degrees which it was possible for him to hold in his profession . . . ”26 Fothergill had earlier enjoyed an experience in military hospital in Omdurman and had never had the slightest cause for complaint: “At the first glimmer of dawn, tea, if one was allowed it . . . was brought in and one’s friends could visit one at whatever time was convenient to them, except, of course, when the doctor was in actual attendance.”

24

Linda Proud. “Truth is No Stranger to Fiction.” in History Today. (November 2004), p. 30. 25 Edward Fothergill. Five Years in the Sudan. (London: Hurst & Blackett. 1910). 26 Ibid., p. 253.

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Here was the rub, Fothergill had to wait hours for his early morning tea when at a later date he had the . . . ill-fortune to be sent to the new civil hospital at Khartoum . . . it was fitted with broad, cool verandahs, and the rooms were lofty and airy. Nevertheless I would much prefer to spend a week in the old hospital, under the old treatment, than a day and a night in the new, under the code of arrangements introduced, apparently, direct from some of the hospital wards of London. It was, perhaps, not entirely the doctors’ fault that everything they did seemed purposely designed to annoy one: they had come fresh into the country, carrying the lessons of hospital discipline they had learnt in London to the tropics of the Sudan, they did their best, but it was a bad best for the unfortunate patient who came under their charge . . . the sacred rules of the institution were not to be altered to suit the whim of a patient.27

The business of early morning tea was not Fothergill’s only complaint. Visiting hours were a sore point with him. At the old Omdurman hospital, friends could drop by almost any time; in the new hospital the afternoon was the only permissible time, something he claims was inconvenient for friends who would have to give up “. . . a game of polo, cricket, or tennis whereas they might have snatched a few minutes in the morning without any difficulty.”28 The pros and cons of open visiting hours versus prescribed visiting hours are as likely to be as contentious today as they were then. Christopherson’s nephew observed: We had the same problem in our Hospital about 10 years ago. Routine morning visiting made it impossible for the nursing staff (and doctors) to get through various things before the appropriate department shut down, etc. Obviously exceptions could be made and were made but morning visiting is a problem in a high volume/low staff set-ups. Down with Fothergill!! At least the visitors were not off to play polo.29

Fothergill did at least balance his outrage with admiration for the hardworking doctors who he claimed were adored by the Sudanese, and who put their complete trust in these Europeans believing the British would never lie to them.

27 28 29

Ibid., p. 254. Ibid., p. 256. E-mail to author from Dr. T. Peter Ormerod. 13 March, 2006.

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From Fothergill’s account, admittedly a man irritated by not getting what he wanted when he wanted it, I began to see that the department under Christopherson’s directorship may have been criticized because he did not bend to accommodate the local European custom. Some saw his running of the hospital as too rigid. Perhaps Christopherson and his chosen Barts nurse, Maria Pye Moore, together made an efficient, if formidable, team.30 There are instances to show that Christopherson’s sympathy and interest in his ‘native’ colleagues went against the grain with the European hierarchy. He tried unsuccessfully to obtain better pay not only for his English nurses but for the native nurses and his Sudanese servants as well. Budgets were tight and usually his requests were refused or put off. Fraternizing with ‘the natives’ no matter how well educated they might be, was frowned upon. Was this enough to damn him? Those Edwardians in Sudan and the colonies were, seen from our twentieth century perspectives, dyed-in-the-wool bigots. How could they not be? It would be a bold man or woman who tried to buck the system; the one or two who did, suffered the miseries of ostracization.31 There are more than two sides to this story. Christopherson had enemies as did others. He was stubborn and did not suffer fools gladly, although the few family members alive today, who remember him, believe that it was a case of ‘the good is oft interred with their bones.’ They saw him not just as a highly respected and kindly old uncle, but as the hero who saved millions from the scourge of bilharzia. Christopherson was not, as is sometimes intimated, a man without friends. A close examination of hundreds of letters (1904–1919) from his Sudan days identifies a half-dozen people who can be called adversaries and at least a dozen who can be characterized as close friends. Colleagues both black and white thought highly of him and enjoyed his company. Bishop Gwynne in his obituary of Christopherson wrote: “‘Christo,’ a name by which he is known by his many friends in Khartoum, was most popular with the Sudanese who worked with him in his researches,

30 On the other hand, seemingly geniune testimonials after Christopherson’s death show in all candidness how much his professional skill, and particularly his caring attitude to all patients, was appreciated. 31 See Anglo-Indian Attitudes: The Mind of the Indian Civil Service by Clive Dewey. (London: The Hambledon Press. 1993) and the novels of that Memsahib of the Raj, Maud Diver.

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but had little time for social life in the British community, by whom he was much admired . . .”32 I suggest that in a colonial world of convention and hierarchical etiquette, Christopherson stood apart. There is a hint in the Bishop’s kind comments that he did not quite fit. In the outposts of empire, the club, was the gathering place for Europeans when the sun went down. If one wanted to know who of one’s own social standing was in town, the club was where they could be found. It offered a sense of belonging. Sudan Club membership was restricted to senior British officials. Christopherson’s local doctors/colleagues were not permitted. Although the hospital matron was welcome, nurses could enjoy only the Khartoum club, one rank lower. There was a handful of other clubs as well, all founded and frequented by Syrians, Greeks and various other nationalities. As René Malouf, son of Christopherson’s Lebanese colleague Dr. Nikola Malouf, wrote to me about the Sudan Club: “The rest of us could only wonder!”33 Perhaps by not bothering with what seemed like hierarchical nonsense, Christopherson made himself an outsider? Anthropologist Susan Kenyon commented that in spite of the almost two decades he spent out there, his was a case that “remained shrouded in mystery”,34 and John Farley, the author of “Bilharzia” wrote, “he didn’t surface much.”35 Yet he published at least twenty-four papers and letters on the subject of bilharzia alone in professional journals, particularly the BMJ, The Lancet and the J. of Tropical Medicine. His ‘cure’ was used world-wide for over sixty years. Index Medicus shows, from the 1920s onward, under the heading of ‘Schistosomiasis—therapy,’ Antimony etc., dozens of citations over the ensuing years. One can say that in medical journals his name certainly existed. In many of the books of reminiscences written by those in Sudan in the first two decades, there is no sign of his name. If Christopherson had a difficult personality, he was not alone. The amiable Squires mentions two such. “. . . Dr. V.S. Hodson . . . came to the Sudan in 1903 and was incorporated in the new Department from its start. He was very quick and energetic and though kind-hearted and rather sensitive covered this with a brusque manner and a sharp tongue . . . He was a good tennis player and golfer and was generally 32 33 34 35

The Sudan Diocesan Review (Autumn 195), p. 26. E-mail communication to author 23 July, 2005. Kenyon, Op. cit., p. 1. John Farley, personal communication by e-mail, 4 May, 2002.

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5.2. Dr. Nicola K. Malouf, taken in Morhig’s studio, Khartoum.

popular except among those who braved his wrath.” And Dr. Laurence O’Shaughnessy, who went out a number of years later, was “. . . hardworking, persevering and extremely intelligent. He was apt to be off-hand and abrupt in his manner and did not suffer gladly those he considered fools. Consequently he made enemies but learning the hard

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way he gradually acquired a more tolerant and courteous attitude.”36 There is not one word about Christopherson’s being difficult, stubborn, or not getting along with colleagues.

Christopherson and Phipps—Initially so Friendly— so What Went Wrong? As late as the autumn of 1904 Christopherson and Civil Secretary P.R. Phipps appeared friendly, even jocular. Phipps, in a letter discussing enrolment and pay for candidates to go out to Sudan wrote asking Christopherson how he wished to be addressed. Christopherson replied enjoying being a bit playful: I have only one word of criticism with regard to your present method of addressing my letters. The “etceteras” are superfluous and do not add any dignity or distinction to the M.D. which is, was, and always will be the Hall Mark of high respectability in our profession. It entitles me to rank with all doctors of whatsoever professions up at Cambridge, and so I’m content. Now on purely academic grounds I think that it is not strictly correct to say. Smith Esq. M.D. All graduates rank as Esquire Ipso facto so that Esq. is included in the M.D . . . Now you ask how do I like to be addressed—I do not care two damns J.B. Christopherson. M.D. or J.B. Christopherson Esq. (a damn for each).37

He continued with business: Last Friday I went to Dedham to see the P.M.O. to lay before him a proposed scheme of classification and pay for doctors joining the S.M.D. of course one must be thought out and May [Major William. R.S.]38 and I collaborated before I left and drew up something which might be submitted to the Sirdar—it means offering better terms to native doctors, but the M[ilitary] C[ommand] is about at low water mark with regard to its native officers both in respect of quality and number, that some remedy must be found . . . [author’s italics] I wrote to the Sirdar the other day from Falmouth enclosing a letter wh. I had received from a dentist. We need a good dentist in the Sudan and I think that it would be as well to open the door a little and see who is this knocking. He is 41 yrs of age an L.D.S. (not L.S.D. you duffer—so

36 37 38

Squires, Op. cit., p. 52. JBC letter to Phipps. SAD 234/2/44. Assistant Financial Secretary to the Sudan Govt. and a good friend of JBC.

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don’t make that joke when you write to me).39 He is asthmatic and is ordered to a more salubrious climate than London.

He also suggested that a well-qualified young English doctor was needed as Resident M.O. Khartoum—he can get one for £420, and asks for an approved scheme of classification for rates of pay for officers in the SMD so he could tell people what the conditions of service are. He then threw in the request for a ‘decent translator’ and ended the letter “Best love to all your nephews and nieces, I have a lot too.” This is a cheery letter, a letter that suggests two colleagues are working together, joshing one another a bit, and there is not a hint of trouble. But trouble certainly came, so much so that it was Phipps, the eyes and ears of Wingate, who eventually attempted to ‘get rid of this man.’ It is possible that the sentence above in italics, and other similar ones, may have sown the original seeds of trouble. Christopherson needed his local colleagues; however, someone, perhaps Phipps, perhaps Wingate, was not interested in giving them more recognition, nor encouraging them to perform better by raising the rate of pay. Christopherson’s insistence in this area was likely an irritant. Major P.R. Phipps was the second most important person in Sudan and a close friend of General Wingate.40 He served in two capacities. In 1902 he acted as assistant civil secretary and at the end of that year “Wingate appointed him private secretary.”41 So far no concrete reason has come to light to explain why, in a few short years, Christopherson and Phipps came to dislike one another. Becoming an adversary of the man closest to the Sirdar was unfortunate, to say the least. Phipps was a military man. Christopherson’s appointment was civil with, originally, an assimilated rank. The tensions that grew between the civil and military are well documented. Phipps is reported as saying of Charles Armbruster (another civilian and a close friend of Christopherson) “A.[rmbruster] is not and never has been the sort of man we want, and I am afraid his coming to Khm. was a mistake.”42 Phipps learned that Armbruster, Christopherson and their friends were dubbed ‘The Armbruster League.’ This group probably included Wasey Sterry 39

Most likely LDS is London Dental School. LSD is Pounds, shillings and pence. Pownoll Ramsey Phipps, (1865–1932) Civil Secretary Sudan Govt. 1905–14, sometime Private Secretary, and always close friend, of Wingate. 41 Daly, Op. cit. 42 Daly, Op. cit., p. 88. 40

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and James Currie who were all close to Christopherson. By coincidence they were all three born in the same year, 1868, and Sterry died the same year at Christopherson, 1955.43 The problem of advancement would cause concern for years. The civilians resented the number of senior posts awarded to military men, who were often much younger than their civilian counterparts. But in 1902 all was co-operative, even jolly. In December 1903 things were still running smoothly between the doctor and the most important man, Wingate, who wrote: “My dear Christopherson, I have here your excellent speech to my old friends in hospital [Khartoum Civil Hospital] and am very much obliged to you.”44

Everyday Medical Work Meanwhile there was a great deal of work to be done in trying conditions and idiosyncrasies had to be tolerated. Fortunately Christopherson had a zeal for work, an inquiring mind and an enthusiasm for novelty in medicine. We know there was a certain symbiotic relationship with his Sudanese and Egyptian co-workers. He needed their abilities both to translate languages and also to interpret local customs. They, in turn, were learning, earning (minimum wages) and, perhaps, believing that there was the possibility of advancement, even if hopes tended to be dashed from time to time. Christopherson enjoyed the scientific work and began to publish in the major journals for his field. In May of 1903 he had a paper in the Journal of Tropical Medicine on a case of peripheral neuritis simulating beriberi. The patient was an Egyptian tailor admitted to the Omdurman Military Hospital in November 1902 with pains and partial paralysis. Christopherson felt that the rice diet might have caused the neuritis. Others had also thought the same. He thought that rice paralysis was distinct from beri-beri while admitting that his reasoning was not conclusive. A Dr. Travers in Kuala Lumpur, also in 1902, investigated

43 Sir Wasey Sterry, (1868–1955) First Legal Advisor to Sudan. Sir James Currie. (1868–1937) Director of Education in Sudan. 44 Wingate to JBC SAD 407/7/1.

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the possibility of a rice diet inducing beri-beri. Dr. James Cantlie,45 in commenting on this latter investigation, wrote: “So scientifically and thoroughly was this investigation carried out by Travers that it would seem a flawless and conclusive proof that the specific agent concerned in the production of beriberi is not conveyed by food.”46 He was wrong. beriberi is a lack of vitamin B1 which is found in unpolished rice. Polished or refined rice has vitamin B1 removed. Later, the author Dr. H. Harold Scott admitted, “Time showed that several of these apparently contradictory opinions were correct: the disease was shown to be dietetic in origin but not necessarily associated with the eating of rice. Many articles of food besides rice were demonstrated to be deficient in neuritis-preventing vitamins . . .”47

Medical Curiosities In early 1903 Christopherson published a case description in the BMJ of: an Egyptian cavalry man, aged 22, [who] came to the hospital with a swelling in the right inguinal region extending from the external abdominal ring into the scrotum. . . . As it was painful and rendered it possible for the man to become ‘sick’ when he chose, I operated on him.48

Christopherson described the presenting symptoms in detail, while noting that his patient [the Egyptian cavalry man] was married and had fathered a child. He concluded: In Egypt developmental lesions are common. Rudimentary nipples are common. I have seen as many as five, besides the normal structures, in one man, and one or two are quite common . . . I believe hermaphroditism also. Congenital herniae are common. Supernumerary digits and webbed fingers and toes also.49

45 Cantlie, Sir James (1851–1926) Instrumental in setting up the Journal of Tropical Medicine in 1898 and the London School of Tropical Medicine in 1899. President of the R. Soc. Of Trop. Medicine & Hygiene. 46 H. Harold Scott, in A History of Tropical Medicine. Vol. II Cantlie, Sir James, (London: Edward Arnold & Co. 1939). Quoting Sir James Cantlie: p. 879. 47 Scott, Op. cit., p. 879. 48 BMJ (February 7, 1903), p. 312. 49 Ibid., p. 312.

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In 1904 Christopherson and a colleague, Dr. A. Webb Jones published a paper in The Lancet on two similar but rare cases:, two young boys with hypertrophied breasts (gynaecomastia).50 One boy, so embarrassed by his condition had amputated his right breast and attempted to do the same to the left. The physicians, in both cases, operated to give the boys back the manly figures they hoped for. What was amazing was the physicians’ final comment, that “The Firtitawi (the tribe the boys belonged to) are a very primitive people and this, so far as it goes, supports Williams’s theory that the hypertrophy is a reversion to the condition prevalent when the males aided the females in suckling their young.”51 The Journal of the Royal Army Medical Corps (1905) has a clinical note by Christopherson who had been asked to examine blood taken from a donkey suffering from Trypanosomiasis (sleeping sickness as a result of being bitten by the tse-tse fly). Christopherson also looked at some accompanying mules and reported that “their heads drooped, ears hanging, back legs leaning against each other for support, ribs very conspicuous etc . . . anaemia of mucous membranes and running at the eyes. The animals looked starved but ate and drank voraciously.”52 He had earlier been looking after the regimental mascot, a jaguar that had run a temperature and been generally rather poorly. Doctors in those early Sudan days had to turn their hand to anything and everything. One success reported by Christopherson, in the 1905 Annual Report, is so charming it deserves to be retold. There is something to be said for charity as an instrument no doubt, hope and faith are equally virtues in the Sudan. A little Jaalin boy was admitted into Khartoum Hospital for Cerebro-spinal meningitis, and he was at death’s door for three weeks when one day he was found in a bed which had just been vacated by another boy. He said that everybody who occupied the bed went out cured, so he would try it, and the following day his temperature did go down and he quickly got well.53

50 51 52 53

Dr. A. Webb Jones, FRCS (1874–1917). The Lancet. (26 March, 1904), i: p. 896. [Williams is not identified in The Lancet]. J.B. Christopherson, J. Royal Army Medical Corps (1905 Vol. 5), p. 139. SAD Annual Report of the Sudan Medical Department. 1905. p. 104.

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5.3. Regimental jaguar in JBC’s care, with friendly dog.

The Occupying Force and the Land They Found The occupying force had had a formidable task. Beginning on 4 September 1898, following the ceremony when the flags of Britain and Egypt were raised officially signifying that Sudan was conquered (and General Gordon’s death avenged) they faced a formidable task. There were few usable buildings no administrative structure. Work had to begin with basic sanitation and prevention of disease; these last became the job of the Director of the Wellcome Laboratory, Andrew Balfour. Vaccination was largely Christopherson’s enterprise. Squires points out that immediately, “a campaign of vaccination against smallpox in the principal centre of population . . .” was begun and that by “. . . 1902 the number vaccinated annually was over 10,000.”54 Heather Bell wrote in her book The Frontiers of Medicine in AngloEgyptian Sudan 1899–1940 that “Both military and civilian doctors

54

Squires, Op. cit., p. 4.

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concentrated on preserving the health of British officials . . . they were engaged in the project of safeguarding the colonizing elite . . .” and she quotes from Ellen Gruenbaum that it was “no accident that the first civilian doctors were concentrated in Khartoum, the capital, Atbara, the headquarters of the Sudan Railway, and Port Sudan . . .’55 The implication is that this was self-serving. One can justifiably argue the opposite, that these hospitals were built in the centre of the cities, available to the people, with extra dispensaries equally available and hours posted when qualified practitioners would be available. The civil hospitals, as is evidenced by Christopherson’s diaries and letters, catered to the Sudanese, not just Europeans or military men. The British were there to establish bases from which to rule and rule in good health, and eventually to conduct profitable business. Railways cannot be built by men in poor health nor can armies fight when debilitated by bilharzia or other sicknesses, as Christopherson was to point out more than once. The colonizers believed in doing well by doing good. During the Victorian and Edwardian eras and the great so-called ‘scramble for Africa,’ this mindset went unquestioned. The medical scene for Christopherson’s first four years in Sudan, 1901–1905, was dominated by a somewhat unevenly weighted triumvirate of doctors—Crispin, Christopherson and Andrew Balfour (about whom more later)—opinionated, energetic and talented men with a zeal for work and an expectation that they would make their mark. It was a stew, over-salted with resentment, jealousy and jockeying for position, a situation that did not improve much with time.

55

Bell, Op. cit., p. 24.

5. 4. Dr. E.S. Crispin

5.5. Dr. J.B. Christopherson

5.6. Dr. A. Balfour

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CHAPTER SIX

THE WELLCOME LABORATORY ON THE NILE AND A RELAPSING FEVER DISPUTE. A STORM IN A TEACUP? SOME OF WHAT REALLY HAPPENED IS REVEALED ONLY IN 1923

A profession in which there are no difficulties to surmount would not be worth going into. Life has its hurdles, which some take awkwardly, others gracefully, some complainingly, others joyfully, depending on one’s temperament, health, and character. —Harvey Cushing

In January of 1901 Queen Victoria died. She had been on the throne sixty-four years, so long that most of her subjects had known no other monarch. The Victorian era closed with an extravagant and emotional funeral; the Edwardian era was ushered in to be enjoyed with the portly and dissolute Edward VII. The new monarch was fifty-nine, a gambling, overweight, hard-drinking, overeating man whose private life, fortunately for him, rarely ruffled his subjects, given the respectful press of that first decade. He inherited an England rife with poverty and disease; one of the first influenza epidemics was killing fifty people a day. Upstart women were vociferously demanding the vote. On the other hand there was the Empire. “Nearly one person in four lives under British rule in one form or another in an empire that now covers one-fifth of the world’s surface” wrote the editors of the Chronicle of Britain in February, 1901.1 On the surface, for the gentry with their top hats and frock coats, hansom cabs and concerns about etiquette, life continued in the belief that being masters of the world meant that this was how things would remain. Even in the tropics European men, far away from civilization, dressed for dinner, thus keeping up appearances in front of the ‘lower orders.’ Everyone knew his or her place and there was a certain comfort in this, even if one did not always like one’s place.

1 H. Heald, Ed. Chronicle of Britain. (Hampshire: Chronicle Communications 1992), p. 1020.

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On to this late Victorian scene strode an American, ambitious, curious, and enamoured of England and her empire. Henry Wellcome made a splash wherever he went.

Henry Wellcome and His Gift—A Fully Equipped Laboratory on the Nile Henry Wellcome (1853–1936) was a remarkable man. He was born in his grandfather’s large log house in Wisconsin, USA, but many years later took British citizenship.2 As a young man he trained as a pharmacist and in 1880 formed a pharmaceutical company with a friend, Silas M. Burroughs. Burroughs & Wellcome prospered but the two men eventually quarreled and dissolved the partnership. Wellcome diversified his business and in time became fabulously wealthy. His extraordinary wealth and his incurable interest, not just in medicine and pharmaceuticals but also in anthropology and archeology, culminated in a monumental, almost dizzying, collection of artefacts—medical, tribal, historical—from the merely curious to the gruesome and the bizarre. His curiosity had ignited a passion, a passion he was able to indulge to a degree bordering on mania. Along the way Wellcome became fascinated with the romance of Africa, as it was seen in the early 1900s, and with the story of Kitchener’s avenging the death of Gordon at the battle of Omdurman in 1898. He had already responded handsomely to Kitchener’s public appeal for money to build a college at Khartoum in memory of the murdered Gordon. His enthusiasm for Sudan extended to his buying more than eight hundred copies each, of Rudolph Slatin’s Fire and Sword and G.W. Stevens’s With Kitchener to Khartoum, and in a grandiose gesture, distributing copies to friends and employees for Christmas, 1898. In 1900 he sailed out to Sudan with letters of introduction to Wingate and Lord Cromer, the British Agent in Cairo. During his visit to Sudan, Wellcome was distressed by the appalling conditions in the city of Khartoum as well as by the sickness and resultant lethargy of the local people he encountered as he journeyed down the Nile.

2 Robert Rhodes James. Henry Wellcome. (London: Hodder and Stoughton Ltd. 1994), p. 13. Wellcome took British citizenship in 1910 having renounced his American citizenship in 1905.

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During my visit to one of the small islands of the Nile, just above the Shabluka Cataract, there were perhaps thirty or forty inhabitants, everyone lying helplessly prostrated, weak and emaciated, suffering from malaria in an extremely virulent form. I am sure that no one could have seen those mere skeletons of men, women and children without being moved by deep emotion to do something to mitigate the pitiful condition of these poor and sorely distressed people . . .3

Henry Wellcome was a compassionate man in many respects. Regrettably his empathy did not always extend towards his wife, Syrie, who left him after a number of unhappy years and married Somerset Maugham.4 Wellcome’s enthusiasm for collecting and travel, which perhaps compensated for his disappointing personal life, came as a result of his first-hand African experience. This excitement generated an ambitious plan. He arrived on the banks of the Nile like a fairy godfather and proposed to upgrade his earlier idea of a dispensary for Khartoum to that of a major tropical research laboratory. He volunteered to stock it and donate all the equipment. It was agreed that he would choose the director, and the Government of Sudan would pay the salaries of both director and staff. The Wellcome Research Laboratory on the Nile was born. Wellcome chose Dr. Andrew Balfour, a Scotsman, young and highly qualified, who had served in the Boer War and spoke Arabic, to be its Director. Balfour’s degrees were in public health and he had specialized in tropical medicine under the tutelage of Sir Patrick Manson. Balfour’s zeal and expertise were directed at sanitation and malaria mosquito eradication, and within a few years he achieved remarkable results. The laboratory, housed in the Gordon College, was to be well equipped in every respect. Reports on the work and progress would be issued whenever possible. The reviewer of the first official Report wrote a glowing tribute in the BMJ 10 December, 1904; it is regrettable that he referred to Dr. Andrew Balfour as Arthur Balfour, the name of the current British Prime Minister, who was not related.

3

Rhodes James, Op. cit., p. 250. This was astonishing, given Maugham’s known homosexual tendencies. Inevitably this marriage was also a disaster. 4

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The mandate of the laboratory covered just about every botanical, environmental and medical aspect of Sudan and was set out as follows.5 FUNCTIONS OF THE WELLCOME RESEARCH LABORATORIES GORDON MEMORIAL COLLEGE, KHARTOUM.

a. To promote technical education. b. To promote the study, bacteriologically and physiologically, of tropical disorders, especially the infective diseases of both man and beast peculiar to the Sudan, and to render assistance to the officers of health, and to the clinics of the civil and military hospitals. c. To aid experimental investigations in poisoning cases by the detection and experimental determination of toxic agents, particularly the obscure potent substances employed by the natives. d. To carry out such chemical and bacteriological tests in connection with water, food stuffs, and health and sanitary matters as may be found desirable. e. To promote the study of disorders and pests which attack food and textile producing and other economic plant life in the Sudan.

[This line was added to the 1906 Second Report, presumably with the idea of a future cotton growing industry.] f. To undertake the testing and assaying of agricultural, mineral an other substances of practical interest in the industrial development of the Sudan.

The papers in the Reports were described in Laboratory on the Nile, as “a time capsule of what was known about disease in the tropics . . . before any of the modern drugs had been discovered.”6

What Did the Wellcome Laboratory and the SMD Mean for the Sudanese? Any ‘altruistic mission’ is suspect. It was a few years before those Sudanese being ‘technically educated’ at Gordon College realized that their education would be limited to lower-level work. African students with

5 See aims of Wellcome Lab. in First Report, Wellcome Research Laboratories at the Gordon Memorial College, Khartoum. (RWRL) p. 7. 6 Patrick F. D’Arcy. Laboratory on the Nile: A History of the Wellcome Tropical Research Laboratories. (London: Pharmaceutical Products Press: 1999), p. 244.

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the brains, energy and ambition to rise through the ranks found a brick wall once they graduated. All this has been eloquently researched and discussed in Heather Sharkey’s book Living with Colonialism.7 Although the hospitals and clinics served the general community more and more, their original purpose had been to serve the army. Any work on ‘tropical disorders’ was carried on with a view to enable an expansion of the British empire, and to ensure that Europeans did not end up dying of some untreatable fever. The British arrived as conquerors, unquestioning in their moral superiority. They immediately began ‘improvements,’ in water, health, sanitation, roads, railways. While undoubtedly doing much good, the British managed to undermine the existing rituals and traditions of the Sudanese, and life in Sudan was changed for ever. The need to control the spread of epidemics—cholera or smallpox, for example—leads to a convenient rationale for social control. It depends on which side of the fence you sit as to where your sympathies lie when you view this situation. To the British of the early 1900s, there existed no dilemma. They gloried in the rectitude of their ways, they steadfastly believed in their work with a messianic zeal, and accordingly endured harsh, miserable conditions without complaint. Their cheerful stoicism is reflected in the many published reminiscences of their period.8 Indeed, Christopherson, although he never published a memoir, left notes and a few letters from those early years, all of which show a man of determination with an enormous energy and with rarely a complaint about the physical circumstances.9 Africa and the tropics in general were the focus of this ongoing wave of late Victorian and Edwardian interest and exploration. Henry Wellcome, intrepid traveler and generous philanthropist, was also entrepreneurial and interested in expanding markets for his pharmaceuticals. Without a doubt Wellcome made a remarkably successful choice when he picked Balfour as director. As Wellcome wrote to James Currie, principal of Gordon College, in August of 1902 about the appointee, “. . . He has a private income, otherwise it is not likely that we would be 7 Heather Sharkey. Living with Colonialism: Nationalism and Culture in the AngloEgyptian Sudan. (Los Angeles: U of California Press. 2003). 8 See: William Byam, The Road to Harley Street; Cruickshank, Alexander. Itchy Feet—A Doctor’s Tale; Edward Fothergill. Five Years in the Sudan. Etc. 9 After his marriage in September 1912, he wrote many letters to his wife. They were apart a great deal, as a result of the war, and later when he lived and worked in London and only went home to their retirement house in Gloucester on weekends. These letters she kept although regrettably she judiciously destroyed one or two as instructed by JBC.

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able to secure his services at anything like £500 per annum . . . He has good health, is well seasoned, and takes an abundance of exercise.”10 The laboratory’s mandate included rendering assistance to the local hospitals. This was clearly sensible. The Wellcome Laboratory on the Nile, housed in one wing of the Gordon College, had equipment for storing and examining specimens; the hospitals would be generating specimens. With this in mind it was obvious that goodwill and cooperation between the two—hospitals and Wellcome Laboratory—was essential. When, somewhere around 1904, these ingredients were in short supply, at least between Balfour and Christopherson, more than just these two personalities were affected.

Christopherson and Balfour—Peace and Goodwill in Those First Years Andrew Balfour was born in 1873 and was five years younger than Christopherson. This ‘canny Scot,’ as Christopherson was later to call him when they had quarrelled, was a burly man, famous for his football prowess. He was a man who worked himself literally to a standstill on a number of occasions, so much so that occasionally he was obliged to take medical leave-of-absence. His severe periodic depressions were probably responsible for his suicide at the age of fifty-eight. Balfour was to play a central role in Christopherson’s early career in Sudan. It might also be said that Christopherson played a partial role in the mental health of Dr. Balfour. Balfour was only twenty-nine when he arrived to start work in Khartoum; this was a plum job, an exciting and extraordinarily responsible post for such a young man. As editor of his first Wellcome Report covering the period between February 1, 1903 and February 1, 1904, he generously acknowledged Christopherson’s contribution to the Laboratory: . . . what promises to be a very fine and complete set of photographs illustrative of the native disease of the Sudan taken by Mr. Turstig, Omdurman for Dr. J.B. Christopherson and kindly presented by the latter. . . . In addition to these exhibits a collection has been made of the remedies indigenous to, or used in, the Sudan by the native races.11

10 11

D’Arcy, Op. cit., p. 44. First RWRL (1904), p. 9.

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Indigenous medicine greatly interested Christopherson. He enjoyed learning from his local colleagues throughout his time in Africa. He was not the only European in Sudan to be fascinated with ethnography, this was the Edwardian era and learning how ‘primitive peoples’ lived was of interest to traveller and scientist alike. In the spring of 1903 Christopherson was still riding high in the estimation of Balfour who wrote to Wellcome on 17th March of progress at the lab and of his expectations: . . . travelers [sic] are going to remind the outlying medical officers that the Gordon College labs will be glad of specimens. In this way I hope to get many useful & interesting things. The R.A.M.C. officers are very obliging & I was able to aid Major Bray in the diagnosis of a case of liver abscess, by microscopical examination. My chief hope, however, is Dr. Christopherson at Omdurman, an extraordinarily keen man on his work. He has charge of the military & civil hospitals there & is very willing to aid the labs.12

Christopherson’s name is found throughout this First Report. He had observed numerous ‘local affections:’ malaria, elephantiasis, leprosy, beriberi (the subject of a later paper),13 goitre, mycetoma, (another of his special interests), and many cases of blindness and other serious eye problems such as “Cataract and corneal ulcer . . .”14 Leprosy, ‘the tuberculous variety’ is mentioned and Christopherson included a number of photographs of lepers from Omdurman and Kassala.15 Bilharzia, (S. haematobium and S. mansoni were and are also present in Africa) and would become his major field of study years later. Balfour’s First Wellcome Report had this to say: Endemic Haematuria (Bilharzia).—Of frequent occurrence amongst the Egyptian soldiery, was supposed not to exist in the Sudan, save such cases as had acquired infection in Egypt or elsewhere. Recently the urine of

12

Wellcome letter books 17 March, 1903 Balfour to Wellcome. WF/E/1/3/23. WA/TRL/Rep/1 Box 22 Balfour wrote to Currie, 3 May 1903 “On visiting the Military Hospital at Omdurman I was shown a case which I suggested might be Beri Beri. If Dr. Christopherson’s investigations confirm the observation this will be an important point as, so far as Khartoum, the disease has not . . . been reported either in Egypt or in the Anglo-Egyptian Sudan.” 14 First RWRL (1904), p. 55. 15 Osler, in his The Principles and Practice of Medicine, 8th Ed. and most likely the edition owned by JBC, mentions Tubercular Leprosy “the eyelashes and eyebrows and the hairs on the face fall out. The mucous membranes finally become involved, particularly of the mouth, throat, and larynx; the voice becomes harsh and finally aphonic. Death results not infrequently . . .” 13

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chapter six three Sudanese boys have been sent to the laboratories. All three showed blood, pus and the characteristic ova.16

Balfour remarked that the boys of a local school had been drinking from the same well and ‘were in the habit of bathing in the Blue Nile.’ It was certainly known in 1903 that one could become infected by bathing in slow-moving fresh water and that snails were the source of the problem. It is also possible, perhaps likely, that as the boys were drinking from the same infected well, they may have contracted the disease in this manner too. Balfour’s Report stated that of the seventy-three boys in the school, twelve boys (17 percent) were infected. Bilharzia at first onset is not always seriously debilitating. Young African males have been known to refer to the frequent passing of blood in the urine as male menstruation and to speak of it as a rite of passage. In the course of time it becomes a very painful illness infecting the urinary system and liver and sometimes leads to cancer and death. No treatment for this disease was mentioned in this Report. There was no effective treatment.

The Second Report The Second Report (1906) covers from January 1904, where the First Report left off, to some time late in 1906. In this volume, medical officers and military men alike were thanked by name for their contributions of pathological material and for example, specimens of biting diptera.17 Sir Rudolph von Slatin “kindly presented a goat showing an interesting malformation.”18 These Reports, it must be noted, apart from being useful to others working in the recently acknowledged field of tropical medicine or ‘medicine in the tropics,’ were public-relations instruments, beautifully printed, handsomely bound, with many colour plates. There is only one reference to Christopherson among these many acknowledgements in the Second Report: “I regret that the beautiful series given by Dr. Christopherson during the first year of the labora-

16 17 18

First RWRL (1904), p. 51. Insects with one pair of membranous wings. Second RWRL (1906), p. 11.

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tories’ existence has not been further augmented.”19 Taken at face value this is a comment suggesting disappointment. Initially I had wondered whether Christopherson had felt piqued for some reason and refused to make any contributions to the new laboratory. As with all medical staff, his was a punishing daily regimen in most trying conditions—debilitating heat, dust, lack of the local language, lack of trained staff, and total absence of modern (for then) facilities and equipment. Yet this Second Report has nothing else to say about him, or his work. He managed to publish only three papers from 1904 to 1906, not much of an output, but probably indicative of the demanding and time-consuming working conditions. He did manage to send two letters to the journal of Barts Hospital, his old alma mater, boasting about how many Barts men had come out to join the Sudan Medical Department.20 Given that once again these pages are peppered with the names of Christopherson’s colleagues the omission of his name cannot go unremarked. Was Christopherson intransigent or difficult? Was he somehow guarding his ‘turf’ against real or imaginary trespassers? Nothing negative written by Balfour about Christopherson has come to light and, bar a few letters Balfour wrote to his mother during those early years, there are no personal letters or diaries from the period 1901 to 1913 when he left Sudan. We do know, from a note written by Wingate, that there once existed a long letter from Balfour with respect to what became known in 1908, and again in 1911, as ‘the Christopherson affair’ (about which more later).21 Regrettably, this letter has also disappeared from view.

Third Report and Trouble Exposed By the Third Report in 1908, Christopherson’s name is nowhere to be found, nor is it in the Supplement to the Third Report which came out later the same year. This Report, as I realized only a number of months, held a good many clues to the reason behind the rumoured bad blood between Balfour and Christopherson, although there were no clues suggesting a specific genesis for the trouble. There is the likelihood that

19 20 21

Ibid., p. 11. St. Bartholomew’s Hospital Journal. Health in the Sudan (July 1906), p. 152. Letter from P.R. Phipps to Wingate. 4 June 1908 SAD 282/6/16.

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Christopherson, with his growing dislike of the Scotsman, had cause to regret the disaffection. Were the rumours of disaffection true? Whatever went wrong in the period 1904–1905 became serious enough to upset what had hitherto been a perfectly good working relationship. It seems likely that Balfour was first of all genuinely regretful, and then when he made no headway, thoroughly annoyed with Christopherson.

Finally, the Story behind the Balfour–Christopherson Disaffection It was not until I re-read Christopherson’s letters from the Peter Ormerod collection, those written much later, in 1923, that I felt I had found at least a partial answer. That year Dr. A.O.F. Atkey, Director of the Sudan Medical Service (as it was by then renamed), sent out a six-page brochure: Memorandum on the Kitchener Memorial Medical School, Khartoum. This outlined the history of the original idea and strategy for the future. Two letters written by Christopherson, one to Dr. Atkey and the other, written the same day—August 11, 1923—to his wife, referred back to that initial proposal. Plans to raise money had been floated as early as 1916 and by April, 1922 “. . . although sufficient funds had not yet been raised, it was decided that a commencement must be made.” Building was begun in May. The school was to make possible the education of native Sudanese to become ‘Assistant Doctors’ and in time, those who were successful would be brought back to complete their education to become fully-fledged physicians. It has also been noted that the curriculum at the Gordon college, was welcomed on one hand but resented on another: “Some of them [students . . .] resented that their educations had been vocational . . . our education was curtailed . . .”22 Christopherson’s reply to Atkey, and his even franker comments on this subject to Joyce, confirm how all this came about and most importantly, how the Balfour element featured. On 11 August, 1923 he wrote to Dr. Atkey hinting only at his original concern:

22

H. Sharkey. Living with Colonialism. (Los Angeles: U of California Press), p. 72.

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Dear Atkey, Many thanks for the memorandum of the preferred Medical School at Khartoum. I shall be very pleased to support the scheme in every way that I am able. When the idea was originally brought up—I was not quite satisfied that the Medical Department was controlling the movement nor that it was then to be under its administration, and having worked during all my time so far as my opportunities allowed to have an independent Civil Medical Department and only one—it seemed to me that as it was then proposed the Med. School would tend to link up the Medical Department to another department in a Subordinate way to the disadvantage of the medical world of the country. [author’s italics] However this matter appears to have been put straight and the Medical Department is taking the lead in an important Medical question assisted by other departments which are able to help, and I wish it success . . . .

Next he sent Atkey’s letter on to Joyce and elaborated further: 11 Aug. 1923 My dearest Joyce, You like to read some of my correspondence so I am sending you Atkey’s letter with the Med. school Scheme . . . When it was proposed before the med. School it was to be organised from the Wellcome Labs and the Med. Department would have run the risk of being dominated by the Wellcome Lab etc. [author’s italics] I originally proposed the School in 1905 and the Sirdar referred the matter to Currie who turned it down as premature and perhaps it was then . . .

Christopherson’s letter to Atkey mentioning ‘. . . another department in a subordinate way . . .’ hints at Balfour and his Wellcome Laboratory. His letter to Joyce leaves this subject quite unambiguous. Earlier, from 1902 onwards, both men had been running important institutions: Balfour the Wellcome Lab and Christopherson, first the civil and military hospitals in Omdurman, one each in Omdurman and Khartoum, and shortly after, the Sudan Medical Department as a whole.23 Both had built these fiefdoms themselves, battling climate and isolation from the major European medical community in London, and in Christopherson’s case, a paucity of both funds and equipment. Both were justifiably proud of their achievements, both should have been working side by side complementing one another; indeed both

23 “Hospitals in the major towns of Khartoum, Khartoum North, Omdurman, Halfa, Dongola, Berber, White Nile province, Port Sudan, Suakin, and the railways administration . . .” Bell. p. 23.

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began in that manner. Looked at practically, the Wellcome Lab needed the hospital and the hospital needed the Wellcome Lab so the disaffection that grew served no one well. Another reason for disaffection, I submit, was Balfour’s insistence that his post as Medical Officer of Health for Khartoum “be under the sole jurisdiction of the Khartoum province administration, with no connection to the nascent medical department.”24 It is natural enough that both having worked so hard and risen in stature and accomplishment neither Christopherson nor Balfour would want his own little empire to be subservient to the other. One can well imagine that Christopherson, known to be somewhat lacking in tact, may well have been overly forthright in his opposition, both to the Wellcome Labs’ isolation from the SMD and to even a hint of a medical school under the control of a privately funded enterprise such as Balfour’s Wellcome Lab. Such a situation would disrupt the lines of authority that led from the medical department up through the administration to the Sirdar himself. Christopherson had immediate negative reaction to the possibility of the medical school’s becoming ‘Subordinate.’ He wrote the word with a capital letter for emphasis. In his letter to Joyce he claimed that he had generated the idea of a medical school back as early as 1905. Nothing has surfaced to deny or confirm this. I suggest that given shortage of money and suitable staff, Christopherson had been rather carried away by the idea so early in the condominium years, and that James Currie’s answer, in his capacity of Director of Education, was practical if for no more than financial reasons. It should be remembered that James (later Sir James) Currie was the Sudan Director of Education, and it was in his large and imposing building that the Wellcome Laboratory was housed. Presumably any medical school would be staffed in part by physicians from the hospitals, both military and civil, and such physicians were in very short supply, particularly British-trained men. Christopherson would have been obliged to add teaching to his already overloaded schedule so it is surprising he even suggested such a scheme so early. Further, as Dr. Ahmed Adeel pointed out, the Gordon College was little more than a high school for boys at that time.25

24 25

Ibid., p. 23. E-mail to author from Dr. Ahmed Adeel, 23 June, 2006.

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Had the school been subordinate to the Wellcome lab, Christopherson would have been subjected to Balfour’s authority, something that would have been a source of more trouble. These two men ran very different establishments and had very different interests in the field of medicine. Balfour was a public-health man looking at the big picture, Christopherson was a physician dealing with one patient’s problems at a time. A similar distinction between the modern terms, medical safety and patient safety, has been called to my attention.26 We do not have other letters on this subject, which is unfortunate, but Currie, noted Christopherson, smoothed things over at the time by suggesting that the medical school venture was premature. If all this grated on both Balfour and Christopherson, and I suggest it did, I proffer three items engineered by Balfour in an attempt to make Christopherson regret his intransigent attitude. All were instigated to obviate Christopherson’s priority in the field one way or the other. These could not have been mere coincidences. First: The paper by Captain R.G. Anderson on Medical Practices and Superstitions of Kordofan which appeared in the Third Report, scooped the paper that Christopherson’s had been working on for some time. Second: The paper on The Healing Art as Practised by the Dervishes in the Sudan during the Rule of the Mahdi and of the Khalifa bearing Hassan Effendi Zaki’s authorship27 was actually a combined effort by Christopherson and Zaki, and lastly: Fast on the heels of the Third Report, in its Supplement, there was an article on relapsing fever by Balfour’s friend Leonard Bousfield, which ignored Christopherson’s priority in recognizing the first such spirochaete to originate in Sudan.28 Christopherson’s anger at this turn of events was justified. Early in 1907 Wingate had written to Wellcome: Dear Mr. Wellcome, In reply to your letter of January 1st asking me to procure, if possible, for you any information respecting medical and surgical aid, if such was

26

Personal communication—Prof. John W. Senders May, 2005. Dr. Zaki, friend and colleague of Christopherson from his first days in Sudan. 28 There is later evidence in a Wingate letter to G.F. Clayton suggesting that Bousfield was not sympathetic to JBC. “I can quite understand that neither P, [as yet un-identified] and B [probably Sir E.E. Bernard, Financial Secretary] are particularly keen about Bousfield, their sympathies being Christo-wards.” 21 August, 1912. SAD 649/4/27. 27

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chapter six practised, in the armies of the Mahdi or the Khalifa, I now enclose you [sic] a memorandum which is the result of a considerable amount of enquiry and research, and if the information which it contains is suitable for your purposes I am sure that this fact will be ample compensation for any trouble which Doctor Christopherson and his staff may have incurred in compiling it.29

Christopherson, along with his friend and colleague Dr. Zaki, and with assistance from others on his staff, had evidently spent considerable time collating and writing this report.30 Fortunately there is both a draft, meticulously edited and annotated in Christopherson’s hand and, a cleanly typed final document which was the copy sent to the administration to be forwarded to London. I found that final copy in the Wellcome archive along with Wingate’s letter to Henry Wellcome. What is crystal clear is that Christopherson had done the major work of interviewing, collating and editing. He had also given credit where credit was due, writing, on page one of the report: Dr. Hassan Zaki, a Sagh31 in the old Army, was in charge of the Khartoum Hospital in Gordon’s time and he says that Gordon often came round and visited the sick. Hassan Zaki at the fall of Khartoum himself practiced his profession in the unwelcome employment of the Mahdi. He had his Hospital such as it was and the people were told to come to him. However, he was chiefly engaged in making gunpowder in which occupation he blew off his right thum. [sic] . . . He is a well regarded official in the present Sudan medical Department and has contributed largely to these notes. He is, I may add, now to be respected for his knowledge of medicine as before for his knowledge of the world.32

In tracing the path of this work as it became seriously filtered before being published in the Third Report we learn: 1 January, 1907, Wellcome had written to Wingate (as reflected in Wingate’s letter of 21st February to Wellcome, see above) for help in collecting information on medicine during the Khalifa’s time for an exhibition Wellcome planned to put on in London. Wingate naturally turned to Christopherson who submitted his report in an incredibly short space of time along with a cover letter dated 7th February:

29

21 February, 1907. Wingate to Wellcome. WL. MS.8221. The draft of the Report can be found in the Durham archive. SAD 407/1 series. 31 Sagh” is a military rank in Ottoman jargon, equal to “Major” in English. Personal communication from Alsir Sidahmed. 23 January, 2009. 32 WL. MS. 8221. 30

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Acting on instructions received through you I have collected some account of the Medical and surgical resources during the Khalifa’s time in the Sudan, particularly in Omdurman. Owing to pressure of work I have not been able to do more than edit and correct and add some rough notes, but I shall be glad if they are found useful—they are attached. J.B. CHRISTOPHERSON. DIRECTOR, S.M.DEPT.33

15 August, 1907 Balfour wrote to Henry Wellcome from the Hotel Sterman, Schluchsee in Germany: “I returned Dr. Christopherson’s notes to Miss Perreton after making the necessary extracts of which I hope to make use in due course.”34 Here he has acknowledged ‘Christopherson’s notes’ which he says he will use shortly. To call this report ‘notes’ might well be construed as a slight. It was a major report, sixteen pages in length. In 1908, precise date unknown, Balfour, in the Introduction to his Third Report removed Christopherson’s name entirely from the aforementioned Christopherson/Zaki paper: I would also draw attention to the historical paper by Dr. Hassan Effendi Zeki of the Sudan Medical Department . . . I approached him at the suggestion of Mr. Wellcome, to whom he had previously sent a paper on the subject. The present article has been enlarged and amplified from the original, and, perhaps more than anything else could do, points to the change which has come over the Sudan since it fell under civilising influences . . . Bimbashi Anderson and Bousfield kindly sent in valuable papers, dealing to some extent with the [same] question . . .35

Leaving aside the typically colonial remark about ‘civilizing influences,’ there are two errors of fact to be dealt with. First, Zaki would never have presumed to send the paper directly to Wellcome. It went quite correctly via Wingate from whom the original request had come. Second, Balfour’s remark that: “The present article has been . . . amplified from the original . . .” is quite incorrect. Christopherson and Zaki’s article was chopped around and shortened by Balfour, not enlarged. I suggest that Balfour was not above plagiarism in his war with Christopherson; he knew he could get away with it. Adding insult to injury, as Christopherson was likely to see it, Balfour tacked on two more ethnographic ‘native medicine’ papers, one from his friend Bousfield and one from Captain George Anderson.

33 34 35

1907 7 February. JBC to Wingate, WL. MS 8221. 1907 15 August, Balfour to Wellcome. WA/HSW/Co/Ind/A.1. Third RWRL (1908), 15–16.

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It is not known whether Christopherson got wind of the fact that George Anderson was interested in native medicine and tattooing, something which would put the two of them in competition for publication dates, but there is a Christopherson letter extant dated 26 March 1908 which is in effect a request, sent to twenty of his local doctors, for answers to five questions: Tribal markings, earth eaters, tattooing, circumcision of female children, and finally “. . . any notes on Native remedies or surgery or appliances, splints & etc. that you may come across in your Department.”36 Christopherson had planned to write a book on these subjects. In fact as late as October 1934, fifteen years after he left Sudan, he was still intending to finish this work which he referred to in a letter to Joyce as ‘the Sudan illustrated book of diseases.’ For reasons unknown this never came to fruition. When the Third Report came out one can imagine his fury. He had effectively been ‘pipped at the post.’ He expressed his rage over Anderson’s paper in a one-page personal note, and with reference to the tattooing He wrote: “All his [Anderson’s] article is written in a loose—unsympathetic cock sure—almost sneering—slovenly and smug, slipshod, inaccurate & misleading—touched on and dismissed, youthful levity unbecoming without accuracy.” and “Nil else.”37 Anderson was twenty-eight, Christopherson, forty.

The Fourth Report: A Matter of Interpretation Again, Christopherson’s name does not appear but by then letters written by Christopherson (discussed in a later chapter) actively testify to his personal animosity towards Balfour. In this Fourth Report (1911) Balfour wrote what could be judged as yet another slap at Christopherson: “. . . we require more facilities for seeing cases, though, so far as the military Hospital in Khartoum goes, these are most generously afforded, . . .”38 Christopherson, by 1911, was in charge of the two civil hospitals at Omdurman and Khartoum. Heather Bell, in her detailed examination of the Sudan Medical Service, wrote that this comment by Balfour:

36 37 38

SAD 407/11/2. SAD 405/9/57. Fourth RWTRL (1911), p. 23.

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. . . suggests that Christopherson, in his new capacity as director of the Khartoum and Omdurman civil hospitals, denied the laboratories access to cases under his charge. Such an interpretation accords with the view, expressed decades later, that ‘In the early history of the laboratories, medical research was considerably handicapped by the lack of cooperation between the Sudan Medical Service and the bacteriological section.’39

It is likely that Bell is correct, that putting two and two together—the reputed bad blood between the two men and the comments of Dr. R.G. Archibald (who joined Balfour’s laboratories in 1908 as a pathologist and much later became director)—add up to a considerable lack of cooperation. In that case, Balfour’s comment really is an oblique swipe at Christopherson. Archibald, at the end of his tenure in Sudan, in February of 1934, wrote a report intended for the future reorganization of the Wellcome Tropical Research Laboratories. Overall he suggested that there be an amalgamation and that the bacteriological section would become an integral part of the medical Service and the staff placed under the Director, Sudan Medical Service. With obvious reference to the first decade in Sudan he wrote: In the early history of the laboratories, medical research was considerably handicapped by the lack of co operation between the Sudan Medical Service [sic] and the bacteriological section. A wide gap existed—indeed there was no co operation.40

I suggest that although we have evidence from Manson-Bahr that Balfour and Christopherson were adversaries by 1908, they had been treading down this path ever since the argument over control of the proposed medical school. By 1908 and the publication of the Third Wellcome Report, the articles mentioned had precipitated a storm over the naming of a spirochaete, and a full-blown fight. In fact over the generations nothing much has changed in academia or the medical world, for example, a recent argument in Science: “One Virus, Three names, Three Claims.”41 Dr. Ahmed Adeel, a Sudanese parasitologist interested in colonial medicine, contributed the following to this discussion: 39 R.G. Archibald, “A Note on the Future Organization of the Wellcome Tropical Research Laboratories,” 7 February, 1934, CIVSEC 1/55/152 in Frontiers of Medicine in the Anglo-Egyptian Sudan 1899–1940, (Oxford: Clarendon Press, 1999), p. 66. 40 CIVSEC/1/55/152. 41 Science 28 January, 2005.

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chapter six I think the two men had different interests and professional attitudes. Balfour was not interested in clinical practice, he left his father’s practice in UK and preferred working in Public Health. . . . His main achievements were at the level of administration and management of an effective public health system in Khartoum . . . he did not really make any significant original scientific or clinical discoveries. He was mainly interested in public health fieldwork and editing the reports.42

There is one letter by Christopherson in support of the existence of problems written when Christopherson was on leave and staying with his friend Dr. Charles de Segundo in London and already mentioned in chapter four and restated here. The question to be considered in the Balfour context is, is he referring to the Wellcome Laboratory or, to tensions between civil and military medical departments? 1907 14 September JBC, 97 Gloucester Place, Portman Sq. London. Dear Sir Reginald Wingate, . . . There are several things which will interest you—most of all you will be pleased to see evidence of the entente Cordiale between the two medical departments. I am sure that during this last year we have made considerable progress towards a Rapprochement—there are no difficulties in the way which cannot be removed.43

Christopherson, in this optimistic letter, is trying to get things on an even keel again and reassure his superiors.

Balfour and Christopherson—The Storm in the Teacup Dr. H.C. Squires, author of The Sudan Medical Service: An Experiment in Social Medicine does not mention the rumoured battle between Andrew Balfour and Christopherson over the naming of the spirochaete for relapsing fever. He was asked to describe social medicine in Sudan, and in 1958 there were still a number of the main players or their immediate families alive. Christopherson’s old friend, the less cautious Philip Manson-Bahr, wrote with oblique reference to the disagreement in Christopherson’s biographical note:44

42

Dr. Ahmed Adeel, e-mail to author, 5 May, 2005. JBC to Wingate. 14 September, 1907. SAD 281/3/90. 44 Dr. Gordon Cook, who also knew Manson-Bahr remarked that the man was “arrogant and aloof but had the biggest clinical practice of anyone—enormous.” Personal communication Sept. 2005. 43

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When circumstances warranted it he [Christopherson] could be surprisingly stubborn and tough. There were occasions when he was criticized for his work on spirochaetosis of man and fowls in Khartoum by those in authority in the Sudan [Balfour], but he stuck to his point and won.45

Walter Ormerod, nephew of Christopherson and a noted expert on trypanosomes and sleeping sickness, wrote to me about a conversation he had when he first joined the London School of Hygiene and Tropical Medicine in 1954: “I was talking casually to old Philip Manson-Bahr who told me about a terrific row between ‘Christo’ and Sir Andrew Balfour who became Director of the newly established LSH&TM. The row was about the naming of a spirochaete and it became so intense that Balfour was stated to have brought a legal action against Christo.”46 This too must have fizzled out. Dr. Ormerod added that he had attempted to learn more from his widowed aunt Joyce Christopherson, but she had been “unwilling to say anything about it except that Philip M-B had been of support to them at the time.” A close inspection of what was going on shows that it was not actually the naming of the original spirochaete; this had been done years before when Dr. Otto Obermeier, a German scientist, first described it in 1873. Rather it was the finding of a specimen of this tick-borne or louse-borne variety in a new location and then possibly giving it a name as another strain of the original. In other words it was a rediscovery but of a strain originating in Sudan. Christopherson did not attempt to give the spirillum a name in his rather odd telegram [see photo below] which reads: “I found spirillum relapsing fever in my patient’s [illegible], Wadramleh near Khartoum Nov. 12th [signed] Christopherson”47 or in his follow-up letter published by the editor, C.W. Daniels, a month later in the Journal of Tropical Medicine and Hygiene.48 In early 1921 when William Byam was writing The Practice of Medicine in the Tropics, he wrote to Balfour on the subject of relapsing fever and said: “we place the spirochaetes and all the relapsing fevers as a single species, and the various species of the past as varieties. In this way the spirochaete in question [for African Tick fever] becomes

45 P. Manson-Bahr, History of the School of Tropical Medicine in London. (London: H.K. Lewis & C. 1956), p. 203. 46 E-mail from Dr. Walter Ormerod. 11 November, 1999. No evidence of a lawsuit has been found. 47 Telegram in Wellcome WTI/RST/C. 8. 48 Telegram reported in J. of Tropical Medicine and Hygiene. (15 November, 1909), p. 347. Notes on the case reported by Dr. C.W. Daniels, (1 December, 1909), p. 353.

6.1. Telegram from JBC to Dr. C.W. Daniels. 18 November, 1909.

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Spironema recurrentis (duttoni).”49 The ‘duttoni’ was as a result of Dutton and Todd’s work. When Dutton died Todd honoured his colleague’s name.50 As Walter Ormerod described: The genuine argument is about whether the African form of relapsing fever, spread by the tick Ornithodorus moubata, is different from the European form which is transmitted by lice. Most people now think that they are the same species with strain differences that show up in features like virulence or incubation period, both types are now included in the genus Borrelia recurrentis. Although the trouble was due to a non-argument, it seems to have generated much bad blood.51

There is yet another angle from which to consider the rumour surrounding Balfour’s reputed threat to sue Christopherson. Walter Ormerod, in 2004, was recalling his Manson-Bahr conversation from the fifties; Manson-Bahr was remembering back at least another forty years. It has been suggested that the lack of further evidence, regarding legal action on the part of Balfour, is probably due to a conflation of ideas stemming from the words ‘legal action.’52 Perhaps Manson-Bahr knew about the 1911 Court of Enquiry in Khartoum and the charges brought against Christopherson and discussed here in chapter eleven? Perhaps he knew or believed, that Balfour was instrumental in bringing this about? Perhaps this was what Manson-Bahr was referring to, although only one letter from the voluminous Wingate–Phipps correspondence mentions Balfour’s name in connection with the Enquiry. All this conjecture brings to mind Walter Ormerod’s words to me about Manson-Bahr: “Manson-Bahr was an unreliable witness. Charming bloke but some of what he said was ‘eyewash.’”53

Relapsing Fever—What Is It? A diversion is necessary here to give some explanation for this illness that became pivotal to the arguments among the medical profession in Sudan, and crucial, once it took hold, to the inhabitants of subSaharan Africa. Spread by lice or ticks, relapsing fever epidemics had

49 50 51 52 53

WA/BSR/BA/Pub/63. Dutton, Joseph (1876–1905) Todd, John L. (1876–1049). E-mail communication 11/10/1999. Input from Prof. John W. Senders, June 2005. Personal communication from Dr. W. Ormerod, c. 2003.

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been known in England, Scotland and Ireland, as well as in Africa. An epidemic in Darfur in 1927 resulted in the deaths of 10,000 people out of a population of 40,000.54 The symptoms of this spirochaetal infection of the blood are: “. . . a high fever with severe headache and pain in the back, chest, abdomen, legs, and joints . . . .Nausea and vomiting may also occur. Patients are apathetic, mentally dull, or simply confused. The initial attack of fever normally last five to seven days . . . ”55 After the fever subsides there are a few days respite then the fever recurs, often more than once, although for fewer days. Today the spirochaete genus is renamed Borrelia. The particular species for relapsing fever is Borrelia recurrentis. Manson’s early edition of Tropical Diseases lists spirillum fever (and famine fever, tick fever etc.) as old names for relapsing fever. Manson-Bahr, who wrote a memoir of Christopherson’s for the history of the School of Tropical Medicine, came down firmly in Christopherson’s camp in all respects. He trumpeted the story of the battle over the naming of a spirochaete for relapsing fever “. . . a battle which resounded through the deserts and filtered down the Nile to the Tropical School in London. It was indeed a battle-royal and in the end Christopherson won.” During the preparation of this he wrote to his old friend: “I have for the sake of posterity referred briefly to your epic victory over Balfour—He did several of those silly things in his life—actions which were really quite absurd.”56 Decades later Lise Wilkinson in a talk at the Wellcome’s 150th anniversary echoed this story of Balfour: “Some of his excursions into experimental science there [Khartoum] even ended in public defeat, as in one case of the naming of the tick-borne spirochaete of African relapsing fever, when he objected to the label of spirillum recurrentis (now Borellia recurrentis) bestowed on it by J. B. Christopherson at Khartoum—a battle royal won in the end by Christopherson.”57

54 H.H. Scott, A History of Tropical Medicine. Vol. II (Baltimore: The Williams & Wilkins Co. 1939), p. 783. 55 G.W. Hartwig, & K. David Patterson, Disease in African History. (Durham NC. Duke University Press. 1978), p. 208. 56 Manson-Bahr, Sir Philip to JBC 13 February, 1954. In possession of the author. 57 L. Wilkinson, Anglo-America Medical Relations Historical Insights, at the meeting to commemorate the 150th anniversary of Sir Henry Wellcome’s birth. 19–21 June 2003.

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Walter Ormerod wrote: “[it was] clearly something of a storm in a teacup . . .”58 The story seems never quite to lie down. It bobbed up again when in September of 1931, Christopherson wrote to the Wellcome Bureau Librarian looking for the telegram he had sent “in about 1910 or 1911” addressed to Sir James Cantlie.59 Shortly the librarian wrote to confirm they had found the telegram and that it was in fact 1909 and had been received by C.W. Daniels of the London School of Tropical Medicine (LSTM), as it was then called, who remarked to the editor of the Journal of the Royal Society Of Tropical Medicine: “As far as I am aware this is the first observation of the kind from the Sudan and I should be much obliged if you will inform the meeting of the contents of the telegram.”60 The telegram had been noted in The Journal of Tropical Medicine and Hygiene, Volume XII November 15th, p. 347 and a few paragraphs received and printed on December 1st. p. 353 under the title of “spirillum found in cases of relapsing fever in the Sudan,” confirm this. A first observation of something already discovered and named, but now found in a totally different location, is of scientific importance. Today, in the twenty-first century, the first report of birds infected with avian flu in yet another country is front-page news, for the public as well as the medical community. It must have both hurt and infuriated Christopherson when he read, in Balfour’s Fourth Report, a paper by Bousfield on the subject of relapsing fever that ignored Christopherson’s priority in this field. Bousfield wrote: “I believe relapsing fever had never been diagnosed in the Sudan before Captain A.G. Cummins, R.A.M.C., reported it in two cases . . . . Late in 1909 a case was found at the Civil Hospital at Khartoum, and this case apparently came from Egypt, as did five of the six cases treated at the Military Hospital Khartoum.”61 Bousfield was completely in error in his statement. The case found late in 1909 was of course Christopherson’s twice-published report of his case. The important feature was not as Bousfield reported it as ‘coming from Egypt.’ Rather it was as described by Christopherson, that although

58

W.O., Op. cit., 11 November, 1999. WTI/RST/C8 Sir James Cantlie founded The Royal Society of Tropical Medicine and Hygiene in 1907. Their Telegraph address was ‘Plasmodium.’ 60 WTI/RST/C.8. 19 November, 1909. 61 A. Balfour, Ed. Fourth Report. p. 62. 59

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the soldier was originally from Egypt, he had “left for service in the Sudan three years ago. He has not been south of Khartoum, having done all his military service at Khartoum, Omdurman and district.”62 This did indeed make Christopherson’s case as the first identified in Sudan, and of Sudan. Bousfield had incorrectly identified both the patient and the origin of his disease. Further misinformation followed via Squires: The first reported case in the Sudan occurred at the end of 1908. [Squires is incorrect as was Bayoumi who quoted him thus, demonstrating the danger of not going back to the source; it was 1909]. The patient was an inhabitant of Wadramleh, a village some fifty miles north of Khartoum and had been admitted to hospital in Khartoum. The spirochaetes were found in routine examination of the blood by a Syrian medical officer and their presence later confirmed by Christopherson.63

Would it have been possible for Balfour and Bousfield both not to have known about Christopherson’s assertion? There was a space of perhaps two years between the publishing of the telegram and letter in major journal and when it found its way to the Wellcome Lab library in Sudan. It stretches credibility to suggest that neither of these physicians, Balfour in particular, who had done such a volume of work on these spirochaetes, (although mostly in fowl), could possibly have missed it. Squires appears to be the only source found so far mentioning a Syrian medical officer as responsible for finding the spirochaete and noting Christopherson as only confirming the finding. For Christopherson to take full credit for finding the spirochaete is unusual; he was known for generously giving credit to his juniors. I can only suggest that he was so irritated and upset at constantly being bested, that his left his goodwill by the wayside.

62

J.B. Christopherson, Spirillum found in cases of Relapsing Fever in the Sudan. J. of Tropical Medicine and Hygiene. (1 December, 1909), p. 353. 63 H.C. Squires, The Sudan Medical Service. p. 42. NB. Squires does not cite his source for this.

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Dr. Sheffield Neave, Travelling Pathologist, and Colleague of Christopherson, Was Also Soon in Trouble For some time now Balfour had felt the need for what he termed a Travelling Pathologist and Naturalist attached to his laboratory. Henry Wellcome also enthused over the idea and agreed to finance such a position for a period of three years. Dr. Sheffield Neave was engaged in 1904 to collect for the Wellcome Lab. He was fifty-two, a product of Eton and Oxford, and an amateur scientist who qualified in medicine around the age of forty.64 With experience of a number of entomological field trips in Africa and geodetic survey work in Northern Rhodesia plus medical know-how, he looked to be a good choice. It took Dr. Neave six weeks to collect equipment and make the journey out to Sudan, then his actual collecting safari used up four months. It proved to be a rugged assignment. He described the conditions experienced on one section of the trip at a camp on Bahr-El-Jebel, and in 1906 his nineteen-page paper detailing his work was published in Balfour’s Second Report: In all I made some 800 blood slides, and it has been a matter of great labour examining them. While at work in camp the thermometer was often up to 110 F. and over in the tent. This, together with numberless flies attacking one’s face and Myzomyia [type of anopheles mosquito] attacking one’s legs, etc, made life unpleasant, especially when it is remembered that two hands are required when examining a blood slide under the microscope . . .65

On the dura [local grain] famine, which he observed during his travels that year at Bahr-El-Jebel he wrote: The natives were much emaciated, especially the women. On remarking on the emaciation of his women to a Bari, he explained that the men went out hunting and fishing, but it was not the custom to bring home anything to the women, who were dependent on the grain: besides, ‘A man’s belly is easily filled, but a woman’s requires much.’66

And finally, at Bahr-El-Ghazal:

64

S.H.M. Neave, father of the more famous Airey Neave. Member of Parliament. Assassinated by the IRA. 65 RWRL (1906), p. 189. 66 Ibid., p. 190.

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chapter six I had only time to hurry . . . through the country, and that I made the best use of my time is, I think, shown by the fact that I walked some 400 miles in twenty-seven days, including the distance from point to point.67

Dr. Heather Bell notes in her book that Neave was ‘dismissed.’ Given his information-packed article in the Second Report, including the story of his epic walk across the desert, this statement seemed extraordinary. A reading of the circumspect letters between Balfour and Wellcome left more questions than answers. Wellcome had interviewed Neave and been somewhat dismayed that the doctor had “pressed very hard for the permission either to do geological work himself or to take with him a geologist to be associated with him and to share expenses.” The very idea had alarmed Wellcome who considered such work “would be fatal to his success as pathologist and naturalist.”68 Wellcome also smelled potential trouble. Should gold or other precious metals be discovered en route this could amount to temptation and he was not having that, not on his money. He put a special clause in the contract to guard against such an event. Neave, if one reads the nineteen pages he submitted to Balfour, appears to have achieved a lot in challenging conditions. Some of the information included notes of what did not exist or what could be better prepared for on a second expedition. But, for some reason not explained, both he and a Mr. Bright, who accompanied him, were dismissed. Wellcome wrote to Balfour: “I am very sorry that it was found necessary to terminate Dr. Neave’s engagement, but I cannot question the wisdom of the source in the special circumstances.”69 Wellcome then wrote to James Currie, Director of Education at the Gordon College: “You may rest assured that I feel satisfied that you have been guided by only the highest motives . . .” He also mentioned “an investigation” leaving the reader to conclude that Currie had learned something untoward about Neave and his assistant.70 As usual, exactly how Dr. Neave had transgressed is not spelled out, Wellcome wrote that he would discuss things more fully with Currie and Balfour later. In the absence of other information it is also worth

67 68 69 70

A. Balfour, Ed. RWRL (1904), pp. 186–189. WF/C.01/01/07. WF/E/01/01/09. Ibid.

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considering that on occasion the dismissal of a subordinate may say more about the dismisser than the dismissed.71 Neave, obviously stung, wrote in his report of his Sudan expedition, “I deplore the absence of further opportunity to verify and work out the indications many of these [blood film examinations] matters give.” This comment, surprisingly, was left in by Balfour, the editor, and had I not read earlier that Neave was dismissed, I would not have made much of his comment. Balfour wrote blithely and enigmatically, “Although it has been impossible to retain Dr. Neave’s services for a second period of six months, he has achieved a considerable amount of valuable work, often under very trying circumstances, . . .”72 And with this praise, Neave returned reluctantly to England where he continued to make a name for himself in the world of zoology and entomology, and for all the most admirable reasons. Neave may well have enjoyed the company of his colleague, Christopherson. He appears to have had privileges in Omdurman Civil Hospital, at least in March of 1904, as he published a paper in the BMJ in May on a case of Leishmania donovani in a patient in Sudan at that time.73 “The case [H.B. a boy of eight] was under the control of Dr. J.B. Christopherson, and it is by his kind permission that I publish this account.” It was, as he claimed, the second instance of leishmania found in Africa, an earlier case occurred in Tunis that same year. Neave says that on April 14th he told Balfour of the discovery and Balfour “. . . deemed it of much more importance than Dr. Christopherson and myself.” Balfour at once telegraphed to Major Ronald Ross (of malaria fame) who was also interested in Leishmaniasis. Balfour followed the telegram up with a letter to Ross commending Neave as the “fortunate discoverer of the parasite.”74 A number of tests were done on the blood of this patient “with a view of possibly discovering another phase in the life-history of the organism . . .” and in a paper on Trypanosomiasis

71 In fact, after discussion with John Symons, late of the Wellcome Institute, London, I came to the conclusion that Symons’ information about the rigidity and stubbornness of Henry Wellcome, who would fire people who had worked for him faithfully for many years, but had indulged in some minor transgression, was most certainly what had happened to Dr. Neave. It is not known where exactly Neave strayed from the Wellcome path, but stray he did, and Wellcome gave no quarter. Neave’s family know nothing of this and Dr. Neave went on to a stellar career. 72 RWRL 1906, p. 9. 73 Sheffield Neave, Leishmania Donovani in the Soudan. BMJ (28 May, 1904), p. 1252. 74 LSHTM Ross Archives, File 51/192 .

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in Sudan in the BMJ in November, 1904, Balfour again noted that the Leishman-Donovan bodies had been found. Recently another observation on this story came to my attention. As one might expect, other writers have been interested in these early medical pioneers. With the aid of the indispensable Google, I found Dr. Ahmed Adeel’s essay, J.B. Christopherson: A forgotten Pioneer of Tropical Medicine in the Sudan, on a web site. “Sheffield Neave,” he wrote, “did the first splenic puncture in Omdurman hospital and diagnosed the first case of Kalazar [sic] in the Sudan in 1904.”75 That was only a few months after the first case of kala-azar in the world literature was diagnosed by splenic puncture and reported in the BMJ by Charles Donovan in 1903. At that time cases of kalaazar in Sudan were considered as “malaria not responding to quinine”. Researchers in the WTRLK were on the wrong track. They were looking for Leishmania in monkeys after the advice of Ronald Ross.”76 Dr. Ahmed Adeel also later commented to me that he found it odd that Balfour had “failed to express his appreciation of this discovery in the First Report of the Wellcome Laboratories.”77 He mentions Neave’s success in a footnote only and does not mention Christopherson. Perhaps even this oversight or slight was the beginning of trouble between these two men. Neave’s gift of his travelling microscope to Christopherson was significant.78 Although it is not known whether, in Sudan, Christopherson already had access to a microscope, we know he used this one avidly. He thought so much of this gift that he carefully labelled it: “Travelling Microscope of Sheffield H.M. Neave MRCP, Millgreen Park, Ingatestone, Essex. Given to JBC 1904.” It is most likely that this had been bought with Henry Wellcome’s money—we know he paid for Neave’s equipment—so was destined to remain in Sudan. Christopherson had stern words for any physician who ignored using a microscope. “A doctor who cannot himself intelligently examine faeces and translate into practical values what he sees should not be doing

75

BMJ (28 May, 1904), p. 1252. www.geocities.com/aaadeel/JBC.html 77 E-mail to author 22 June, 2007. 78 It was probably handed over to JBC because it had been part of the equipment paid for by Henry Wellcome who financed the travelling pathologist. The microscope is now in the possession of Dr. T. Peter Ormerod. 76

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6.2. Dr. S. Neave’s Microscope, given to JBC in 1904.

medical work in the tropics. A whole volume of medicine remains unknown to him. He is groping in the dark.”79 Dr. Adeel, wrote to me again to say: I know first hand what it takes to do a clinical trial in the Sudan. This is why I appreciate the diligence and perseverance of JBC. I could think of him sweating over an old monocular microscope in the heat and dust of Khartoum, with the sun as light source to diagnose the cases . . .80

Christopherson appears to have been fired with as much enthusiasm as Balfour and the others. These men were zealots with a mission, to save the ‘natives’ from themselves and to show them the benefits of British 79 80

BMJ (April 19, 1919), p. 481. Personal communication 5 May, 2005.

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civilization and British medicine. Sudan was a tabula rasa and on this they would make their mark for themselves and for their Empire. A comment in the Times Literary Supplement seemed to sum up their thinking: “. . . England . . . was bound together by a set of assumptions held so deeply that the English themselves were largely unconscious of them . . . .[they were] uniquely brave and incorruptible, and therefore uniquely gifted to rule over others.”81 It was for these reasons that they were unable to think the unthinkable, that is to say, to consider the point of view of those they had colonized.

81

TLS 11 March, 2005. No. 5319. pp. 11–12 Commentary by Dan Jacobson.

CHAPTER SEVEN

CHRISTOPHERSON’S DIFFICULT YEARS: SURVIVING DISASTER; 1908–1911

. . . somehow or another I always appear to pick up a friend at the last moment and am able to save the ship. —JBC to Said Bey

The Problem of the Missing Papers Towards the end of the first decade of the Anglo-Egyptian Condominium, in the comparative isolation of Khartoum, a high-stakes drama, over not just one but several incidents, played out under the relentless sun. All involved Christopherson in his capacity as Director of the Sudan Medical Department. Of course, this isolation was a two-edged sword. On the one hand, mis-information from the press or local gossips would not be so likely to travel back to England. On the other hand, Christopherson had some powerful friends in London who could otherwise have supported him; there were fewer friends on hand in Sudan. Now, almost one hundred years later, the crucial and frequently mentioned ‘Christopherson papers,’ the key to clarification of a major incident which resulted in an investigation by the Council of Secretaries, and three years later a formal Court of Enquiry, are inexplicably missing. I say ‘inexplicably’ because Wingate, and a number of others, certainly had read them and commented on them, and Wingate was known to keep absolutely everything.1 As a result it has remained for me to sort out the most likely truth from what is available, untangling events as I sorted one after the other from the plethora of excuses, innuendo and finger-pointing.

1 Personal communication from Jane Hogan, archivist for the Sudan Archive, Durham University, UK.

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During 1907, and the difficult year of 1908, Christopherson ploughed ahead with running the department and arranging for the first British nurse, Barts-trained Maria Pye Moore, to come to Khartoum from her prior position at the Anglo-American hospital in Cairo. In the end Nurse Moore, daughter of a Welsh farmer, was hired in early January 1907 with a contract that included extra money for washing [laundry], and for forage for a donkey, her transport. When the new hospital was opened in 1909 she became the Matron. Until then she had worked without a murmur of complaint in the temporary hospital, a mud-brick building containing thirty beds. As the only European nurse,2 and despite the primitive conditions, she “. . . cheerfully performed her duties . . .” for more than three years at the same salary before being considered for a raise.3 Christopherson had been battling to get properly trained nurses since he arrived. He reported his experience using local women: So far they have been a failure as regards training for Nursing is concerned, they are indolent, incapable of learning and quite unfit to be left in charge. They soon grow tired of anything they take up, this can only be expected from women who are almost savages from the point of view of mental development.4

His report also states that the hospital was dilapidated, with roofs collapsing to the extent that patients refused to remain. He asks for an out-patient room for the 13,000 out-patients “who attend yearly—they are at present examined and treated in the office”5 He had also written to Civil Secretary Phipps in 1906 for a house to serve as a nursing home: “an annex to the present [Khartoum] hospital which simply requires augmenting . . . to make it a thoroughly good hospital.” Th is would be “a small Government Nursing home and charge adequate prices . . . on business-like lines and not as a charity.”6 In November of that year he wrote: I must say this, that it is not fair to any European doctor or nurse to ask them to look after typhoid fever and dysentery cases in a mud brick home.

2

She was joined by nurse M.G. Jones in 1908. JBC. 24 March, 1910. CS/CRR/814. 4 Annual Report, SMD 1908 Sud.A PK 1561 GRE. p. 224. 5 Intermediate Annual Report: Sudan Medical Department. 1909. SudAPK 1561 GRE. p. 414. 6 JBC to Phipps 30 May, 1906. 3

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Any single Englishman in Khartoum may get either of these illnesses at any time and it is folly to further handicap his chances—already diminished by the climate—by an unsuitable house. If the nurse herself is not looked after she will not remain. She must be in a position where her safety can be looked after and be conveniently placed for the doctors. The Home is proposed especially for the more fortunately placed class of British official and I appeal for a house in the best quarter of town—with a verandah and an upper story if possible. I think this will be the means of saving somebody’s life.7

One may imagine that this last might strike a chord with the European community. During 1907 the stalwart Nurse Moore remained right through the summer while her boss, Christopherson, took his annual mandated leave. The heat must have been soul-destroying. In sending Wingate an update on the medical department Christopherson had enclosed a letter from Nurse Moore, unfortunately not found. Only Christopherson’s comments on it remain. By reading between the lines we infer that the new nurse had worked admirably and had been mending fences with regard to the tensions between civil and military medical personnel. Nurse Moore’s first year in Khartoum seems more like a test both stamina and diplomacy, and she succeeded in both. “I think that the nurse has justified her presence in Khartoum during the summer and has satisfactorily shown that trained nurses can remain and work (she has done so under not the most favorable conditions.)”8 Maria Pye Moore retired in 1930 with a special grant of 3,000 Egyptian pounds for her ‘unique services,’ declaring that her years in Sudan were the happiest years of her life. In retrospect, the twenty-three years of Nurse Moore’s tenure in Khartoum could be considered one of Christopherson’s finest, if unsung, achievements in the Sudan Medical Department.

7 8

JBC to C.S. Phipps 19 November 1906. CS/CRR/814. JBC to Wingate 14 September, 1907. SAD 281/3/90.

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chapter seven The Pharmacy Problem: Who Is Selling Drugs Illegally?— The Background Story

Naturally the Khartoum Civil hospital had a pharmacy.9 In 1904 there was an announcement in The Sudan Gazette under the heading ‘Khartoum Civil Hospital;’ that a dispensary had also now been established in the Government Buildings near the Banks for the civil inhabitants of Khartoum who could not afford to pay for medical advice.10 For other than urgent cases, the dispensary would commence seeing cases at 7 a.m., except Fridays, until all outpatients were seen. A dispenser would be living on the premises and a British Medical Officer would also attend at stated times. It was not mentioned, but was likely well known, that British doctors were in short supply. The last item in the announcement read somewhat confusingly: “Until the establishment of a qualified chemist in Khartoum the public will be allowed to purchase medicines at the dispensary at charges approved by Government between the hours of 4 p.m. to 6 p.m.” By 1905 the Sudan annual Medical Report noted five Medical Inspectors (British, including Andrew Balfour for the town of Khartoum), thirteen native doctors and three apothecaries.11 In other words qualified medical help was stretched thin over this huge country, even though the facility described above was really only intended for the northern half of Sudan.

George Morhig Alleges . . . Around June 1906, George Morhig, a Lebanese Christian, established a pharmacy for the town of Khartoum. At once an agreement was drawn up governing who might, or might not, purchase drugs from the Government hospital pharmacy. In spite of this, the sale of drugs from Khartoum Civil Hospital pharmacy to unauthorized buyers was uncovered. This cut into Morhig’s profit, and by 1908 he was quick to 9

Sometimes referred to as a ‘dispensary.’ Sudan Gazette SAD SudA + PK1540 (1904–1906), p. 230b. 11 The distinction or definition of terms is not made—one wonders if it was perfectly clear to everyone that an apothecary and a dispenser were not the same. Presumably a physician could write out prescriptions, an apothecary could mix and dispense and a dispenser could only dispense over-the-counter drugs or those which had been pre-designated. 10

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complain to both Christopherson, Balfour and Civil Secretary Phipps. The hospital pharmacy was Christopherson’s direct responsibility, with consequences to be expected when things went wrong. Balfour and Phipps, neither by now kindly disposed towards Christopherson, and with sentiments returned in full, soon jumped into the pharmacy row. In a very long letter largely dealing with this and even more serious charges against him (about which more later), Christopherson wrote to his friend Said Pasha Shuqair. Shuqair was a Syrian official who served both the Egyptian and Sudanese government as director of accounts and later as financial adviser. Shuqair was a man of some significance, and presumably a friend to be counted on, to whom Christopherson wrote freely.12 Regrettably we don’t have the Pasha’s answer. Nevertheless Christopherson’s fury comes through loud and clear for a picture, one-sided of course, of the circumstances: Balfour is a very malicious chap. Just before he went away he went to Morhig and told him to write to C.S. [Civil Secretary Phipps] and complain of my selling in the dispensary, drugs to un-authorized persons. Morhig laid several traps (One of wh. caught my impetuous Corporal and Storekeeper and I saved the situation by discharging him on the spot). Morhig also spent a few hours each morning behind a pair of field glasses making observation on the patients. The result of this was the devil of an attack on ME to the C.S. [Civil Secretary Phipps] (who loves to engineer rows) and get to the bottom of any holes in case there might be something to tell Master [Wingate] about etc. I am coming out of this all right on top I think but it is damnable having to devote my time to these stupid attacks and it gives people the opportunity of saying that I am running my show badly.13

From this, one can deduce that sides had been picked and open warfare declared involving Phipps, Balfour and Christopherson. There was some substance to Christopherson’s comments on Phipps’ role here; the Civil Secretary acted as eyes and ears for the Sirdar who, more often than not, was out of the country. In this role Phipps seemed to relish a bit of intrigue and gossip. When it came to British versus Lebanese, even Phipps’ fury was tempered in favour of his own ethnicity and class, i.e., British and an

12

Said Shuquair Pasha was knighted in 1924. JBC to Shuquair, Said. Exact date not known but approximately early June 1908. SAD 494/11/2. 13

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Army Officer. On 27th June 1908 Phipps wrote to George Morhig after hearing that Morhig had written letters of complaint to Christopherson on the 16th, 17th and 20th June, and that Morhig had not felt that a visit to Christopherson would be useful. Phipps, knowing well that the problem must be settled on good terms all around, laid out the facts as he saw them and no doubt as Christopherson himself saw things too: You opened your establishment with the understanding that all sales to private persons should be discontinued from the Government Dispensary at Khartoum. The Director Sudan Medical Department, issued instructions to his subordinates to this effect with the practical result that the cash taken for sales has dropped from £E 91.450 m/ms from June to September, 1906, to £E 16. 380 m/ms for corresponding months in 1907, which shows on the face of it that Dr. Christopherson’s orders are being adhered to.14

The above was part of a long conciliatory letter, explaining that any culprits caught stealing were immediately discharged, and that to make matters clearer a public notice of the rules would be issued. Phipps ends his letter by suggesting that Mr. Morhig should visit Christopherson and, that he, Phipps, would be willing to send an independent Government Official along to the meeting “and I have no doubt that by this means the whole situation can be cleared up and the former friendly relations between you and the Sudan medical department resumed with mutual benefit to both parties, and the sooner this can be arranged the better.”15 At this juncture a mystery doctor, Dr. Michu (sometimes spelled Michou) and referred to, unlikely as it sounds, as a ‘Greek doctor,’ is added to the story. In letters to Wingate on the 14th of June the indefatigable Phipps had claimed “there are now series of accusations against him [Christopherson] for selling drugs to private people. Altogether the situation is not nice with Michous [sic] and Morhigs [sic] as accusers of a British? Official.”16 Phipps’s suggestion by writing ‘British?’ that Christopherson was not British was the sort of slight calculated to be offensive in colonial times. Christopherson was most certainly British. There is a whiff of ‘not one of us’ and therefore perhaps not fitted for ‘our club.’ It would

14

Letter from Phipps to George Morhig 27 June 1908 courtesy of Alfred Morhig, London. 15 Ibid. Morhig letter. 16 Phipps to Wingate 14 June, 1908. SAD 282/6/50.

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not take much to begin an unpalatable rumour, and connecting this with his ‘native’ friendships would add fuel to this particular fire. Then on 18 June Phipps continued his attack: “In the mean time Morhig sends in letters with proof of the S.M.D. selling drugs & to non official or poor people contrary to the guarantee given him M[orhig] when he started has had the effect of making Christo bestir himself and he is under my instructions taking strong measure to stop all this game. Which appears to be entirely sub rosa as no entries appear in his books.”17

The Morhig Connection Brought Up to Date In 2003, as suggested by another researcher, I visited René and Sonia Malouf who live near Washington, D.C. Enthusiastic about my project, they instantly picked up the phone and put me in touch with their good friends Alfred (son of Pharmacist George) and Madeleine Morhig, in London. Alfred and Madeleine live in England now, and I was able to visit them later that year. They are still angry at having their “. . . business, estates and personal effects . . . all nationalised without any compensation whatsoever . . . everything . . . pillaged in the crudest of ways . . . removed from Sudan at a moment’s notice . . .” in the 1970s coup.18 Alfred used the word “piracy” and pointed out that even Idi Amin gave his Indian population three months to vacate Uganda. Interestingly, Morhig’s letter from Phipps, quoted above, is kept by Alfred in a security box in London. Along with a few postcards taken by his father, this is all that remains of what had been a flourishing pharmaceutical and importexport business covering a city block in Khartoum. “We left everything” Alfred told me, “even the pictures on the wall.”19, 20 Alfred remembers his father as holding a high opinion of Dr. Christopherson. Perhaps peace was made and honour restored. It was all a long time ago.

17

Phipps to Wingate 18 June, 1908. SAD 282/6/57 Letter from Alfred Morhig to the author 7 July, 2003. 19 Morhig’s pharmacy introduced Burroughs & Wellcome products to Sudan and the Morhig name was better known than that of the Sirdar. Personal communication from Alfred Morhig 1 January, 2006. 20 Henry Keown-Boyd, who lived in Sudan and wrote a number of books on military history there, recalls Morhigs as being the ‘Fortnum & Mason’ of Sudan. Personal communication 2 January, 2006. 18

7.1. Morhig’s English Pharmacy, Khartoum.

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A decade after Christopherson left, sometime in the late 1920s, Dr. C.E.G. Beveridge, another medical officer in Sudan, caught one of the hospital dispensers, a man who was about to set up his own pharmacy, stocking it from the hospital pharmacy by daily trundling his loot away in a baby carriage.21 The challenge of guarding the pharmacy continued.

Serious Trouble in the SMD The years 1907 and 1908 were difficult. One of Christopherson’s jobs as Director of the Department was to select young physicians suitable for work in Sudan. In early March 1907, he was staying at the Ghezireh Palace Hotel, Cairo, from whence he wrote to Wingate. He had picked four men (one of these was a Russian, Dr. Joseph Maschoieff ), three for existing vacancies and one “because I wish to drop a man whom I consider unsuitable and not up to the standard.” There was a shortage of medical personnel graduated from the Kasr-el-Aini School of Medicine, Cairo. “During 1909–11 the School . . . did not graduate a single student, and admissions in any one year under British rule never exceeded 50.”22 This situation, which Christopherson must have known, elicited this paragraph in his letter: There seems to be a certain Masonic feeling amongst Mohamedans which renders it desirable to have Mohamedan doctors for the Sudan if possible, but practically Mohamedan doctors are all Kasr el Aini men and it is not necessary for them to go further afield than Egypt itself for a living.23 In a department like the SMD however there is a considerable amount of work for which it does not seem to me to be necessary to have cut and dried ideas about religions for instance out patients work for other government departments. Prisoner inspections and quarantine.24

A day later Christopherson was sounded out by Sir William Garstin’s private secretary to see if he would consider accompanying him on

21 Beveridge, C.E.G. Allah Laughed. Melbourne: The National Press. (n.d. circa. 1946), p. 89. 22 Amira el-Azhary Sonbol. The Creation of a Medical Profession in Egypt, 1800– 1922. (Syracuse: Syracuse U. Press. 1991). p. 111. 23 Egyptian hospital and medical school, Cairo. 24 Ltr. to Wingate from JBC. 8 March, 1907 SAD 280/3/13.

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a protracted trip in April.25 Sir William was advisor to the Egyptian Minister for Public Works, an important post. Christopherson, noting which way the wind was blowing, wrote privately to Wingate: Of course I should like to go but I couldn’t possibly leave my work. It seems to be an unfortunate failing of mine not to be able to convince people of the truth of my assertions. I evidently have been fitted with the wrong sort of face but if anything further is said will you say—unless you yourself want me to go—that the work of the department will not allow of my leaving Khartoum at that time. If Sir W.G. were ill I should be particularly glad to think that I might be selected to go but he probably won’t be ill, and so I do not think that it will be difficult to find a more suitable man than myself. Please excuse me writing privately about this before you have spoken to me but I do not wish you to think that I am indirectly asking to go nor that I think the Head of a department can go off on a pleasure trip of this description without the work being inconvenienced. Yours etc.26

However Wingate sent him a private letter asking him to do just that. Christopherson, still the preferred clinician for senior administrators and visiting grandees, hurried to comply and threw in an extra plea for the Financial Secretary to allow the Medical Department more men next year saying, “There is plenty of work.” Presumably the trip was accomplished and the Medical Department work seen to, because in late August Christopherson was writing to Wingate from The Rectory, Falmouth, Cornwall, his parents’ home. “Thank you very much for your jolly letter which gave me very great pleasure to receive.” It is a rather obsequious letter discussing the health of Wingate’s only daughter, Victoria, who will remain in England for a while: “notwithstanding Lady Wingate’s splendid watchfulness Victoria was not quite so robust at the end of the season as at the beginning—a little thinness and a little paler indicating some deterioration in the quality of the blood . . .”27 Christopherson added that he was struggling to master Freemasonic Ritual and “learning French which I hope to be able to fire off in Paris soon and incidentally to see the hospitals there . . .” 25 Sir William E. Garstin (1849–1925) Advisor to Egyptian Public Works Dept. (1905–1908). 26 JBC to Wingate 11 March, 1907 SAD 280/3/27. 27 “There was a current XIXth c. diagnosis of ‘green-sickness’—in pale and wan girls, usually . . . really iron-deficiency anaemia . . . If they were in the tropics, it was always a matter for discussion—are they losing their English-rose looks? Should they be sent home?” E-mail communication Dr. Pauline Mazumdar, U. of Toronto. 17 December, 2005.

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Wingate was Grand Master of the Masons in Egypt and Sudan so there was reason to mention his efforts in learning the complicated questions and answers associated with the ritual. Freemasonry, referred to by Eric Hobsbaum as an “. . . invented tradition of great symbolic force” played a part in heightening the exclusivity of the British hierarchy, influence and authority, to say nothing of secrecy and the mystery of their power.28 One wonders about Christopherson, a bit of an iconoclast, currying favour with Wingate via Freemasonry. Did he really believe in all this ritual? He doesn’t seem the sort of man to waste time on this; but he did and there are certificates to prove it.29 His long letter gives chapter and verse on the difficulties of getting office staff, whom the Financial Secretary would like engaged, for a pittance. His gambit was not successful and Christopherson suggests he must have financial authority to engage men at a realistic enough wage to have them remain on the job. He finishes by sending “love to Victoria.” Although August 1907, when the letter was written, was supposedly on the cusp of the maelstrom stirred up by Secretary Phipps against Christopherson, the Sirdar and Christopherson seem on almost familiar terms. Wingate addresses him thus: “My Dear Christopherson . . . I hope you are having a real holiday and not occupying it altogether with professional work. I am sure you wanted a thorough rest.”30 Frequently there are letters mentioning Phipps’s suggestion that either Christopherson or Acland, as the senior men, should be called in to discuss the health of a particular high level official; in August of 1907 it was Sutherland Bey, at one time Governor of Bahr al-Ghazal.

28 E. Hobsbaum and T. Ranger, Eds. The Invention of Tradition. (Cambridge: Cambridge U Press. 1983), p. 6. 29 Freemasonry: Wingate was District Grand Master. It is not known whether Christopherson really wholeheartedly endorsed the idea of Freemasonry or how much he considered it politic to belong. It certainly was advisable in such a politically charged situation as Sudan. In 1908, right in the middle of his personal troubles with the administration, he was appointed “District Grand Pursuivant” of the District Grand Lodge of Egypt and the Sudan. For some reason the second part of this document was not fully endorsed until eighteen months later when in January 1910 the Sirdar put his name to it. There was a similar delay when he was, in June of 1915 appointed District Grand Senior Deacon although this was signed in October of the same year, again by Wingate. 30 Wingate to JBC 20 August, 1907. SAD 281/2/122.

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chapter seven Phipps Moves to Get Rid of Christopherson

Christopherson was working solidly in Sudan all during the cooler winter season 1907–08. Then on 17 March, a particular letter from Phipps to Wingate showed how the picture had changed; hitherto, with the exception of the pharmacy issue, there had been no documentary suggestion of trouble, at least none noted in any correspondence found so far. The Christopherson case, so far not spelled out, was to be brought before the Committee of Secretaries. Phipps’s letter has a totally different tone. Although it begins with a mention of using Christopherson and his colleague Dr. V.S. Hodson to administer a medical examination to Colonel H.W. Jackson, the remainder of the letter was a personal attack on Christopherson. I am curious to see how the S.M.D. will take the Council of Secretaries remarks. I have thought a good deal over the whole question and am pretty well convinced Christo is only fit to be in charge of a Khartoum General Hospital, and should have no administration work for which, everyday, he shows himself less fitted. I do not think it really interests him, or I should not always be having to interfere between him & Hunter.31 I am sorry to say the more I think of it the more I feel [Dr.] Waterfield would be well away out of it. He is now pretty well spoilt, & his attitude over the pensions examinations shows a determined disregard which one might expect from a young man with Christo as his guide unfortunately. I expect you will find it best to put Matthias[sic]32 over them all, as Dir. Gen.! & give Christo a billet as Director of the Kh. Gen. Hospital, possibly Waterfield would stay as his assistant, I am convinced Christo won’t go unless he can’t help it, on account of the money he gets, which is all he thinks of.33

This is a wide-ranging letter addressing a number of problems, all having to do with allegedly serious, yet unspecified allegations, against Christopherson. A week later Phipps, becoming even more irritated, fired off another letter to Wingate. I note what you say about my views on the future of the S.M.D. The more I watch the more I see C[hristopherson]’s inclination is hospital work.

31

Hunter, George Douglas (1860–1922) PMO Egyptian Army, 1905–1908. Mathias, Col. [Dr.] H.B. (1863–1912) 1909, Mathias made Dir. General of SMD with combined responsibility for the military forces in Sudan and Civil Dept. By 1912 the civilian medical staff numbered seven. June 1912 Col. Mathias died in Khartoum Hospital and Major H.A. Bray of the RAMC succeeded him as Dir. Gen. 33 Phipps to Wingate 17 March, 1908. SAD 282/3/80. 32

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I’ve had great trouble with him today over a hopeless case of maladministration putting a military Medical man under a young Civilian native doctor. He cannot understand it, talks glibly of discipline of which he has absolutely no conception.34

It is likely that this letter shows Phipps’s irritations and biases clearly laid out, and at the nub of at least one of the problems. Phipps understands discipline in military terms, i.e., rank and ethnicity. Christopherson as a civilian saw things differently. One wonders whether he realized he was risking opprobrium? He may well have judged the civilian native doctor more capable or, perhaps they just worked better together as a team.35 Nothing more surfaces until early June, although there must have been undercurrents. Tempers would have been shorter as the sun beat down. Khartoum in June is an oven. Sick people must be attended to however stifling the heat, and there may well have been more patients as a result of the blanketing dust of the haboobs. That same month Phipps mentioned to Wingate that it was “Much cooler only 106 or so . . .”36 There was no electricity for fans or refrigeration, and the new hospital was not yet completed. To some degree Phipps is correct. Christopherson was better suited to clinical work; perhaps the administrative work had simply got the better of him. In a letter to his friend Said Shuquair, he recited the multitude of tasks he is bombarded with: I do not pretend to be Napoleon but I am doing my best with what I can get and sometimes, when [Dr.] Waterfield is away and I have to be Physician, Surgeon, Director—Medical Inspector—do operations many big ones at K.C.H, Quarantine specialist, Sanitary Specialist for the Provinces write reports—frame regulations for Pension Examinations, revise Hospital regulations—Answer letters, receive telegrams—count the drugs and instruments and generally turn my hand to anything either professionally or officially—I feel that I am doing the Collar work and that someone else is doing the Parade work.37

34

Phipps to Wingate 24 March, 1908. SAD 282/3/145. We don’t know who this was. The term ‘native,’ according to René Malouf whose father was Lebanese Christian doctor in Khartoum at the time, referred to the Sudanese only. However it is doubtful whether, in 1907, there were any Sudanese doctors. There were Egyptians, Syrians and a few Greeks. 36 Phipps to Wingate 4 June, 1908. SAD 282/6/16 37 JBC to Said Shuquair Bey undated, but probably early or mid June 1908. SAD 494/11/4. 35

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The Mysterious Case of Dr. Michu/Michou, Intimations of ‘Unprofessional Conduct’ against Christopherson, and the Council of Secretaries’ Meeting The name Michu turns up in the disturbing and enigmatic series of letters involving Christopherson in his role first, as at Director of the Sudan Medical Department, and later from 1909 when he was in charge of the two civil hospitals. Michou is mysterious because his name has not surfaced before and because at one point he is referred to as ‘the Greek doctor.’ There are no Michu/Michous, or anything similar listed in the Sudan Gazette where appointments are usually noted, and from references Michou is reputed to have made about himself, one learns that he was not working directly for the Sudan Medical Department and is a ‘poor man.’ Sometimes he is simply identified as ‘M.’ He turns up as a reluctant and controversial character deeply wedged in this troubling episode of the 1908 Council of Secretaries’ meeting, and later the 1911 Court of Enquiry.

Are Michou and Maschoieff One and the Same Person? The name Michu sounds French so perhaps he was Algerian? It might be a nickname which would confound things even more. For a couple of exciting days in 2005, the mystery seemed solved. I had been looking at this question on and off for two years. Finally an important clue surfaced (or so I believed) in a letter written about a year before Christopherson’s death, from Manson-Bahr to Christopherson. Manson-Bahr had been writing the history of the London School of Tropical Medicine and in particular the biographies of the physicians who were involved. He was interested in reaffirming the timing of a visit he made to Christopherson at the Khartoum Civil Hospital and mentioned meeting ‘the Russian doctor with the unpronounceable name.’ In 2005, sitting in Toronto airport, en route to London and the Wellcome Institute, I showed my husband a copy of this letter. Immediately he made the leap of imagination that the name Michu/Michou must surely be a nickname used by the British—notoriously unable or unwilling to learn foreign names—for the Russian name Maschoieff, and that the Russian doctor with the ‘unpronounceable name’ must be

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Dr. Maschoieff possibly also known as Michu. That day we both felt as though we’d been hit by a thunderbolt of revelation. Nicknames certainly were used in Sudan among the British, Christopherson was referred to as ‘Christo’ by many. Maschoieff is thanked by Christopherson in more than one of his published papers so one may assume the spelling is as the Russian doctor wanted it. Only a researcher who has been stymied by such a seemingly trivial problem can appreciate the excitement of finding such a possible answer. Initially I felt sure it was the answer. This was not all. Upon returning home I Googled the name and immediately the Maschoieff family tree appeared. Dr. Joseph Maschoieff is shown as dying in Alexandria aged ninety-four, in 1974. His daughter Viviane Pescov Maschoieff was listed as ‘living’ at an address in Kensington, USA. Five minutes later I had her on the line: yes this was she, and yes, her father was the Dr. Maschoieff who had trained in Egypt and then Paris, before being hired for the Sudan Medical Department. The next question about papers, diaries and so on drew the customary blank. In 1956, at the time of the Suez crisis, the Maschoieff family had been ejected from Egypt and could take very little with them; in particular it was considered dangerous to carry correspondence in English or French. Nevertheless I stood to learn at least some anecdotes but, could I definitely say I now knew the identity of the mysterious Michu? His daughter said she never heard the nickname. At the club he was always called ‘Dr. Mischief ’ while being teased for being a teetotaller. As I had built my case to fit my hypothesis, I was also about to learn this could very well collapse like the proverbial house of cards. Maschoieff was actually interviewed by Christopherson, in Cairo, in the first week of March 1907.38 Even if he had arrived at Khartoum to start work within that week, his tenure with the SMD by June of 1908 would have been only fifteen months not twenty, so that when ‘Michou’ is reported by Phipps to have said “he had never had a patient from the SMD before in the 20 months he has been here,” immediately discrepancies of both with timing and authority were thrown into relief. The Russian was hired for the SMD by Christopherson, the Director. Dr. Michu, if Phipps quote is correct, was not of the SMD as evidenced

38

1907 8 March. JBC Cairo to Wingate. SAD 280/3/3.

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by his claim not to have had SMD patients. I now know a good deal about Dr. Maschoieff but Dr. Michou remains as elusive as ever. When Phipps in Khartoum wrote to Wingate saying that “Balfour has just sent in a long official letter on the Michu case . . . it is odd how Christo still does not realize he has been insulted by Michu . . .”39 the whole story resurfaced, at least in correspondence, and it must have been bubbling under the surface for over two months even though no documents have been found. Did Christopherson have his head in the sand or was he just too busy to get involved? There are several mysteries here. First, the ‘long official letter from Balfour,’ clearly no longer Christopherson’s friend, is missing. It is not in the Sudan Archive in Durham, nor in The National Archives, the Wellcome Trust Library nor the London School of Tropical Medicine and Hygiene Library with Balfour’s papers.40 Second, if ‘Michou’ were the Russian, Maschoieff, he is said by his daughter (a biased observer but nevertheless a reasonable source) to be a man well liked for keeping out of the fray. Maschoieff does not appear to have been a man likely to put himself in the way of trouble, yet we are told that Michou did just that. Perhaps having made a foolish move he found himself unwillingly enmeshed with very little room to maneuver? On 9th June Phipps wrote to Wingate, who was on his way to England to escape the summer heat, that the Council of Secretaries was now looking into the “Christo affair.” Christo’s attitude last evening was most painful. He said no friend came and told him to go and request Michou to withdraw his letter until Bernard kindly did! He asked me why I had not! I said everyman is keeper of his own honour.41 I much regret to say I have, since, as we were bound to do, telling Balfour of Michou’s withdrawal, heard Michou now is sending in a statement that he sent the semi withdrawal to help out a colleague, but that every word he wrote in his first letter is absolute truth. He also states he wishes to say this before any court of Inquiry. So I’m afraid it is all in the air. C had many patients round him waiting & was very busy. He, M. could not know what was in Cs mind He wanted to be friendly & have

39

Phipps to Wingate 4 June, 1908. SAD 282/6/16. Balfour’s papers before 1913 have not surfaced except for a very few he wrote to his mother, now in the SAD. 41 E.E. Bernard, later Sir Edgar Bernard, Financial Secretary, and his wife were lifelong friends of the Christophersons. 40

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peace. In writing his first letter he meant to clear himself for giving up the patient and not to charge C with unprofessional conduct. This is the gist of it all. I’m writing out notes of the interview (1 p.m.—3. 15 today) and C[hristopherson] is to make a statement on it. I think we must get M[ichu] to accept C’s explanation & withdraw his letter. As you will realise we are convinced there is really nothing in it & if C had behaved properly at first the question would have been settled at once. Private. L-S [Legal Secretary E.G. Bonham-Carter] & I of course are perfectly conscious C’s explanation is a fabrication made up of other’s ideas, or suggestions for his odd conduct, made by others. But that is the man & nothing will make him stick to the truth. I doubt his understanding Truth or Uprightness as we do. L-S & I after getting C’s explanation will wire you the results and our recommendations with regard to our previous ones sent last mail . . .42

Two days later, on 11 June, Phipps wrote another long complicated letter to his boss on the subject of ‘The Christopherson Affair.’ This letter with the pertinent section reproduced here is, like most of the letters from this period, from the Sudan Archive, Durham and is a good example of how Wingate dealt with such things.43 He annotated letters with comments and instructions down the side in thick blue pencil. I suggest that this particular letter, annotated as it is with three comments, all with question marks, and one section struck through with blue crayon, shows Wingate’s ambivalence towards Christopherson. On the one hand he admires and needs the doctor for his medical and surgical expertise, about which there was never any doubt, on the other hand he seems ambivalent, even perplexed and exasperated over the whole contretemps. Added to which, he was dealing with a delicate situation when the character of a British physician and a gentleman, one who had been there from the very early days, is being called into question. . . . Re Christo. Michou’s 3rd letter came in yesterday & LS [Legal Secretary, Bonham-Carter] and I interviewed M in my office this morning with Christopherson and [Dr.] Waterfield present. We saw C. first & he was anxious for M to be interviewed which LS & I had settled to do. But I thought we would see what he thought. M stuck to his point of the words used by C, and said no mention was made of the patient going to Hospital. Said he wrote second letter in C’s house & C helped him to write it, he said dictated first (N.B. C wrote to

42

Phipps to Wingate 9 June, 1908. SAD 282/6/38. Until JBC married in 1912 and was writing to his wife, there were very few letters extant in private hands. 43

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chapter seven Bernard I have his letter, that he could make no suggestions to Michou what to write!!)44

[written down side by Wingate “Drop it?”] We pressed Michou to say if C brought any pressure on him to write No. 2 letter. He said No! not at all nor expected any after it. He added that altho’ he had never had a patient from the SMD before in the 20 months he has been here, one did come last Thursday with a note, since torn up from Christo—a case he M could do nothing for. C said he could not remember sending the case C. explained that on seeing M that morning he associated a hospital case with him & if he asked if the patient was rich or poor. It was solely for the admission to hospital and M must realise such question could not refer to his C. getting a fee. M said no mention was made of hospital only assistance to take the puncture & he was very angry with C’s question about poverty or not. M [owned?] still and goodness knows when we shall settle it. I suppose I ought to tell you that Michou told a credible witness, tho’ of course he won’t own it now, that C. offered to send him many patients, do extra things for him if he would withdraw his letter, also C stood over him when he wrote it. It is certainly not Michou’s style. I have a note from C. to Col. Bernard in which he writes he could make no suggestions as to what M. should write.

[Wingate crossed out the whole paragraph and wrote down the side “Expunge?”] When all said and done it is one man’s word against the other and the only way to settle it is for the Govt. to tell C. to bring an action against M. or resign.

[Wingate wrote down side here “Drop the personal matter now?]45 I interpret the story as follows: The unfortunate patient in the middle of this maelstrom was a cerebro-spinal meningitis case complicated by pneumonia, whom Balfour had sent along with Dr. Michou for a lumbar puncture. Christopherson, neither wanting, nor having the time then to do something he felt Balfour or “his Assistant or Michou” could well have done, refused. Christopherson then claimed that he, being busy with patients all around (something confirmed by Michou) asked if the patient was poor, thinking that this patient had come to be admitted to hospital. At least this was his version.

44 45

E.E. Bernard, the Financial Secretary and friend of Christopherson. Phipps to Wingate 11 June, 1908. SAD 282/6/41.

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Michou then “threw up the case saying that as I [Christopherson] would not come without a fee why should he a poor man.” When the ‘Greek doctor’ had also given up the case, Christopherson sent one of his staff doctors to attend. So now we know (or do we?), that Michou is a Greek doctor? It was not long after first writing this that I spoke by chance to Henry Keown-Boyd, a historian of Sudan and Egyptian military history. It was actually his wife who came up with the suggestion that Michou was a diminutive of the Greek for Michael and not uncommon in Sudan, so perhaps this is the beginning of the answer? However this idea also came to a dead end. In any event Michou complained to Balfour, in writing, who sent it to Phipps who sent it on to Wingate. This chain of events must have fed the gossip in the Sudan Medical Department and at the various clubs for quite some time. Shortly Michou did a U-turn and wrote a second letter withdrawing the first, and then he wrote a third, where he flip-flopped again saying the first was correct. In digging himself in deeper he pulled everyone else in too. In a long letter marked “PRIVATE” and “tear it up” to his friend Said Shuqair Bey, Christopherson thanks Shuqair for a telegram alerting him about “B[alfour] receiving my letters.” Fortunately Shuquair did not tear it up. Although undated the content indicates it was written in early to mid-June 1908 and shows just how furious and beleaguered Christopherson felt at the time.46 His first target was Balfour whose behaviour over the earlier Wellcome Reports probably still rankled. Balfour seems to be bent on dragging me down by fair means or foul . . . now you see why the Englishman smiles when you talk about the Scot . . . no dung hill so foul but he will turn it over in the hopes of finding something useful in his indecent attempts to succeed in life at all costs. . . . Well what happened was this! B has been lately terrifying every body on account of a case or two of Cerebro Spinal meningitis which occurred here. (we have it every year in one part of the Sudan or another) Balfour was writing reports, isolating battalions—spraying with antiseptic lotions hundreds of soldiers noses and throats daily—looking down microscopes and looking up the records of other outbreaks—surrounding

46 Christopherson to Said Shuqair Bey undated but probably early to mid June, 1908. SAD 494/11/3.

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chapter seven houses with gaffirs (whereon of course all the patients friends ran away and would have spread it if it had been possible). The 4 sanitary inspectors kept galloping up to the patient’s house (when there was one) to enquire how it was getting on and then galloped to the Gordon College to report to Balfour and then Galloped back to the med director to write a report and then when one patient died—The MOH and Assistant MOH. 4 sanitary Inspectors most of the conservancy officials—he Sub Mamur and a posse of Police and Gaffirs pulled down the house and burnt all the valuable furniture and fittings usually found in a Soudanese Gentleman’s house and their clothes and marched off patients’ family and relatives of 4 generations back and neighbours to the Old Khartoum jail and kept them—hugely delighted—for 10 days—at Government expense and nothing happened—excepting compensation.47

This last really shows Christopherson’s antipathy towards Balfour. It also shows, although to a lesser degree, his sympathy for the ‘Soudanese.’ The diatribe against the Scots was truly ridiculous. The great Sir Patrick Manson was a Scot, as was Sir James Cantlie under whom Christopherson had worked years ago at the Seamen’s hospital, then John Chiene, James Currie, Dr. Innes, and many more with whom he had never had any problems, or at least any that surface in print. What follows next is Christopherson’s explanation for the quagmire in which he has managed to find himself. This last sentence seems both contrived and self-serving. I did not think if necessary for a man of my professional standing (The Director SMD) to defend myself against such a obviously stupid charge. It was malicious but it was not a criminal charge. I think my attitude throughout has been officially correct. I am sure that it has been professionally so. However Master put the matter before the Committee of Secretaries (and perhaps it will go before the Curate’s Stipend Committee before it is finished). Well, the night before the meeting I was told by. . . . That I had better get Michou to withdraw his letter. I refused at first but eventually next morning I sent a note to Michou and he knew what he was coming about and came voluntarily, wrote voluntarily, [two last commas inserted by author] copied it when I was away and this went to the Committee of Secretaries who were satisfied (and bored I should think) Hearing this Balfour actually went to M and then wrote to him and got him to withdraw letter no 2 and I was dragged up before C.S. [Civ. Sec. Phipps] and L.S. [Legal Sec. Bonham-Carter] and told: I said—better have

47

Ibid. JBC to Shuqair. SAD 494/11/5.

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Michou and M gave his version and I wrote out mine etc. I do not know what is going to happen but the whole thing is so mean and Scotch that I am disgusted, my one spark of comfort has been the Finance Elderton has very kindly helped me to compose counter-bombs.48 . . . I am coming out of this all right on top I think but it is damnable having to devote my time to these stupid attacks and it gives people the opportunity of saying that I am running my show badly . . .49

On the face of things it looks as though Dr. Michou was getting pushed and pulled. He certainly made a tactical error in writing to Balfour in the first place, and may have realized this later when it was all too late. In currying favour with one side, one can expect trouble from the other side. Perhaps having been in Sudan for only twenty months, he was not aware of the Balfour versus Christopherson disaffection. Also at that time it was not yet generally known that Christopherson would soon be given the opportunity to resign prior to the whole department’s undergoing a major shakeup. The Council of Secretaries more or less clarified the situation between the posting of two of Phipps’ letters to Wingate in the summer of 1908. The first on 14th June: Today LS & I have made up our minds on the Christo affair & a wire goes to you tomorrow when you will have got the papers. I am sending today the record of our interview with Michou. I’ve kept copies. Christo’s remarks show very clearly exactly what sort of mind he is. I have put one or two notes in pencil. L-S has stronger views than I have and is of opinion he ought to be got rid of. We have of course said nothing to C. . . .50

Phipps’s copies have not been found. On 18th June, just four days later, Phipps appealed to Wingate to make a statement, adding the weight the Legal Secretary’s opinion to his letter: “Also Bonham[-Carter] & I feel Dr. Christo ought to be told of the extent to which you think he has cleared himself. He has been at Atbara to see Crispin and so has not been here to impress on everyone how he has come out of it all “with flying colours” as he said to me the other day.”51 A closer look at Christopherson’s friends shows that at least two who were involved in this fracas were considered outsiders by Wingate and

48 49 50 51

Elderton, Major Roland Percy Somerset (1876–1958). JBC to Shuqair SAD 494/11/7. Phipps to Wingate 14 June, 1908 SAD 282/6/50. Phipps to Wingate 18 June, 1908 SAD 282/6/57.

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Phipps. Edgar Bernard, the Finance Secretary, was a Maltese Catholic and the butt of a number of bigoted comments; Said Pasha Shuqair was a highly placed Syrian official, later knighted. Although Christopherson’s other local friend, Dr. Zaki, must have been around at the time there is no mention of him. Of the Europeans, Major Rowland Elderton was certainly onside, so were Dr. Waterfield; Wasey Sterry, first legal advisor; James Currie, Director of Education, and C.H. Armbruster, Amharic scholar. All were known to be loyal and long-time friends. Certainly Christopherson was a man with enemies, but he was also a man with friends. The new nurse, Maria Pye Moore, must have known something, even sensed an atmosphere of some tension, seen various comings and goings of her boss, notes being delivered. Yet years later, looking back, she remembered nothing but happiness from her years in Khartoum Civil Hospital. Christopherson’s character had been called into question; it had been suggested that money was a driving force for his behaviour. Certainly he was cautious with money, and given that he married late one would imagine he had enough money put aside not to have to worry, but worry he did. Such frugality does not make him avaricious. Phipps’s spiteful letter suggesting that Christopherson was only interested in money says more about Phipps.52 It is highly out of character for Christopherson to turn away a patient who could not pay. His history does not demonstrate this. It demonstrates a hasty man with a stubborn streak, given to rash statements and, like others in Sudan, not above toadying to the Sirdar. Found among Christopherson’s papers are a few lines copied out in his hand on a scrap of folded paper which would seem to underline his personal credo: A Christian has no sect He can dwell in the midst of sects and Appear In their Services without Being attached or bound to any. He hath but one knowledge and That is Christ in Him. Jacob Boehme53

52

Vide Phipps letter to Wingate. 17 March, 1908. SAD 282/3/80. Jacob Boehme (1575–1624), a great mystic writer, Teutonic theosopher, influenced by Paracelsus. 53

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A Temporary Dénouement in the ‘Christo Affair’ Only one letter survives from this ‘believed to be final’ instalment of the ‘Christo Affair.’ It is from Wingate to his old friend and personal doctor, Acland, on 29 November, 1908. My Dear Theodore, This is only a line to tell you that we fully discussed the Christopherson case before the Central Government Board Last Monday, [ November 23] and I enclose for your private information an extract from the Proceedings dealing with the case. I have not yet had any reply from C. and suppose he must be turning it over in his mind. The Board was absolutely unanimous in the view they took, and I think that C, for his own sake, will make a great mistake if he refuses to accept the offer made to him by the Sudan Government. Of course one cannot but sympathise with him in the feeling that he has been a failure administratively, but that fact in no way militates against his professional ability which, as both doctor and surgeon, is in my opinion of a high order. Therefore I think it would be a thousand pities if he allowed his feelings to militate against his professional career. However, in these matter a man must decide for himself, and although I think C. has many excellent qualities, there can be no doubt that he has altogether failed to obtain the friendship or confidence of any of his profession, including even those actually in his own Department. I suppose it is a peculiarity of his nature and I am afraid that these defects, or whatever they may be called, had a good deal to say to his want of success in south Africa and other places. I imagine that if C. refuses the appointment he will at once go home and will probably endeavour to stir up trouble amongst some of his powerful professional friends in London, but I am sure that you and any of his real friends will do what you can to prevent him making a fool of himself . . . I think it is now fully understood that the present failure is due to the personal equation and that had there been at the head someone endowed with real administrative ability and tact, we should not have been forced into this temporary retrograde step. . . .54

I suggest that the words ‘real administrative ability’ and ‘tact’ are the operative words here.55

54

Wingate to Dr. Acland 29 November, 1908 SAD 284/3/68. Examples of his forthright or tactless style of writing can be found in the Annual Medical Reports of the Department. These, presumably were not only read by Europeans: “Native Women as Nurses . . . they are indolent, incapable of learning and quite unfit to be left in charge. They soon grow tired of anything they take up, this can only be expected from women who are almost savages from the point of view of mental development.” Sudan Annual Report of the Medical Department, 1908 (Sud. A PK 1561 GRE) Christopherson’s report writing is so distinctively his that there is no need 55

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The ‘extract from the Proceedings’ sent to Acland has not survived. The Central Government Board was not a Court of Enquiry. That particular event would take place in 1911 when some of the same problems would emerge again. Wingate’s letter is clear. Christopherson was given a practical offer, step down from the directorship of the Sudan Medical Service and accept directorship of the two civil hospitals, Omdurman and Khartoum, or—the ‘or’ is not spelled out. Implied is “go home,” or perhaps that he had the alternative to bring an action against Dr. Michou. Undoubtedly this was a difficult time. He had to acknowledge his administrative failure, although specifically where he failed, apart from the pharmacy thefts issue and his tendency to ignore military protocol, is never made clear. His proficiency in surgery and medicine is acknowledged, as is his reputation in England and his influential friends there. The statement that he has no friends is patently untrue as discussed earlier. The hint at his trouble in ‘South Africa and other places’ remains puzzling. I can only assume that Phipps enjoyed spreading rumours when he could. His letters show a considerable determination to dislodge the doctor. Christopherson, for his part, seemed not too concerned about whom he crossed swords with, as long as it was not the Sirdar. I suggest that if Wingate could be so wrong about Christopherson’s perceived lack of friends, he could be wrong about other stories too. The small European community on the Nile seems to have been thick with jealousies and rumour. The SMD was certainly ready for a major shakeup. Once the dust had settled Colonel Mathias, Director of the Medical Department, was at the helm; Crispin was “brought back from Port Sudan to become Assistant Director. . . . Waterfield took over from Crispin at Port Sudan.”56 Christopherson was settled in the work he did best, clinical work. In January of 1909, having sensibly taken up his new position as director of the Civil Hospitals at Khartoum and Omdurman, he went home on leave. He was not well. He was finally diagnosed, via letter, by his father-in-law, Dr. J.A. Ormerod of Upper Wimpole Street, to be

to look to see who signed. No one else, writing reports before or after his directorship, wrote thus. 56 H.C. Squires, The Sudan Medical Service: An Experiment in Social Medicine. (London: William Heinemann, 1958), p. 11.

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suffering from peripheral neuropathy following diphtheria.57, 58 Even had the situation not had been exacerbated by the emotional turmoil of the recent weeks, he was certainly due some respite from the climate, emotional and physical, of Sudan.

Nothing about Christopherson and the SMD Is Found before 1911 That the Sudan archive in Durham holds nothing of significance to do with Christopherson for either 1910 or early 1911 does not signify that peace and brotherly love existed. It soon appeared that—to the contrary—much had been going on. The 1909 trouble erupted again, and of course Phipps was quick to notify ‘Master’ of the situation in a letter of 16 May 1911: . . . Mathias [PMO at the time] asked me to go and listen to him on Christopherson yesterday evening and I found C[hristopherson] had sent in a formal complaint against M[ichou] of course written by someone else . . . Mathias is writing to you and sending in a report which I fancy will mean the assembly of a Committee to investigate the case of Christopherson’s communicating home news of a communicable disease some days before he notified it officially and then told a jumbled story, which seems to be incorrect, to get out of the mess.59

Once again, there is no explanation of the complaint against ‘M,’ whom I can only assume to be the mysterious Michu/Michou. One wonders why, as Phipps says, it was ‘written by someone else,’ and who this was? On the face of it the move seems foolhardy and underscores Christopherson’s tendency to be rash. At first, I had imagined the ‘communicable disease’ might be typhoid but a search of the BMJ and The Lancet for December issues of 1909 produced nothing. The clue was the phrase ‘the case happened in Nov. ’09’. It was in fact the old story of the spirochaete for relapsing fever and the argument with Andrew Balfour, discussed in chapter six, about who first made the identification, and Christopherson’s ignoring

57

Personal communication from Dr. T. Peter Ormerod 13 May, 2005. Years later, in April 1935, Christopherson, remembering his illness of 1909, wrote to Joyce saying: “Neither Hodson [Dr. V.S. Hodson] nor Squires [Dr. H.C. Squires] ever dreamt I had peripheral neuritis which Dr. O [Ormerod, his father-in-law] diagnosed from my letters.” 59 SAD 300/5/77. 58

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his obligation to report this first to Balfour as the local MOH. In his haste to establish his claim, Christopherson had telegraphed to Dr. C.W. Daniels at the London School of Tropical Medicine and asked him to inform the next meeting of the Royal Society of Tropical Medicine.60 Daniels saw that this was done and the telegram was then duly reported in the November 15, 1909, issue of The Journal of Tropical Medicine with a follow-up letter in the December 1st issue. Balfour had published Bousfield’s report in the Fourth Wellcome Report that came out in 1911, but of course he had been beaten to the post by the 1909 announcement. Phipps’s May 16th letter went on to say: Apparently Mathias has only just got proof against C. altho the case happened in Nov. 09. Anyhow Christopherson’ action in reporting Mathias has brought up the old matter and M. who was furious . . . means to bring matters to a head. I cannot think who ought to sit on it if it is held. Mathias wants a legal man and I agree. Christopherson must be called on to explain properly his conflicting statements. Currie can’t sit . . .he is so biased.61 There is Tottenham and Turner. I am sure C. would object to me as knowing too much. No Doctor can sit possibly. There are besides Matthews and Crawford I suppose the latter will be here soon from Cairo. I think I must say privately that Sterry62 has been receiving much attention lately from Christopherson and has I know in some measure advised the latter, but he does not know the facts nor has he heard of this special case against Christopherson . . . It is all very troublesome—but one must see it through. Yours very sincerely, P.R. Phipps.63

One has to ask whether Christopherson was really spoiling for a fight over the relapsing fever issue? He and Balfour were both tenacious and both had their supporters. The other possibility was that Christopherson was accusing Mathias of the same behaviour he himself had been accused of, sending information home before reporting it locally—a tit-for-tat gambit. I checked Index Medicus for H.B. Mathias over the years 1909–1911, and found nothing.

60 61 62 63

Dr. C.W. Daniels (1862–1927). Currie, James [later Sir James.] Director of Education. Sterry, Wasey. [later Sir Wasey] First Legal Advisor appointed 1901. 16 May, 1911 Phipps to Wingate SAD 300/5/77.

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In late spring just as the weather was beginning to turn hot, a panel began to be assembled to look into the likelihood of unprofessional conduct, not the most palatable term when applied to a senior British physician. On 18th May Phipps wrote again to Wingate: “. . . Col. Mathias came in and said if you ordered an Inquiry on Christopherson’s affair that I ought to sit on it. I said I was perfectly willing. My only wish was to have no one on it that would enable C. to say afterwards he never had a chance . . .”64 Two days later Wingate, ensconced at the cooler hill station at Erkowit, replied: My dear Phipps . . . With regard to the Court of Enquiry on the Christopherson business, I have just received a notification from Turner to say that he is leaving for Halfa on the 25th and in that case we should appoint someone in his place:65 I am very reluctant to put you onto it as you have an immense amount of work to do, and besides, I do not wish to interfere with your proposed trip to rail-head with Midwinter:66 at the same time I think it is very desirable that you should, if possible, give evidence at the first sitting, which I hope will be able to take place before you leave. I have been careful conning over the list and it is clear that with two purely Military members of the Board, i.e. Crawford67 and Matthews,68 we must have one to balance of [sic] the Sudan Government, and I see no reason why it should not be Burges,69 he, with his judicial training ought to be a useful member.70

Frank Burges was only technically ‘not military.’ He had resigned in 1908 after a distinguished career in both British and Egyptian armies. It is worth adding an extra word or two about Frank Burges here. After Burges’ death in 1943, N.R. Udal, an old Sudan hand who always managed to say something delightful about everyone, sent a short appreciation in to The Times. He described how Burgess Pasha, as he was better known, once roasted a sheep at the foot of the hill until the savoury smell wafted up to a hungry fugitive who was then lured out and caught by the wily pasha. But more relevant to the Christopherson story is that Udal described Burges as “a source of terror to all miscreants 64

Phipps to Wingate 18 May, 1911 SAD 300/5/100. Most likely Ernest Vere Turner (1872–1949) Director of Sudan Posts and Telegraphs. 66 Midwinter, E.G., General Manager of Sudan Govt. Railways. 67 Crawford, Col. Archibald, (1861–1929). 68 Matthews, Godfrey Estcourt (1866–1917). 69 Burges, Frank 1867–1943 Retired from both British and Egyptian armies in 1908. 70 1911 20 May Wingate at Erkowit to Phipps. SAD 300/5/123. 65

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in the early days of the Sudan administration, and his reputation was a most effective deterrent to crime both then and in the later days of his service in the Sudan as police magistrate in Khartoum.”71 This last makes one wonder; would Burges have voted to clear Christopherson’s name unless he believed the doctor was wrongly accused? On the other hand, there may have been a majority vote and he might have lost. On 25 May Wingate wrote to Phipps again from Erkowit. My dear Phipps, . . . I have been carefully through the papers in connection with the Christopherson case and they have also been fully explained to Crawford, who will preside at the Court of Enquiry with the assistance of Davidson and Burges as members; 72 I agree with you and Clayton that the substitution of Davidson for Matthews is a right step, as it is as well to bring in a purely civilian as well as legal element. I agree with you and Mathias in the desirability of confining the enquiry to one specific point and on that of course the Court is to be asked to give an opinion. I am inclined to think that if the question turns on purely professional etiquette, before bringing matters to a head with Christopherson, it will be as well to take Acland’s advice so as to have an unbiased opinion on a point regarding which we cannot possibly have expert knowledge . . . 73

And so members to sit on the Court of Enquiry were decided: P.R. Phipps, Frank Burges, Judge Nigel Davidson; Archibald Crawford would preside. Dr. Acland, close friend of Wingate, but certainly friendly with Christopherson, a fellow physician, would advise and perhaps also be on the court. Whether Acland would have a vote was not specified. Whether G.F. Clayton was there is also not clear. What is suggested by Wingate’s letter is that no other complaints, meaning presumably those of the earlier pharmacy issue or that involving Dr. Michou and the patient requiring a spinal tap, would be considered.

And behind All This . . . In the end, after all this, the Court’s enquiry would rest solely on another issue: The sending home information of a communicable disease without following protocol and reporting it to Khartoum’s Medical 71

N.R. Udal in The Times, (8 May, 1943), p. 6 e. Nigel George Davidson, (later Sir Nigel) a judge and later Legal Secretary in Sudan. 73 25 May, 1911 Phipps to Wingate. SAD 300/5/154. 72

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Officer of Health first. And who was Khartoum’s MOH? None other than Andrew Balfour, Christopherson’s nemesis. This stemmed, in part, from the first years of the Condominium when Balfour had insisted that the post of MOH of Khartoum must be under “the sole jurisdiction of the Khartoum province administration, with no connection to the nascent medical department.”74 I suggest that Christopherson and Balfour’s mutual antipathy had rankled so much that Balfour had found a convenient tool with which to pillory the irritating doctor. Just how major an offence not reporting a communicable disease locally first was, (the spirochaete for relapsing fever, again) one cannot be sure. Balfour, who essentially made this issue his weapon, was a big enough figure to impress upon everyone that it was serious, and enough people in the administration were happy enough to agree. The Court must have sat (as I have deduced from correspondence) at the beginning of June or perhaps the last day or two of May. Also the names of those who knew about it and who actually saw this report are clear. Crawford, on 14 June, wrote to Wingate enclosing the ‘C. of E.’ papers as they became known, although actually addressed to the Private Secretary [then Clayton], along with “. . . an explanatory letter under separate cover addressed to yourself . . .”75 There were clearly two versions here, one official and one personal. In July Phipps was home on obligatory summer leave from where he wrote to Wingate forwarding the above mentioned letters: My dear General, . . . I have also sent on Crawford’s letter and enclosure to Clayton. The Christopherson affair is a most extraordinary one and he was very unlucky in having such a marvellous run of apparently adverse circumstances against him. On the face of it there seemed no doubt and anyhow it is difficult to reconcile his writing to his friend [Dr. C.W. Daniels] the letter afterwards published in the Dec. number, [J. of Tropical Medicine] when his official reports of later dates were so vague about his discovery. In his private letter to his London friend he had no doubts and gave details not borne out by facts or his official report whatever date he wrote the letter. I don’t know what the Court thought of this. I have not seen the proceedings. Yours sincerely P.R. Phipps

74 Heather Bell. Frontiers of Medicine in the Anglo-Egyptian Sudan 1899–1940. (Oxford. Oxford U Press. 1999), p. 23. 75 Crawford to Wingate 14 June, 1911. SAD 300/6/7.

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Wingate wrote down the side: “I think you have the proceedings and were going to send them to C.”76 16 July Gilbert Clayton wrote to Wingate. . . . I don’t know if you have yet received the proceedings of the Christopherson enquiry from Phipps with his remarks. If not I fear the delay is my fault as I was some time in sending the papers on to him. I think all that can now be done is to write something on the proceedings to show that you consider that any aspersions on Christopherson’s character are now removed. If he sees fit to take any further action, I suppose it is not possible to prevent it. He will be foolish if he does I think . . .77

29 July Clayton wrote again to Wingate . . . Re the Christopherson case—Phipps has now the papers and will doubtless send them on to you with his views. I think that all that you can do now is to say that you concur in the opinion of this court and consider that the explanations set forth in the proceedings have removed the misapprehensions which apparently existed regarding Christopherson’s action and motives . . .78

From now until mid November the archives have nothing more on this until Wingate wrote on 14 November, again to Acland saying: PRIVATE. I am still greatly puzzled what to do about Christopherson. It is quite evident that he is intensely unpopular with the other members of his Profession in Khartoum, both Civil and Military. He seems quite unable to get on with any of them and I am sorry to say I do not hear one good word for him amongst his own people. I honestly believe that he would do far better to resign, but I do not suppose he will see it in the same light. Possibly, without saying anything to him, you might convey some such hint, though I fear it is not likely to have much effect. I have just written to him in reply to an appeal for an increase or pay to say that no increase can be granted.79

So after all, Christopherson’s name was cleared again. Being British and senior would have carried weight; had his name not been cleared, the problem of what to do next would have drawn even more attention to a generally unseemly situation. Wingate’s last sentence, indicating that Christopherson had asked for a pay increase, suggests that the doctor

76 77 78 79

SAD 301/1/16. SAD 301/1/25. SAD 302/1/143. SAD 301/5/42.

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had a poor sense of timing. He must have known that having his name cleared did not indicate he was actually free and clear of innuendo. A pay rise and or a promotion would have signalled a one-hundred-percent endorsement by Wingate, and the Sirdar was certainly not about to do that. What is never discussed is how often these rules of reporting are transgressed. Christopherson transgressed by only a ‘few days’ yet it brought a storm of protest, most probably engineered offstage by Balfour. The degree of transgression is most likely linked to the interest and objection of someone with personal investment on getting his ‘find’ acknowledged. Thus something seen through the distant mirror can assume a lesser importance as it all but vanishes into the minutiae of history. Wingate’s sentence about Christopherson not being able ‘to get on with’ any other members of his profession bears some examination. This has been taken as gospel by both Martin Daly and by Heather Bell. I suggest that certainly Christopherson had enemies: Legal Secretary Bonham-Carter, then Balfour and Phipps who were both powerful and manipulative. Bousfield and Crispin were lower on the scale of importance but could still make difficulties. For friends Christopherson could count on William May, Bishop Llewellyn Gwynne, James Currie, Wasey Sterry, Shuqair Said Pasha, Slatin Pasha, Rowland Elderton, Charles Armbruster, Financial Secretary E.E. Bernard, Noel Waterfield, Dr. Zaki and many of his non-European colleagues. The year 1911 was survived. Christopherson remained in charge of the two civil hospitals, running them with Barts efficiency as much as possible. A happier period in his life was on the horizon.

CHAPTER EIGHT

1912 MARRIAGE AND THE DECISION TO REMAIN IN SUDAN

Britain in 1912 1912 was a momentous year for Britain—there were both successes and failures. On January 17th Captain Scott and his men reached the South Pole but all died on the return journey. In Sudan, the Anglican Cathedral in Khartoum, built after a massive effort to raise money for such a great enterprise, was consecrated on 26th January, the anniversary of the death of General Gordon. The event was reported as being magnificent and rather on the theatrical side, something favoured by Wingate who loved to impress with colourful regal trappings. Christopherson, a dedicated churchgoer, would certainly have attended, although he was known to disapprove of an excess of show. On 15th April, the SS Titanic, pride of the British fleet, on her maiden voyage, struck an iceberg and sank. This spectacular ship, filled with both the rich and famous and hundreds of steerage passengers, went down in the freezing waters of the north Atlantic and more than 1,500 people drowned.

The Ormerod Family In the autumn of 1912 Christopherson must have felt that finally he was entering a period of peace and sanity. He was about to marry Joyce Eleanor Ormerod, daughter of Dr. Joseph Aderne Ormerod, the consultant for whom Christopherson had been house physician at Barts Hospital in 1898. A Christopherson cousin alleged that he had earlier been engaged to marry Dr. Ormerod’s older daughter Betty who died young, and ‘being in want of a wife’ to go with him to Sudan, he

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married the next daughter in line, but no one else in the family can substantiate this.1 Joyce must have known her fiancé since she was a child when he was an occasional visitor to the house. Whatever the story, all agree that his marriage to Joyce Ormerod was a very happy union. The groom was forty-four, his bride twenty-four. The wedding day, Tuesday 24 September, was fair and it was sixtythree degrees, warm by English standards for early autumn. In fact there had been no rain for almost two weeks and there were concerns of a drought.2 The wedding was quite a grand affair at St. George’s, Hanover Square, London. As The Times reported, Christopherson’s cousin, the Rev. Denton Jones, Dean of Salisbury Cathedral officiated, assisted by Llewellyn Gwynne the Bishop of Khartoum. The groom’s father, an honorary Canon of Truro Cathedral, was there of course, bearded and impressive. There was a clutch of bridesmaids: Joyce’s sisters, Barbara and Diana, then Miss Howard, Miss Ailsa Ballance3 and Miss Amy Dowling, and lastly, Elsa and Ena Christopherson, twelve and thirteen respectively, nieces of the groom. These two were the children of the youngest Christopherson brother, Ted, the ‘bad hat’ and his luckless wife Aimée, both of whom had abandoned them as babies. The groom’s best man was long time friend William Southall Reid May, Assistant Financial Secretary in the Sudan Government.4 The Ormerods were a distinguished medical family. Their home, 25 Upper Wimpole Street, was a fine address; the reception was held there and, then, the newly-weds left for their honeymoon on the continent before travelling on to Sudan. Christopherson always appreciated his connection with the Ormerod family. He revered his in-laws and got on well with his unmarried sisterin-law, Diana, who, years later, came to live with them in Gloucestershire. He always took great care that in letters to Joyce and writing ‘love 1 Ena Edwards, née Christopherson, told me this story but it has not been confirmed. It is certain that Betty Ormerod, born 1883, died in February 1908 of meningitis, which gives some credence to the tale. It is most likely that Jack would have often visited the Ormerod household at 25 Upper Wimpole Street. The latter is personal communication from Dr. T. Peter Ormerod. 2 The Times, 24 September, 1912. 3 Most likely the daughter of Mr. Hamilton Ballance with whom JBC had worked in the Boer War. 4 May, William S.R. (1864–1937) Commissioned in the East Yorkshire Regiment in 1885 and served with the Egyptian Army from 1899 to 1916. From 1901–1916 he was Assistant Financial Secretary in the Sudan government.

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8.1. Joyce Eleanor Christopherson, née Ormerod.

to Diana’ he sent ‘very best love’ to Joyce. When he was in town, in 1917, writing the Commission Report, he often stayed at the Ormerods’ London house or occasionally at their country house ‘Greenhill’ near Winchester, and he attended the family when illness struck. He also came from a large family, although not as large or as accomplished as the Ormerods. His older brother Arthur struggled to make a living in Australia but his sisters married well. Only his youngest brother, Ted, who was somewhere working in the copper mines of Rhodesia, was conveniently forgotten.

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By now, in Sudan, conflicts with the administration and accusations of misbehaviour had been annulled if not forgotten. There is no doubt that now, with a sensible and warm-hearted partner at his side, he had chosen the right path—to return to Sudan and take up directorship of the two major civil hospitals, Khartoum and Omdurman. To have resigned and returned home for good earlier that year would have been a clear indication that he had been a failure in Sudan. His intended wife and her well-known medical family would very soon have learned of the purported reasons behind his abrupt move. I suggest he never gave the option of leaving Sudan a second thought. It would have meant that all he had worked for over the years since 1901 would count for naught: the building of the new hospital, the setting up of the satellite hospitals and clinics, the hiring of British trained nurses, (the latter a particular success), the training of local staff and of course the epidemiological work with communicable diseases and, the ongoing task of overseeing thousands of vaccinations. Not until after his marriage, and only when he and his wife were apart, are we privy to Christopherson’s private quotidian thoughts. Fortunately for the biographer, circumstances mandated long separations during which they corresponded frequently. Occasionally Joyce spent time at the hill station at Erkowit, and once she was invited to accompany friends on a trip down the White Nile while her husband was tied to the hospital. One year, Diana, stayed with the couple in Khartoum. This suggested to some of the Muslims that Jack had two wives! There were longer and more worrying separations, particularly for Joyce, when he was in Serbia during the winter of 1915–16 and again during his time in Flanders in 1917. Later, when he became a consultant in London with a fine Georgian house in the prestigious Harley Street area and a small Gloucestershire estate, Joyce remained in the country managing the ‘farm’ while he stayed in town and took the train down on weekends. During those weeks their letters shuttled to and fro on a regular basis. Those were the days when a letter posted at tea time in London would arrive early the following morning in another part of the country. His letters—and only one of Joyce’s to Bishop Gwynne after her husband died—have survived, and they give a good day-today picture of their lives. I am temporarily entrusted with these letters, thanks to the careful stewardship by their nephew, Peter Ormerod. Peter

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remembers with affection the kindly old uncle who handed him a pair of binoculars and encouraged him to enjoy the countryside rather than attending to homework on school holidays.

Christopherson’s Friend William May Is Not Immune from Controversy Major May, one of Christopherson’s closest friends, was four years his senior. A snapshot of May in the operating theatre of the new Civil Hospital in 1912 shows him looking every inch the proper finance officer. Unassuming, balding with a trim mustache and sticking-out ears, he stands next to Bishop Llewellyn-Gwynne who is immaculately garbed in a starched white outfit. May’s rumpled and rather grubby jacket might suggest a lack of care, but otherwise he dresses like any other civil servant in the tropics, so it is hard to imagine this is the same man described by Wingate in a letter to civil secretary Phipps as ‘Bohemian’. What alerted me to look more closely at Christopherson’s great friend was a correspondence between Phipps and Wingate in 1911 (the same year that had brought so much trouble to Christopherson) over the selection of an Inspector General of Accounts to succeed Said Pasha Shuqair. Intelligence Officer Rudolph Slatin had also inserted himself into this discussion. According to Wingate, Slatin ‘is very strongly opposed to the [appointment of May] . . . I expect he thinks an Arabicspeaking official is absolutely necessary and suggests a Syrian, a Copt or a Jew.”5 Wingate tried to give a balanced view on the subject of May for the post: “Of course I fully appreciate the many disabilities of May . . . On the other hand, May has many good points, though I admit his somewhat Bohemian method of living and being such an absolute recluse makes it very difficult for other British Officers to get on with him.”6 How must one live in colonial Khartoum to be described as Bohemian? As for being an absolute recluse, perhaps this simply meant the man did not frequent the Sudan Club? Although it is not known whether Christopherson was actually a member of the Sudan Club, it is known that he did not spend much time there. It is likely that the two friends

5 6

Wingate to Phipps 17 May, 1911. SAD 300/5/98. Ibid. SAD 300/5/98.

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8.2. Bishop Gwynne & W.R.S. May in the operating theatre, KCH 1912.

soon became seen as outsiders and therefore different. Perhaps if May chose not to have many servants and ‘do for himself’ that might make him thought to be Bohemian. What is known regarding the circles of friendship in Khartoum is that Phipps, Wingate and Slatin were close, and that Slatin was also a friend of Christopherson, although this friendship may have grown later. Slatin sent at least two patients to Christopherson. One was Asha bint Abdallah, the wife, probably widow, of Ahmed el Aigel “who managed my escape. She is complaining about her eyes and her son is ill about 2 months! They will pay you a visit! Yours R. Slatin.”7 7

R. Slatin to JBC 16 November, 1912 SAD 407/7/3.

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Certainly Said Pasha Shuqair was a trusted friend of Christopherson, and Phipps saw the Shuqair as representing “humanity and common sense” and being “always amenable to argument.”8 Bernard, over the years, while objecting to May’s taking over from Shuquair, remained a good friend of Christopherson; there is ample evidence of this. Of course it is possible that any objections in the field of official work might have been kept quite separate from personal feelings in the social world. According to Phipps, May and Bernard had different working methods, May during Bernard’s absence does his best to institute new arrangements to correct the Bernardian system and so it goes on . . . Bernard wants a native—they suit his methods & they are prepared to accept treatment no Britisher ought to accept—for Bernard is a bully in his office & most inconsiderate of everyone but himself.9

Phipps rather threw in the towel over settling on a man for the post. He wanted a white man, but although May was well qualified for the job, he felt May would not put up with Bernard’s bullying. Arguments were still going on in May of 1912 when Major May complained to Shuqair . . . clerks are sent on leave, or to Cairo, and the officials left here [presumably Khartoum] all through the summer have to get along as best they can. It is not right or fair and if Bernard insists on doing it then there is going to be some very plain speaking . . . It is no conceit on my part to say that I can do as much in one day as he will do in a week, and I have found the work here in summer very harsh indeed for the last two years . . .10

So what was going on? May’s comment about summers in Khartoum in 1910–12 being ‘very harsh’ would certainly be true, but May has also said that ‘the work’ was ‘very harsh indeed’. Most Europeans took their mandatory leave during those stifling months, but Major May seems to have soldiered on as the work piled up. It would be small wonder that the physical conditions fed his irritation. Shuqair pleaded ill-health in his request to retire. He wrote to Bernard in November 1910, “I am sure that if you really knew how I suffer physically you will sympathise with me and do all in your power to enable me to retire.”11 He followed this up with two letters in similar vein in February of 1911 pleading

8 9 10 11

Phipps to Wingate, 28 May, 1911. SAD 300/5/84. Ibid. SAD 300/5/84. May to Shuqair SAD 494/10/2–3. SAD 494/9/60.

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“insomnia and indigestion . . .” yet the Sudan Gazette of February 1912 still identifies Shuqair as Director General of Accounts and the SAD catalogue states that he had this post from 1907–21.12 No less an authority on the Condominium than Martin Daly wrote of E.E. Bernard’s unpopularity: “In 1920 relations between Bernard and his subordinates deteriorated to the point where A.J. Forster, the senior financial inspector, led a departmental revolt.”13

Christopherson Runs His Hospitals His Way Christopherson did have a particular personality trait: a lack of tact, as noted by Wingate in his letter to his friend and personal physician Dr. Acland on the outcome of the Court of Enquiry. “I think it is now fully understood that the present failure is due to the personal equation and that had there been at the head someone endowed with real administrative ability and tact, we should not have been forced into this temporary retrograde step.”14 Now left more or less to his own devices, running the two civil hospitals, he did indeed get things done the ‘right way,’ which was the same as saying ‘his way.’ There were, and still are, at least two opinions on the way one’s local hospital is run—recall journalist Fothergill’s opinion of Christopherson’s methods.

Joyce Enjoys Sudan, but War Is on the Horizon Now a new chapter in the lives of Jack and Joyce began. The lack of personal correspondence in the period 1913–14 indicates they had a year and a half together before the First World War would have direct effect on their way of life. Joyce enjoyed Sudan and loved the Sudanese. She painted a number of water-colours (some now in the Sudan archive, Durham), and was considered a better than average amateur artist. She was musical and played the violin. The ‘Bohemian’ Major May was also an amateur

12 13 14

E-mail from Harjyot Hayer, at the SAD library. 14 August, 2006. M.W. Daly, Empire on the Nile. (Cambridge: Cambridge U. Press. 1986), p. 274. 29 November, 1908. Wingate to Acland from Khartoum. SAD 284/3/68.

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violinist; he and Joyce were known to play duets. This last was told me by Walter Ormerod, Joyce’s nephew, who suggested that this fact may have accounted for May as being seen as ‘different.’ Rudolph Slatin was certainly living in Omdurman. How much he knew of Christopherson’s past troubles in not known. Perhaps he let such things slide; he would have been aware for years of the petty jealousies in Sudan as a whole and in the administration in particular. Slatin occupied an unusual position as a Christian who had temporarily become a Muslim to avoid being killed by his captors. He had lived in captivity for nearly twelve years, lived as an Arab, spoke the language, and knew the customs. He was on intimate terms with Wingate, had been the obvious choice for Intelligence Officer, and held a unique place in local society, holding court with uproarious dinner parties at “Rowdy House,” his home in Omdurman. Slatin had found himself in a very difficult situation at the beginning of the 1914–18 war. He was working for the British and had been a great favourite for many years as their intelligence officer. He was probably the closest friend, apart from Phipps, that Wingate had in his Sudan years. Yet, suddenly, at the opening of hostilities, Slatin, an Austrian subject, found himself identified as one of the enemy. In consequence, he had done the sensible and honorable thing—taken a non-combatant job with the Austrian Red Cross, the section dealing with repatriation and care of prisoners of war. Fothergill, the journalist, had not seen things quite that way. When war broke out in August 1914 it must have been a difficult decision for Christopherson. He was too old at forty-four to sign on for the western front through the war office. Like most men, he hoped to play his part and, he hoped he could gain some experience in war surgery. Eventually he found employment with old friends in a Red Cross unit in Serbia, and Joyce, like many war wives, found herself back in London living with her parents.

An Addendum to the Fothergill Story I might have dismissed Fothergill as having a certain unfortunate manner, and as a member of the press, a convenient method of voicing his complaints. However, I soon came upon some even less pleasing aspects of the man. Edward Fothergill, it turned out, was an ingratiating, selfserving bounder.

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A number of years after the First World War, in January 1928, Phipps was reminded of an article in a newspaper, The Near East, a virulent attack on Sir Rudoph Slatin Pasha. This article had actually appeared in the early years of the war, but it had not been appropriate to tackle the matter then. Rudolph Slatin had already been told by an un-named friend that journalist Edward Fothergill was likely responsible, and word had been passed to his friends Wingate and Phipps. When in the winter of 1927–28, Fothergill rashly poked his head above the parapets to ask for assistance from Wingate for some lectures he was proposing, he cited both Phipps and Bonham- Carter as being on board to help him, and in this manner the matter came to the fore again. The correspondent in The Near East had not been identified, but as Fothergill was a known contributor to that paper, and as the article was a direct attack on their good friend Slatin, both Phipps and Wingate now joined forces to discover who wrote it. Phipps wrote directly to Fothergill, “I shall be glad to hear from you that the rumour is untrue and to learn that in your lectures you give our old friend and ally the fullest credit for the success of the work in the Sudan.”15 He received an immediate response from Fothergill denying culpability, by return post. Fothergill further stated that he’d given many lectures on Sudan and always spoken well of Slatin. Phipps, unsure of what to believe, sent his letter on to Wingate, and Wingate followed up by writing to Mr. Savile, the editor of The Near East.” . . . two or three years ago I think you were present at a Meeting of the Royal Geographical Society when Fothergill lectured and also made some further attacks [on Slatin] which you very rightly protested against . . . ”16 Editor Savile wrote back to Wingate by return post saying that he did not know if Fothergill was the author but that he did know that “Two of Fothergill’s statements in his letter to Phipps of the 10th instant, I can only classify as deliberately untrue: . . .” Fothergill’s lecture had been at the African Society, not at the prestigious Geographical Society as he had claimed and, he had certainly repeated, almost verbatim, the scurrilous attack which had appeared in The Near East.17 Fothergill had also denied awareness of the offending article, but as editor Savile wrote

15 16 17

Phipps to Fothergill, 9 January, 1928. SAD 433/187/20. Wingate to Savile, 12 January, 1928. SAD 433/187/25–26. Savile to Wingate, 13 January, 1928. SAD 433/187/27–28.

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to Wingate, this was “Obviously untrue, as, if he had resented it he would not have publicly repeated it.”18 On 13th January, on a separate sheet of paper, Mr. Savile added a strictly private note detailing how Fothergill had borrowed money from him, using a caravan as collateral and a year later admitted he could not pay the money back, and, that he had sold the caravan. This was the last Savile had heard of Fothergill who appeared to have gone to ground. Doubtless Wingate and friends were relieved to be able to ignore the journalist in future. However, it is doubtful if Christopherson ever read Fothergill’s book, and even more unlikely that he would have heard of the Wingate/Slatin/Phipps/ Savile/Fothergill story.

18

Ibid.

CHAPTER NINE

WITH THE RED CROSS IN SERBIA, AND RUDOLPH SLATIN’S ROLE AS ‘FAIRY GODFATHER’

It looks as if Serbia was easier to get in to than to get out of. Post card from Christopherson in Serbia, to his uncle Richard C. Denton in Harrogate, UK —(Posted 12 Oct. 1915, arrived 9, Nov. 1915.)

Since 1904, Christopherson had not found life in Sudan easy. Although his work continued fruitfully, other events surrounding him became more difficult to contend with. He had been through the Court of Enquiry and suffered almost continual animosity from P.R. Phipps, who finally left Sudan at the end of 1913, and now Dr. Crispin, the man who had wanted Christopherson’s earlier job as Director of the Sudan Medical Department, had finally landed it.1 Even if Crispin had not made any untoward remarks aimed at his old boss, the idea of answering to Crispin must have been an irritant in Christopherson’s daily life. As his brother-in-law, Dr. Tom Ormerod, said “Old Christo rather cherished his enemies.”2 In 1915, for these circumstances alone, Christopherson had reason to find relief in the chance to get out and do something else—something to help the war effort, and, with particular relevance, as war had been initiated in Serbia.

Privately Funded Medical Units Prepare to Leave for Serbia In December, 1914, a meeting was held in London to discuss and promote aid for Serbia and the Serbian people. Among those attending were some old friends of Christopherson, Surgeon James Berry and his anesthetist wife, Dr. F. May Dickinson Berry.3 This husband-and-wife medical team had enjoyed holidays in Serbia, spoke the language a little

1 2 3

Assistant Director SMD. 1911–1915 and Acting Director 1915–1917. Dr. T.P. Ormerod. Personal communication 2005. Surgeons are referred to as Mr. in the UK.

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and had an affection for the country and its people. The Berrys also had the resources to organize and fund a medical unit to go to the aid of the Serbs. At that time they were working at the Royal Free Hospital, London, a hospital that would shortly become the base of operations for gathering personnel, supplies and equipment for their venture. The suggestion at that evening meeting, how to go about setting up a unit, sounded elementary, “. . . you ask your friends for money, and it is sure to come rolling in; you buy with it chloroform and other hospital necessaries, engage nurses of whom there are many dying to go out; get an invitation from the Serbian Government—and go!”4 The Berry Red Cross Unit was one of a number of privately funded medical units that prepared to go to the aid of Serbia in the First World War. In all, five female physicians found work with this unit in spite of, or perhaps because of, the fact that the British Government, in the first two years of the war, had considered female physicians not suitable for the European theatre. Many were retained to fill some of the vacancies made by the exodus of male physicians leaving for France. Even so, when female doctors did have a chance to prove their worth, initially having been turned down by their own people, it was with the French, by setting up a hospital at the Abbaye de Royaumont.5 The British had refused women physicians rank, uniforms and a suitable salary concomitant with rank, denying them status and authority, and without sufficient resources for personal living. In consequence, these experienced women quite often found themselves working under junior and inexperienced men. Such prejudice was less likely to exist in private units, so there were a number of women doctors working in units in Serbia. The Berrys were well known and liked. Once their decision was made, they asked for and received permission from the Serbian government to enter the country. They also sought, and were given, permission from the Red Cross to use the name in the title of the unit. They wrote personal letters to their friends and set up a committee of influential people to help publicize and raise money.6 Shortly, with the enthusiastic co-operation of the Matron of the Royal Free, their bales of equipment, bedding and pharmaceuticals were piled up ready to ship. It had been

4

Berry. Op. cit. p. 10. Ian R. Whitehead, Doctors in the Great War (Yorkshire: Leo Cooper. 1999), p. 108. 6 Presumably they wrote to Christopherson although no letter has been found. 5

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difficult to find accurate information about what was needed for this project but by the end, wrote James Berry, “we felt prepared to run a hospital of fifty beds on a desert island, or in the most destitute part of devastated Serbia.”7 For Christopherson, this must have seemed the perfect opportunity to join his friends and gain some experience in war surgery while at the same time escaping from recent difficulties in Khartoum. He requested, and was granted, a two-month leave of absence from Sudan and offered his services to the mission. The Berrys must have been delighted to have an experienced surgeon on the team. On the last day of August 1915 and during a respite in the long journey to Serbia, he wrote to Wingate from the renowned Shepheard’s Hotel, Cairo. George Anderson, an old friend of both of them, had just died unexpectedly.8 I send you these details because although unimportant in themselves, I think you will like to hear them from a friend who was with him to within a short time of his death and I know that you always had a great regard for Anderson and will probably miss him very much. . . . Personally I am very, very sorry to lose him as a friend—he was one of the first men I knew when I came out over 13 years ago, we both lived in the old Abdin Mess then. I embark at Alexandria for Athens on Saturday, Sept: 4th and get a boat thence to Salonika thence to Uskub and Nissh by train.9

The journey took nearly two weeks. He arrived on 13th September. He could not have imagined at the time that his term would stretch from two months to five months.

Vrnjacka Banja and the Role of the Serbia in First World War The original Berry Red Cross unit, twenty-five people in all, had reached the mountain spa of Vrnjacka Banja on February 11, 1915. Most of the staff signed on for a tour of duty of a minimum of three months. A number did leave the unit in the summer of 1915 after their agreed

7 James Berry, The Story of a Red Cross Unit in Serbia (London: J. & A. Churchill. 1916), 14. 8 George Whitfield Anderson b. 1856 d. 31 Aug. 1915, Director of Stores, Egyptian Army, Cairo. He was originally with the Seaforth Highlanders, and served with them in the Afghan war of 1878–80 and at Tel el Kebir in 1882. As QM of the 1st Seaforths he was present at the Battle of Omdurman in 1898. His service with the Egyptian Army lasted for 1901–1915. Personal communication from Jane Hogan, U. of Durham. 9 SAD 157/7/122.

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time was up, and others came out to take their places. Eventually all medical staff who stayed through the winter of 1915 found themselves prisoners of the German-Austrian army until their mysterious release on 18 February 1916. A brief explanation of events is necessary here to introduce the role of Serbia in the First World War, a complicated subject and not generally well understood. It is generally agreed that the rash act of a Bosnian resident of Serb ethnicity, Gavrilo Princip, initiated the First World War when he assassinated the heir to the Austrian throne, Archduke Francis Ferdinand and his Archduchess.10 As Helen Losanitch Frothingham, (a Serb who

Vojvodina Zemun Sava

ROMANIA

BELGRADE RuŠanj

Tamnava

Da nub e

Mladenovac

Lazarevac

Bosnia

OraŠac Arandjelovac Topola Kragujevac

a av Ml

Valjevo

Re Ša va Ve lik a

Zapadna

ok Tim Cm

Morava

Za pa dna Morava

Timok

Iba r

Mo rav a

eli

Lim

Vrnjačka Banja Uvac

ava Juz Mor

Zlatarsko Jezero

Topli ca

Veternic

Kosova

NiŠ sina Vla Bosička a Morav a zn Ju

ica lan a Jab

Montenegro

B

ALBANIA National boundary Regional boundary

Macedonia

Major roads Major rivers

9.1. Map of Serbia showing Vrnjacka Banja.

10

Personal communication Prof. E. Wayles Browne 24/05/02.

BULGARIA

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married an American and campaigned tirelessly for funds to help her countrymen) pointed out: The Austrian Archduke had chosen to insult Serbian national feelings by picking St. Vitus Day, June 28, 1914, on which to pay an official visit to the Bosnian capital of Sarajevo. St. Vitus Day is the most sacred day of the Serbian year . . . The assassination of the Austrian Archduke and his wife provided the Austro-Hungarian Empire with a pretext for putting into action long-held plans to destroy the threat of Balkan unification and independence, . . .11

and the Austrian Government then sent an ultimatum to the Serbian government with terms so severe that . . . accepting them amounted to renouncing sovereignty. Nevertheless, the Serbian government conceded wherever possible and offered to submit the unacceptable terms to the International Court at The Hague for adjudication. The offer was flatly refused. Austria broke off diplomatic relations with Serbia, and on July 28, 1914 the powerful Austro-Hungarian Empire with its population of sixty million, declared war on Serbia, a nation of four million . . . Serbian aims were openly proclaimed to be the national unification of the Serbs, Croats, and Slovenes into a single state.12

Initially Serbia succeeded in driving the invading Austrians back but this strategy did not hold. By August 1915, Germany had sent reinforcements to Austria’s southern front. With Austria and Hungary invading from the north and Bulgaria striking eastern Serbia in October and Serbian Macedonia two weeks later, the retreating and outnumbered Serbs were to be cut off from any possible retreat southeast towards Salonika on the Aegean Sea. Their only chance, in this winter of 1915–16, was a trek in vicious weather over the mountains of Montenegro and Albania: “an exodus without parallel in modern history. . .” It is estimated that “of 240,000 Serbian soldiers who made the retreat, 100,000 died on the way; of the half-million refugees who fled, some 200,0000 perished, and of the thousands of young boys near military age who followed the army, more than 20,000 fell on the march.”13 The above is a brief explanation of what was in fact an extremely complex political, military and human situation.

11

Helen Losanitch Frothingham, Mission for Serbia; Letters from America and Canada 1915–1920 (New York: Walker and Co. 1970), p. 316. 12 Ibid. p. 317. 13 Ibid. p. 318.

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chapter nine The Medical Units Arrive in Serbia

In November 1914, a Serbian Relief Fund unit had already arrived and journeyed to Skopje. This particular unit was maintained by wealthy philanthropist and hard working nurse, Lady Arthur Paget, of whom it was alleged that “the natives of every class in Serbia, from the monarch downward, revered her almost like a saint.”14 Right away the Paget group had to deal with a serious outbreak of typhus. Their hospital, equipped for 350 patients, had to admit over 600, and Serbia was about to be faced with one of the worst winters on record. Shortly after, a second unit arrived and installed itself at Kragujevac (about fifty kilometres due north of Vrnjacka Banja over mountainous terrain). Here they prepared for 100 patients but were soon responsible for 250, with everything—typhus, typhoid, relapsing fever and surgical cases—coming before them.15 At the end of January the Berry unit arrived at Vrnjacka Banja. They were fortunate in being assigned this site. Vrnjacka Banja was then, and still is, one of Serbia’s major spas where the rich could indulge themselves with ‘cures’ in the sulphur springs, drink the crystal clear water piped in from mountain rivulets and enjoy the bracing mountain air; it was an enviable spot. The town was spread along one major road with shops and villas on one side; on the other, the town park slopes down to a valley and a small river crossed by eleven wooden bridges. Spring and summer were idyllic, with fields of wildflowers and orchards laden with wild plums used in making the local brandy, the famous slivovitz, distilled in many areas of the Balkans.

The Berry Unit Confronts Typhus The Berry unit with its original complement of twenty-five staff and excellent stock of supplies faced a challenge in Vrnjacka Banja. The

14 Lady Paget—the Lafayette Negative Archive catalogue (www.dmoz.org/Arts/Photo graphy/Reference/History). 15 Relapsing fever, also known as recurring fever, “A group of specific infections caused by spirochaetes, characterized by febrile paroxysms which usually last five or six days with remissions of about the same length of time.” The Principles and Practice of Medicine. William Osler. 8th edition. (1916), p. 261.

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free accommodations were dilapidated and filthy, with sanitation close to non-existent. In time, the group took over six buildings including one to use as a bathhouse for delousing. Typhus and other diseases, typhoid and small-pox were rife among the verminous patients brought in, often by train on the one and only railway in all of Serbia. Lice were the major carriers of the miserable and sometimes lethal typhus. The number of typhus patients grew, and the death toll noted in Serbia that winter amounted to sixty percent of those taken ill. To rid a person of lice takes meticulous attention. Lice lay eggs on a body hair and are ‘glued’ on, such that even a harsh scrubbing will not dislodge them, therefore all body hair must be shaved, and clothes disinfected. In Vrnjacka Banja it was soon confirmed that typhus itself was not infectious; it was the lice that carried the infection. This was something many physicians had already read about but not actually seen. As a result, once de-lousing had been accomplished, in theory, typhus patients could be kept in a general ward, even if they developed typhus after being deloused and admitted. Typhus had for years been known to be a disease affecting those living in squalor and over-crowding, generally the poor. The earlier answer had been ‘let the crowds and inhabitants scatter.’ In 1909, the Nobel Prize for Medicine was awarded to Dr. Charles Nicolle (1866–1936) for his discovery that typhus is transmitted by the body louse (Pediculus humanus humanus). He showed that the major transmission route was not necessarily by louse bites but was also the result of louse excrement infecting open sores or scratches. By the time the war began in 1914, the transmission method of typhus was theoretically fully understood, that only lice infected with typhus could infect someone and those lice needed human blood every two to five days in order to remain alive. Therefore a person could have lice and not contract typhus. Despite the fact that this had been known for five years, in 1915 in the Berry Unit there were still a few ‘Doubting Thomases’ so that both soldiers and local Serbs ill with typhus, even though well de-loused, were initially put in a separate ward solely in the interests of peace and harmony. The Berry unit was a very successful and cohesive group. A major part of this success can be attributed to the willingness of everyone to set aside class distinctions, pull on rubber boots, grab a shovel or mop, and enter into any kind of manual labour needed to turn a long-abandoned building into a hospital. As Dr. Berry remarked to a curious visitor “. . . we have no servants. All the people here are giving their services

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freely and we do whatever work has to be done.”16 Two major buildings, an old hydropathia, (the Terapia), and a government coffee house, (the Drzhavna), became central for bathing and waging the eternal fight against lice, and they were also used as operating theatres. Early in 1915, the unit treated wounded or sick Austrians taken prisoner by the Serbs, and a number of these men stayed on to help as orderlies and became well-liked and appreciated. Ironically, a topsyturvy situation developed when Austrian prisoners working as nursing assistants and orderlies were in charge of Serb patients. Yet these prisoners worked without guards, and discipline from Dr. Berry was seldom needed. When all preparation was complete, the unit contained 360 beds. News of medical expertise was not long in bringing the local people who needed attention to their door. Their gratitude in finding that they were not charged often resulted in payment of eggs, milk, herbs and flowers. The British in their turn considered their gift to the people of Serbia to have been the gift of organized cleanliness: the building of a slaughter house, the draining of swamps to help eliminate malaria and so on. At first this was considered by the villagers as English madness, but in time this work was gradually accepted, understood and appreciated. Much of this was accomplished before Christopherson arrived. In the summer of 1915, the great streams of wounded expected had not yet arrived. Rumours of a big push by the Bulgarians on the southeast, the Italians to the south and the Austrian-Hungarians to the northeast along with the Germans, circulated freely but without any substantial evidence. The group was beginning to feel they had done what they could and the masses of wounded were not arriving as expected. Their site was in some respects idyllic and there were grumblings that their help would be of more use on another front. As summer of 1915 progressed, some of the original band of medics withdrew according to their agreed terms of two to three months. If the remaining group stayed. What use would they be if they became prisoners, and what would be the fate of their Serbian patients or their Austrian orderlies who might be swept along and into the army again? Three members of the group made the difficult trek to England late that autumn as they had urgent personal business at home.

16

Berry, Op. cit. p. 66.

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Christopherson Joins in September 1915 Christopherson was a part of the changing of the guard, so to speak. He was forty-seven and known to the Berrys as a man with dedication and energy. Given that the British government initially rejected physicians over the age of thirty, Christopherson may have felt his only chance to get into the fray was to join a privately funded unit.17 Finally he reached Vrnjacka Banja on 13th September, 1915, and took charge of the Drzhavna hospital and the operating theatre. In one sense this was a perfect time to arrive, a time when the major hard work, cleaning, digging of latrines etc. had been done, the weather was beautiful, and the group amused itself, when it was not worrying about what the future held, with picnics, country walks and social evenings.

The First Wounded Arrive—At Last On 17 October, 1915, life in their little group changed abruptly when rumour became fact and the first wounded from the renewed fighting began arriving. It was a boost to the morale of the Berry unit who had felt embarrassed to be enjoying peace, when others were in the thick of things in western Europe. James Berry wrote that there was almost a merry feeling for a few hours when they knew that at last they could be useful. Any prisoner or any patient now back on his feet and having a skill was expected to use that skill for the benefit of the whole. Thus carpenters and artisans of all kinds were busy making prostheses, wooden legs and the like, or repairing wiring or equipment as required. This suited Christopherson’s temperament, he was a man who would roll up his sleeves and pitch in to any work needing to be done without concern for rank. As the Austro-German army approached and overran the area, they took the Austrian prisoners with them. Many of would have preferred to stay with the Berry group, so happy had been relations there, and

17

Ian Whitehead in, Doctors in the Great War, writes that by March 1917 all doctors under forty-one were called up. However this decision had to be reversed as the War Office had neglected to discuss this with the profession and a shortage on the home front developed. p. 78.

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it would certainly have been a better alternative than being sent to the front line. On the day hundreds of seriously wounded men began to arrive Christopherson began to get the surgical experience he had hoped for. Among the cases received on October 17th were several perforating wounds of the brain and numerous compound fractures of the thigh. All wounds had been inflicted at least two or three days previous, and most were already septic. . . . Nearly all the wounds had been caused by shrapnel, a few by rifle fire, scarcely any by bayonet. An extensive wound of the frontal lobe with much loss of brain substance was treated by being laid freely open, nearly half the left frontal bone having to be removed with trephine and forceps . . .18 Another man, under the care of Dr. Christopherson at the Drzhavna Hospital, had been shot through the centre of the head of the left humerus: a conical German bullet was extracted from the lower part of the right axilla in the mid-axillary line. The patient made an excellent and speedy recovery . . .19

Sometimes the yard would be empty, at other times a dozen dishevelled wounded men could be seen patiently waiting for someone to notice them. The rumour mill ground freely. It had been generally understood that the most serious cases requiring surgery would be directed to the Berry unit, but once a rumour circulated that the unit was to be withdrawn, the trains with the severely injured bypassed Vrnjacka Banja causing considerable annoyance at the waste of their skill and facilities. Like most rumours this too evaporated in the light of reality. By November 5th the Austrians had marched all the prisoners (not including the Berry medical unit) out of the town. More rumours followed with discussions about how the British could get back to England. The major route was choked with refugees and the only other possible route would mean two weeks’ walking, carrying enough food and using horses to carry at least some of the hospital equipment. This idea was dropped when the horses failed to appear. The next question was, should those of military age, who were not qualified doctors, try to make it out and then, would the Austro-Germans stand by the Geneva Convention

18 19

Berry, Op. cit, p. 195. Ibid. p. 196.

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rules for dealing with prisoners should they be apprehended? It was a time of great indecision. In fact during these difficult days, when the Austrian troops did arrive, they treated the unit well. Work at the hospital was continued under nominal supervision of their Colonel. What had earlier been an enclave of six buildings, designated as six hospitals, was now reduced to two. Christopherson remained in charge of the Drzhavna and the Berrys the Terapia. “Both were overcrowded with Serb wounded. Many cases were frostbite; one evening a hundred men arrived in this condition. Food was also short but all were somehow accommodated in the corridors, on trestle tables or wherever could be found.”20 James Berry mentioned more than once that he found no animosity from his enemies towards the personnel of the unit and that patients from any of the many nations represented in the hospital were all on the most friendly terms. In fact many of the troops from both the Russian and Italian front admitted to being entirely sick of fighting.

Rudoph Slatin Wrote to Reassure Joyce While the war raged on Joyce stayed with her parents in Upper Wimpole Street to give a hand where she could. Rudolph Slatin, knowing her concern, wrote to her on 12 December, 1915. My dear Mrs. Christo, Your husband writes “I left Khartoum at the end of August having been granted a short leave—I left Alexandria Sept. 4 and went to Serbia to help in one of the hospitals in order to get some practice in War Surgery—On the 15th of Oct the Bulgarians cut the railway to Salonica and on the 9th of Nov. the Austro German Army came along and captured the Anglo Serbian Hospitals.” Well, Dear Mrs. Christopherson—there is no reason to be anxious about your little husband—He is at Vranjacka Banja—works at a Hospital and a “friend of mine” Prinz F. Lobowitz [sic] who is Station Commandant looks after him—I will make inquiries about his detention but as he said that he came to serve to gain professional practice—they may keep him there for a while. Anyhow no harm will be done to him—only that perhaps Bernard Pasha will put him on half pay—not returning to Khartoum after leave is expired.21

20 21

Ibid. p. 229. E.E. Bernard, the Financial Secretary, Khartoum.

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chapter nine My wife is nursing at the Hospital—I am Red-Crossing—My sisters and brothers are well—my only nephew is up in the Dolomites fighting against the Italians— Do have patience—that is all what you want—and [I] shall write as soon as I get again an opportunity. With kindest regards R. Slatin My people send their best salaams.22

We can take it that Slatin was quoting fairly directly from Christopherson’s letter and that the frank statement of wanting to get some practice in war surgery was genuine. He had not been attending to battle wounds since the his days in the Boer War and he enjoyed surgery. It may be that this was the most persuasive reason offered to Wingate to let him go although Wingate may also have felt a sense of relief in seeing his troublesome doctor leave Sudan. Now Joyce knew what her husband may not have known at the time, that the Austrian commandant had been asked, in friendship, to take good care of the group. It was also in the commandant’s interest to do so as the medical team could care for all comers, and did so. Three days later Slatin wrote to Wingate: My dear old Rex— Our mutual friend Penfield has informed you that little Christo was captured by an Aust[rian] Detachment, after the Bulgarians had cut the railway to Salonica.23 He works now at a Hospital at Vrnjacka Banja and is looked after by a friend of mine Col. Perry F Lobkowitz24—As he came to Servia to get more practice in “war-Surgery”—he has now an opportunity and for a Doctor it must be the same for what nation he works [sic]. Anyhow I will do my best for him and I telegraphed to his wife not be anxious about her little husband.”25

Christmas 1915 and a Waiting Game, in Isolation And so Christmas 1915 came and went. The group made as merry as they could in the circumstance with a traditional English pudding “rich

22

SAD 453/702/3. Frederic Courtland Penfield, journalist, writer and U.S. Ambassador in Vienna at the beginning of World War One. 24 Lobkowitz, Prince Perry F. 25 SAD 223/3/19 [No telegram has been found.]. 23

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in coins, thimbles, and other keepsakes . . .”26 and homemade entertainment, and even took a photo of themselves in fancy dress to record the event.27 As January passed, the hospitals slowly emptied out and spring began to brighten and green the region, the group felt “like people living in a little oasis of sunshine surrounded by a wall of impenetrable fog.”28 All communication had been cut off and the last newspaper to reach them was dated 3rd October. James Berry wrote only in generalities about the spirits of the group; some were in cheerful hope one minute and in the depths of despair another. Some took life as it came day by day, and could accept with equanimity the possibility of being imprisoned until the end of the war. Christopherson had joined the group late and one can imagine that having such a capable surgeon on the team was a tremendous asset at this difficult time. Although there is no detail of any particular individual’s mental outlook at this trying time, Christopherson surely would not have been among the faint-hearted. He was, as we have seen, both stubborn and determined. The very idea of despair was not an option he was likely to entertain. In chapter eighteen of his book, James Berry alluded to a book that was popular at the beginning of the war, The First Hundred Thousand, and used some of that author’s charming metaphors to describe what was happening to his unit.29 He mentions the ‘Department of Practical Jokes’ in referring to the many times they had been instructed to leave, or get ready to leave, or to catch this or that non-existent train, only to discover that the rumour mill had been grinding once again or perhaps just the usual military mix up had occurred. Then there was ‘Olympus’ who reigned over all, but was never seen and finally the ‘Fairy Godmother Department.’ I wondered about the latter story as I read James Berry’s book closely. I had heard so often the story of how Christopherson’s friend, Slatin Pasha, had effected their safe conduct out of Serbia. If Christopherson had a pretty good idea who the good fairy had been, when at last he rode the train through enemy-occupied Serbia, he must have felt he should keep it to himself. I can only conclude that even to let a whisper of Slatin Pasha’s involvement out

26 27 28 29

Berry, Op. cit. p. 245. Ibid., p. 260. Ibid., p. 256. Ian Hay, The First Hundred Thousand (Edinburgh: Blackwood and Sons. 1915).

9.2. JBC’s postcard—the railway station at Vrnjacka Banja, one of very few pieces of mail to get through.

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until the war was quite finished might jeopardize the safety and the reputation of this friend who helped him. James Berry made no specific mention of this. The Berry book was published in 1916 in the middle of the war, so likely the full story had not yet trickled out. No further editions or addenda to the book have surfaced. Dr. Berry was as mystified as anyone. He wrote: “By what means the ‘Fairy Godmother Department’ had been moved to take action for the British Missions we do not know. We had been told in the early days of our captivity by Prince Lobkowitz that negotiations were going on about us in high quarters, but we had no definite intelligence either then or afterwards as to what was actually occurring.”30 Belgrade had fallen some time ago. This they knew, yet it seemed that travelling to Belgrade as a first step was being discussed. A number of letters were written to the Red Cross in Geneva and the American Ambassador at Vienna, but there was no reply. Yet when the permission to move came it came not as before from the ‘Department of practical jokes;’ i.e., be on a train tomorrow, instead the orders from the ‘Fairy Godmother Department’ allowed five days—considerate indeed. On 18th February 1916 the horse-drawn wagons with hay to sit on pulled up at the hospital ready to take the group, twenty-five people, to the station. Friends of all nations came to bid ‘good-bye’ and hand them gifts of cakes and other goodies. The carriage was third class but each of the group was equipped with “sleeping bag and a small linen sack containing in it enough provisions for three or four days together with a plate, knife, fork, spoon, and cup.”31

This last also has a whiff of the ‘Fairy Godmother Department.’ One member had also taken the precaution of bringing a glass carboy of clean Vrnjci drinking water. They travelled under the armed guard of two Hungarian non-commissioned officers, and received nothing but courtesy from both Hungarian and Austrian military personnel. In contrast, the Germans they met on those few travel days were reported to have been an uncivil and rude lot. The train stopped at Krushevatz where they changed trains, going on to Belgrade, and here more German rudeness awaited them. On the evening of the fourth day the group arrived at Vienna, and being unable to find rooms in any hotel, they arranged to be put up in three first-class carriages shunted on to

30 31

Berry, Op. cit., p. 266. Ibid. p. 273.

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a siding. Here they slept in comfort for the first time on this journey. Christopherson later wrote: The members of the Berry mission will remember Slatin meeting them at the station in Vienna: his introduction to Sir James and Lady Berry, giving them details of the arrangements made for the journey to England: how he came early next morning to bid them auf wiedersehen, laden with boxes of chocolates for the nurses. How infectious was his gaiety on that occasion!32

James Berry reports on the delightful time they had on that day in Vienna, how even though they were in enemy uniforms, the Red Cross is so highly regarded they were saluted everywhere they went and needed no passes to wander around the city. Berry remembers the happy day when Slatin, “an old friend of Dr. Christopherson’s, now actively engaged on Red Cross work in his native country . . . and was most kind and hospitable.”33 It doesn’t seem to have occurred to Dr. Berry that the ‘Fairy Godmother Department’ might have a Fairy Godfather at the helm. Nowhere does he suggest that he has any idea where all this help came from. He went on to explain that the American Embassy took care of the tickets and arranged for the journey in “comfort to Switzerland, and Sir Rudolf Slatin came to see us off, bestowing a farewell gift upon our nurses in the shape of a huge box of chocolates.”34 The rest of the journey was not entirely without incident, but once they crossed the border they knew that freedom was theirs, and the Swiss welcomed the travellers with joy. First-class carriages were reserved from Switzerland to Paris and it was only on reaching England in mid-March that the reality of English life in wartime struck them. There were no seats on the London train from Southampton: the Berry unit was home.

Finally, Back in Khartoum and Reunited with Joyce Having arrived in England in early March, Christopherson was briefly reunited with his family before turning around to head back to Khartoum. His ‘certificat D’identité’ for ‘the [Suez] Canal’ shows he passed 32 Christopherson, J.B. Slatin Pasha: A friend of the British Red Cross Units in Serbia, Brief Account of his Career British Serbian Units Bulletin No. 23. (February, 1933), p. 5. 33 Berry, Op. cit. p. 281. 34 Ibid. p. 281.

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through there on 11 April 1916. His letter to Wingate, who was still in England, written a few days later, is quoted here in full as it comes in the nature of a report and is packed with information unlikely to be found together elsewhere. The letter also constitutes an account full and serviceable enough to explain his absence beyond the permitted leave to the Financial Secretary, and thus counter the possibility that he might not receive his monthly pay. KHARTOUM 25th April 1916 My dear Governor General, We arrived in Khartoum on April 18th having started from London on March 29th crossing Southampton—Havre and joining the P. & O. at Marseilles. I must thank you for your telegram of welcome on our arrival which we replied to. Lord Kitchener asked me to give you his kind regards—I saw him at the War Office, and Slatin whom I saw in Vienna on February 20th also asked me to deliver from him friendly messages. He was in civilian dress and was quite well. He lives with his wife—whom I called on—in a nice flat in the Karlsplatz not far from the Schwarzenburg Platz, where the coloured fountains play. Slatin’s sister and brother Adolph occupy the flat in Reichrathtrasse. Calling on Slatin was the Austrian Naval Commandant who sank the ANCONA. He was there with his wife and wore two iron crosses. I did not know anything about the ANCONA at that time. Slatin is a great friend of Penfield the American Ambassador at Vienna35 and I have no doubt was instrumental in securing for the British Mission in Serbia proper treatment—I know that he helped me personally very much as did Prof. v. Eiselsberg the Austrian surgeon.36 We were lucky to get away as soon as we did as we were given to understand that all the men would be kept until the end of the war. If I had been kept v. Eiselsberg would have asked for me to be sent to Vienna or I should have been sent to Sofia to work under the Austrian General Staff there—v. Eiselsberg who had been in Sofia on his way back from visiting the King of Greece in December had already spoken about me. At any rate I should have got some work which would have been better than an internment camp with nothing to do. They gave us the ordinary soldiers’ rations which we supplemented with things out of our own stores. Machonochies rations etc. but were not too well off in stores. We had to do our own housework, clean our own boots etc., but everybody was all the better for the experience. The Austrians and Hungarians treated the British Medical Units very well and did not take the drugs and equipment of Units actually doing medical

35

Penfield, Frederic Courtland (1855–1922). Anton von Eiselsberg (1860–1939) innovative neurosurgeon in Vienna, he was first to resect a cerebral tumor, in 1904. 36

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chapter nine work nor their stores from any unless they thought they were being quietly disposed of to the Serbs. So far as I could judge, I think too that their treatment of the Serbs was conciliatory—they wished them to settle down under their administration. At first there were two British Hospital units in Vrujatachka [sic] Banja and three others came in when the Austro-German army advanced: about 120 British altogether; one of these (Scottish women) was sent to Krseratz and thence to be interned at Temserai in Hungary and I believe Dr. (Miss) Alice Hutchinson has given an account of their adventures in the current number of BLACKWOOD.37 The A’s and H’s [Austrians and Hungarians] were quite friendly in their personal relations with us and did not ask us to look after their wounded except in one or two cases of operation when they asked us as a favour. They did not interfere with our professional work. Vrujatschka B.[sic] was packed with Serbian refugees—many of high degree. Ministers and ex-ditto. We had an interesting experience during the journey home; starting in a snowstorm on February 18th on to Kruseratz where we slept—I in the luggage van with soldiers and baggage—next night I slept on the floor of the Belgrade waiting room, next night on the floor of the corridor of a 3rd class carriage in Vienna station etc. etc. It was a regular picnic. We all had sleeping bags made of two or three blankets. We stayed in Vienna only one day and left at 8-pm February 21st destination unknown—SLATIN saw us off at the station and brought the nurses boxes of chocolate. We arrived at Bendenz (TYROL) via Innsbruck next day at 1.0 pm and stayed there 10 days and then we were sent on to Zurich via Feldkirch—Bucks and were handed over to the British Consul-General (Hertslet). Next day I with the Chaplain of the Mission started for England (via Berne, Pontarlier, Dijon, Paris, Havre etc.) We were fortunate in being in the hands of Austrians and Hungarians but it was not difficult to see that Germany was the moving spirit in this last Serbian campaign. As they had made up their minds not to keep us—the Germans would have got us away a month sooner—if we had been in German hands and not Austrian. In a very few weeks the Germans had the railway bridges repaired and trains running one after another laden with war material—Berlin to Constantinople. Serbia was very badly off for food when we left but there was no sign either in Hungary or Austria of any serious deficiency. They appear to be very confident that they will win and I think it will be some time yet before we are able to impose on them our terms of peace. We had no news from October 3rd to March 3rd beyond some Austrian and Hungarian newspapers, so I am engaged now in reading the back numbers of the ‘Times’ in order to see the accounts of the events published at the time, German communiqués as well, the latter are very brief but are as a rule fairly accurate in statements of fact.

37

Blackwood’s magazine.

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I could get 50 Kronen for an English sovereign at the American Embassy Vienna on February 21st. Gold is very scarce in Austria. The Austrians and the Hungarians have called up their last man but the Germans have not by any means. Hunyadi is not killed.38 Cardeza his friend who came to the Sudan with him is Private Secretary to the American Ambassador in Vienna. Mrs. Cardeza is running some hospitals in Austria. I saw Count Kinsky in Serbia39—he was sent over when the hospitals were inspected because he knew English well, he was on the General Staff . . . In consequence of an order to the effect that anything in the way of arms, ammunition, photos, letters, printed material or manuscript would be confiscated at the frontier—I had a wooden box made in Bendenz and put what trophies I had and all the photographs I had taken into it and addressed to Cardeza at the American Embassy and I hope to get them later otherwise I should have sent you a used Austrian shell for the siege of Belgrade which I was bringing along for you. With very kind regards. I hope you will not trouble to answer this letter as you will be in Khartoum soon I expect. I am very glad to see from Lady Wingate’s letter to my wife that you are quite well. I am, Yours very truly, J.B. Christopherson.40

On 7th May 1916, from Khartoum Civil Hospital, he wrote again to Wingate saying he was sending on two letters received from Slatin and a note from Countess Hunyadi written during their sojourn in Serbia. He explained further, “From Oct 12th to Feb 18th (when we left Vrnjacka Banja) no one amongst the 120 English people captured—received any letters paper parcel or communications of any kind outside the county town we were in excepting myself. I received 2 letters from Slatin (one of wh. I send) 2 letters from my wife and a parcel all of which she got thru’ herself.”41 In view of the fact that he was the only person out of 120 who received any outside communication, it would seem to indicate that Slatin, in the role of the fairy godfather, had at least been facilitator, and that Slatin had asked his friend, Printz Lobkowitz, to monitor the group at Vrnjacka Banja. Slatin wrote again to Wingate: “About Christo and the other English R.+ people I didn’t [do] much I only recommended to my Govt. to 38 Count Hunyadi had an estate, perhaps a holiday resort on the southern shore of Balatonszemes, Hungary. 39 Charles Kinsky, 1858–1919. Friend of Slatin. Served in the Austro-Hungarian diplomatic service. 40 SAD 200/2/36–39. 41 SAD 159/5/53.

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repatriate them which was accepted. I hope he and his Diavoletta are ’appy at Khtm.”42 Slatin had great affection for Joyce, he often refers to her as ‘Diavoletta.’ Joyce was taller than her husband and, in some circumstances, shy. She abhorred having her photo taken, and I can find very few. She enjoyed young people, and it is a family story that when playing tennis she would send balls into the shrubbery and ask some of the young people to recover them in the interests of encouraging romance. As Christopherson remarked in one letter to Wingate, Joyce had received a kindly letter from Lady Wingate so we may deduce that Joyce was a decided asset to her husband in smoothing any troubled waters in the community on the Nile. One imagines that as a married couple, they might have spent some evenings at the Khartoum Club, although as Bishop Gwynne wrote in an appreciation of Christopherson after his death, he was not known for frequenting the club. Relations between the Governor General and Christopherson, as evidenced by the letters, seem cordial now, even friendly. The change of responsibility from Director of the Medical Service in Sudan to Director of the two civil hospitals, Omdurman and Khartoum, and finally the greater focus of the war, must have had a beneficial effect on the relationship between the military administration on the Nile and the ‘difficult’ doctor. But perhaps the most important change for Christopherson was the fact that by 1914 both Phipps and Balfour had left Sudan. Phipps had been the particular thorn in Christopherson’s side, and once he left I cannot find one letter of complaint against Christopherson. Nor does the doctor mention his old foe.

Looking Back from the Present Christopherson’s train journey from Southampton took me back to remembering train travel in England during the Second World War. Once a year during the summer holidays, my mother and I travelled from Weybridge, Surrey, to Birmingham to visit her parents. This involved a train to Waterloo station then the extravagance of a taxi, on account of the luggage, for crossing London, then a second longer

42

SAD 223/4/6.

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9.3. Sir Reginald Wingate and Sir Rudolph Slatin Pasha.

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train journey to Birmingham from Paddington station. I was impressed by my mother’s spirit when once she took back the tip she had proffered the taxi-driver in London who complained it wasn’t enough: “In that case I need it more than you” she retorted smartly and turned on her heel. Somehow we struggled dragging the luggage from our house on Hanger Hill to Weybridge station. The wounded had priority for seats on trains. We stood in the corridors straddling our suitcases and Mum tried to shield me from seeing the often heavily bandaged wounded men in the compartments. At major stations Red Cross personnel ran to and fro handing out tea, chocolates and the ubiquitous cigarettes to ‘our brave boys.’ Any civilian complaining of anything would be reprimanded with a curt: “Wot’s the matter, don’t y’ know there’s a war on?” Christopherson’s nephew, Peter Ormerod, entrusted me not only with the Christopherson letters but also with various other precious items.43 I now have Christopherson’s brassards, two of them. One is quite pristine, made of machine-stitched canvas three inches wide and marked in Serbo-Croatian: Military Reserve Hospital, No. 12, 11 Oct. 1915 in VRNJCI. The other is six inches wide with a hand-stitched red cross. On the back written in black ink, ‘Dr. Christopherson.’ There is something moving about handling this grubby, well-worn arm band while thinking about the bitter winter the group endured and some of the demanding surgery he performed while wearing it. That Rudolph Slatin was the unseen fairy godfather to the group is indisputable, and both Joyce and her husband remained eternally grateful for his wartime help. Shortly after Slatin died Christopherson wrote a tribute to the man whose friendship had meant so much to him; it was published in the Bulletin of the British Serbian Units (British Legion) and later reprinted as a little booklet. I received the copy Christopherson had sent to his older brother Arthur in Australia. This has now traveled from England to Australia to Canada, and will now return to England. Christopherson titled his appreciation: Slatin Pasha; A friend of the British Red Cross Units in Serbia and began, “Slatin was sturdily built, rather below the average height, fair, with very blue eyes beaming

43

UK.

All letters and items will be deposited in the Sudan Archive, Durham University,

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with fun.” He was probably about the same height as Christopherson, somewhere between five foot six and five foot seven inches. Slatin’s lifestyle, adventurous, glamorous and at times downright dangerous, meant his reputation was not without controversy. While in captivity by the Khalifa at the siege of Khartoum he had converted to Islam and thereby saved his life but as a consequence drew the opprobrium of General Gordon who refused to convert and was murdered. From Christopherson’s essay we find that, even though a devout Christian, he had no quarrel with Slatin’s actions. Christopherson also refers to Slatin ‘patriotically’ remaining in Vienna to assist his own country at the start of the First World War. Not everyone saw it this way and Slatin went through considerable turmoil of conscience over his divided loyalties between Sudan and the British on the one hand, and Austria, land of his birth, on the other. Christopherson also recalled being taken round Omdurman by Slatin, the Omdurman of Slatin’s memory from the time when he was a prisoner of the Khalifa: All would be re-animated and peopled like the scene of some weird barbaric mediaeval tale. There was a personal touch when Slatin and friend passed through the maze-like entrance of the Khalifa’s house and he pointed out the little room which he had inhabited for ten years, and from which he called the hours of the night that the Khalifa might know he had not escaped.44

After the war the Christophersons and the Slatins kept in touch. Slatin notified them when his adored wife Alice became seriously ill in early June of 1920 and underwent surgery, writing: “My dear old Christo” and ended “my best love to your dear wife.” On the 27th June his wife died, and again he sat down to write to Christopherson. That Slatin wrote to the Christophersons within hours of his wife’s death adds weight to my understanding of the bond between the two families. A year and a half later, at Christmas 1921, he wrote to Joyce referring to her husband as “The sheikh of bilharzia.” In 1927 another letter to Joyce from Slatin begins with: “My dear Diavoletta” ending with “My salaams to your great little husband.”45 Slatin seems to enjoy referring

44

Christopherson, J.B. Slatin Pasha: A friend of the British Red Cross Units in Serbia, Brief Account of his Career British Serbian Units Bulletin No. 23. (February, 1933), p. 7. 45 SAD 453/702/18.

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affectionately to Christopherson’s short stature although he was certainly on the short side himself. Rudolph Slatin died in 1932. His death must have been a blow to the Christophersons, and in many ways it signalled the end of an era.

CHAPTER TEN

FRANCE 1917. THE COMMISSION ON MEDICAL ESTABLISHMENTS

We get very varied stories and it is rather difficult to arrive at the true state of affairs. Sloggett appears to be supreme over here and Keogh over in England and there is nothing between not even sympathy. —JBC to Joyce from France 6 Jan. 1917 If we can stick to it for a few months longer we shall win this war but it will be victory for labour and democracy and it will mean that the old order of things has altogether changed. —JBC to Joyce from England 6 Jan. 1918

1917 and Two Deaths in the Family By early 1917 Christopherson was back in Khartoum at the civil hospital and this time Joyce was with him. Sadly, at Christmas, news of Canon Brian Christopherson’s death was received. He had died in his retirement home in Kent on 24th December, 1916, at the age of seventy-nine. Wingate wrote a kind letter. “. . . I am glad that you will be able to get home to help your mother.” Then added, “I trust you will be able to get the work you wish for in Flanders; there must always be something that can be done by a man of your qualifications even though it is for such a short time.”1 As an extra kindness he referred in a postscript to “young Chappel” Christopherson’s twenty-year-old nephew, William Chappel, favourite son of his sister Caroline, who had been killed a few weeks after the death of his grandfather.2 The casualty lists in The Times and the dreaded delivery of a telegram in its yellow envelope had

1

Presumably Wingate only gave JBC permission to be away a few months but he was obliged to stay longer. 2 Wingate to JBC 9 April 1917. SAD 145/4/84. (William Eldon Chappel, son of Caroline née Christopherson, and Herbert Chappel, buried in Egypt).

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become part of life; still the tragic news of his young nephew’s death, killed in action on 4 April, stunned the family.

The Commission on Medical Establishments in France— Christopherson Is Appointed Secretary in the Summer of 1917 Christopherson’s new job was in the works although not yet officially announced. He was to be Secretary to The Commission on Medical Establishments in France. It was a job he was well qualified for with his background of work in the Boer War and more recently in Serbia. The presented statistics with respect to the need for medical services exposed the short-sighted outlook of the higher command.3 Admittedly this is a view looking back from the year of publication, 1931, but one assumes it was with a fresh and frank perspective, documenting how dire the need for change had become in the early years of the war, a war that would not be ‘over soon.’ The enormous and devastating casualty lists had prompted serious questions to be asked in parliament in August 1917. The Times reported that Sir Garrod Thomas called for the Director-General of the RAMC to be “. . . given his proper place and put on the Army Council . . .” to enable the much needed reforms to take place. The War Office reply was given by Mr. Macpherson [Major-General Sir W.G. Macpherson, Director Medical Service First Army] assuring the House that indeed a committee would be appointed to inquire, in France, whether there was a misuse of the services of medical men who happen to be serving there.”4 Unbelievable as it may seem, in 1914, when the British Expeditionary Force first went to France there was “no responsible administrative medical officer attached to the Commander-in-Chief ’s staff, to whom important administrative questions could be referred for immediate decision. . . .”5 Medical men who had volunteered from their domestic practice were wont to crave a life of glamour and excitement at the Front, and became dissatisfied when this did not always materialize; they complained their talents were being wasted. Medicine in wartime is a case of overworked or under-worked—hours of boredom interspersed

3 T.J. Michell, &. G.M. Smith, Official History of the Great War based on Official Documents; Medical Services Casualties and Medical Statistics. (HMSO London, 1931). 4 The Times, 15 August, 1917. 5 Michell, T.J. etc., Op. cit. p. 34.

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with periods of sheer terror and extreme fatigue. It was perhaps the battle of the Somme (3 and 4 July 1916), generating ambulance trains carrying as many as 29,000 wounded, that forced changes. Inflexible policies dealing with lines of communication, fast evacuation of the wounded and the ever-present ravages of typhus, meant that the medical administration was forever behind in adjusting to the latest crisis. The need for dentists seems to have been all but overlooked. Most were serving as combatants; the Commission reported (on page 85) a ratio of one dentist to ten thousand soldiers, including those fighting. These facts, added stories finding their way home, lent urgency for a Commission to report on the status of medicine and to suggest improvements. At the very least it would show someone was doing something. The concerns that had rattled parliament, as reported in The Times, again in August, 1917, were, for example, that bonesetters were not qualified medical men but, given the dearth of medics in France, ‘should they not be allowed to practice?’ Naturally the physicians saw admitting even skilled amateurs into their ranks as the thin end of the wedge, and they fought hard to protect their profession. The arguments were analogous to those of osteopaths versus physicians today. Sir Watson Cheyne, MP for Edinburgh, took up the discussion in his maiden speech. His fear was that the floodgates would be open to any and all unqualified practitioners and herbalists.6 “. . . bonesetters in general . . . were not educated for their job.” On another subject, there was comment by Sir Garrod Thomas who told of many physicians on duty in France complaining they were wasting their time there with very little to do. He recommended “. . . an inquiry at which all men could speak frankly and fearlessly . . .” He did not mention the South African Commission of Inquiry from the Boer War, which surely would have been worth revisiting. In fact no one did, but even so the conditions, in particular the terrain being fought over in France, were soon found to be the determining factor generating the many cases of tetanus. “Almost every wound spouted pus. Suppuration and gangrene dominated us for the time . . . Hundreds of men died of poisoned wounds . . . This state of affairs came as a great surprise . . .” wrote Surgeon George Gask.7 The

6

Cheyne, Sir William Watson, (1852–1932) pioneer in antiseptic surgery. George E. Gask, The Memoirs of Professor George E. Gask 1914–1919 (Cornwall: Liskeard Books, 2002), p. 11. A note from Peter Ormerod September, 2005 says: George E. Gask, CMG, DSO, became the first director of the Surgical professional unit at Barts when it was set up in 1920 and that Gask also operated unsuccessfully on Ormerod’s grandfather, Prof. J.A. Ormerod. 7

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terrain in South Africa was dry and sandy. The ground in France and Flanders was agricultural and had been manured for centuries. Even small wounds were ripe for infection in France. On 24 August, The Times announced the distinguished group: ARMY MEDICAL SERVICE A Committee of Enquiry. Arrangements have been made by the Secretary of State for War for a committee composed of: Major General Sir Francis Howard K.C.B. K.C.M.C., Chairman. Sir Rickman John Godlee, Bt., K.C.O. Sir Frederick Taylor, Bt. Sir William Watson Cheyne, K.C.M.G., C.B. M.P. Lt.-Col. A.J. Stiles, M.B. C.M. F.R.C.S. Dr. Charles Battar Mr. J.B. Christopherson. F.R.C.S., F.R.C.P. M. D. (Sec.) To proceed at once to France for the purpose of enquiring into various matters connected with the personnel and administration of the Army M[edical] S[ervice] in that country. On their return they will carry out similar investigations in the UK. The appointment of this committee gives effect to an undertaking given by Mr. Macpherson in the House of Commons on August 14 when replying to complaints that the present status of the Army M.S. as a subordinate branch of the Adjunct General’s department is unsatisfactory, and that there is a present wastage of qualified medical service in the Army detrimental to the interests of the civil population in this country. It was contended that the status of the service should be raised by erecting it into separate and co-ordinate Army departments and it was urged that the medical work of the Army could be efficiently performed by a smaller personnel than is at present engaged in the field. In his reply, the under-Secretary sought to discount these criticisms, but promised to appoint the present committee.

The following joined subsequently: Gen. Macpherson, RAMC., Col. Moyan, RAMC., Sir Arthur Sloggett, Dr. Norman Walker, Gen. Burtchaell.8 All except the chairman were medical men.9

8 General C.H. Burtchaell took over from General Arthur Sloggett, who retired in May 1917 having reached the age limit in the army. George Gask described Burtchaell as a man who “impressed us favourably as a man who knew his job: he was a monumental man with a large capacity for work and food.” Gask, p. 85. 9 Major General Sir Francis Howard K.C.B. K.C.M.C.

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When Wingate wrote to Christopherson as early as 9th April, 1917 about ‘the work you wish for in Flanders,’ he must have been alluding to a job on the Commission or something of equal importance. Christopherson would never have been given leave from Khartoum without the firm offer of a particular job even if he did not know the precise details, which clearly he did not. The correspondence regarding the initial approach to the doctor has not been found, nor his letter requesting leave from Sudan. It may be that the ‘powerful professional friends in London,’ once alluded to by Wingate, were the same men who requested him for the Commission.10 He knew Col. Stiles and General Sloggett and from his familiar tone about ‘Freddie Taylor’ in a letter to Joyce, he probably knew Taylor too. Having observed the earlier ‘blue-ribbon’ Commission on hospitals in South Africa when he was at the Imperial Yeomanry Hospital in 1900, he knew something about the nature of the work of such a Commission.

Christopherson Heads to Europe and a New Opportunity; Joyce Moves to the Hill Station on the Red Sea In the late spring of 1917, Joyce travelled up to Erkowit and stayed with their friends Charles and Stefania Armbruster to wait out the war in Christopherson’s absence.11 Erkowit was a cooler resort in the Red Sea hills much favoured by the British colonials in midsummer. By the end of July, Christopherson was off to England, stopping at the Casino Palace Hotel, Port Said, where he wrote to Joyce “[I have] a room right on the roof and I expect to get a really good night free from mosquitoes and other eaters.”12 Concerned about her well-being he suggested that should she need medical attention, Beddoes or Phillips in Cairo were both good friends of his. Phillips was probably Llewellyn Powell Phillips who wrote Amoebiasis and the Dysenteries published

10

Wingate to Acland 29 November, 1908. SAD 284/3/68. Armbruster, Charles H. b. 1874. Author of a number of texts in Amharic. He held several senior positions in the Sudan administration. 12 Letter 27 July, 1917. 11

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in 1915. Christopherson kept a copy handy on his shelf at Khartoum Civil Hospital.13

Was Wingate, the Sirdar, Influenced by Phipps on the Subject of the Difficult Doctor and His Friends? Wingate, through all but one surviving note, had kept an even tone in his written communications on the subject of Christopherson’s difficulties with the administration. One interpretation is that the Sirdar relied on Phipps to deal with any unpleasantness and could distance himself from a face-to-face confrontation with his senior physician, or anyone else for that matter. Another interpretation is that Wingate wrote encouraging letters to Christopherson whenever he saw that the doctor could be spared to go anywhere, as long as it was out of Sudan. Letters of this kind could be seen either as genuine well-wishing or, as an excuse cloaked in friendship, to get rid of him. On the other hand, it is equally likely that the Wingates, as a social couple (even if known to be stiff and formal), got on well with Joyce, who by all accounts was a kind and friendly woman and likely to have smoothed her husband’s path socially after she arrived in Khartoum in late 1912. A fourth, and a very important point, is that Wingate understood well that Christopherson had more surgical and tropical medicine expertise, at least in the early years, than any of the other physicians in Khartoum. Such breadth of knowledge could not be dismissed lightly, and had to be weighed against the occasional nuisance of Christopherson’s contrariness. For instance, Lord Cromer wrote to Wingate on 11 December, 1905, regarding a proposed trip up the White Nile. Cromer had recently suffered a ‘sharp attack of influenza’ and was nervous of getting malaria so soon after. He asked Wingate to “consult one of your best medical authorities on the subject.”14 Wingate consulted Christopherson who replied with a carefully considered letter saying that he could in no way guarantee against an attack of malaria so would not advise the trip. Many years later, in May of 1928, Wingate wrote to his old friend Rudolph Slatin, referring to ‘our dear old friend Christo’15 I suggest that 13

Years later in 2002, this same copy was handed to me as a gift by Prof. Abdel Rahman Musa, director of the Sudan Medical Specialization Board. 14 Cromer to Wingate 11 December, 1905. SAD 234/4/94. 15 Wingate to Slatin 2 May, 1928. SAD 431/11/128.

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either Wingate had mellowed over the subject of Christopherson by then, or knowing that Christopherson and Slatin had long been friends, he sought to write in a kindly manner, or perhaps he always felt friendly although occasionally irritated. All theories are open to speculation, including the notion that Phipps’s patent dislike of Christopherson had influenced Wingate in the past.

Christopherson Heads for the War in Europe Surely Christopherson had qualms about his move to Europe? It must have felt odd that he was heading back to England leaving important things to others at the hospital. We learn more later from some of his published papers with acknowledgements to those filling in for him, that a lot was happening on the experimental front. He does not appear to have told Joyce about his bilharzia work. In general, his letters show a high degree of openness when it comes to the behaviour of individuals in the administration. There is no discussion of how the various doctors (and one mention only of Mr. Newlove) are progressing with his tartar emetic cure. He must surely have been receiving progress reports from Khartoum. In Khartoum he had been on the cusp of a great medical breakthrough, and at the same time trying to hold on to self-esteem earlier damaged by the irascible Phipps. Nevertheless this chance to be a part of the war effort, and find something that would restore his self-respect, was an important opportunity. While he was in England, Joyce remained in Egypt, playing golf and amusing herself while war raged in Europe. It would have been difficult for her to have booked a passage, and in any event her husband would shortly be deployed to France from England. His letters to Joyce are full of solicitous, husbandly concern, and indeed this is the tenor of all his letters to her over their long lives. In some letters he calls her ‘my dearest Joyce;’ in others, in the colloquial style of the day, ‘my dear old girl,’ and he was always concerned that she should not be short of money nor stint herself. The couple were not spendthrifts; on the contrary, they appear frugal. Joyce had one or two small inheritances from her uncles which he put into war bonds for her. They kept their personal money separate, he often borrowed from her and mentions how soon he will pay it back. The curious omission in these letters is that there is no word of his bilharzia work, not a word about the tartar emetic treatments he is

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using at the Civil Hospital. Given that he confides a good deal of his success and frustration to Joyce, this seems out of character. Was it all to be kept a secret until success allows publication? Were Izzedin and Newlove, and others working in the wards, asked to keep quiet? We are left with speculation only. Finally he was really on his way to England and wrote, on July 28: “My dearest Joyce, We sail this afternoon on Norana a B[ritish] I[India] Boat, small but she looks quite a business like affair, 4000 tons.16 Yesterday afternoon 4 or 5 steamers left P[ort] Said as if there were no submarines about.” Then, being more frank than usual he added: I’m glad to get away from the Sudan even for 4 months. Things are not at all satisfactory in the Medical Department and I have no power at all and a most unsatisfactory position, nor has my work been recognised. If I had been a soldier I should have been a Pasha 5 or 6 years ago. However a little holiday is indicated now. Well au revoir and I hope you’ll manage to have a good time whilst I am away I should join the golf club at once at Alex and go round with someone every day.17 Get a book of tram tickets so that you have not to carry about a lot of small change. Find out where the National Bank is and go yourself to cash a cheque so that they will know you by sight . . .

This is a most revealing letter. His concerns as hinted at in the first three sentences of are discussed in a later chapter. With regard to his sea journey home he knew it was not without danger of attack from submarines. On 5 August on a P & O ship he wrote: . . . The weather is glorious and if the boat was faster and the conditions different it would be fine. We shall have been 9 days on the journey. We stopped one day at Malta. It is pretty unhealthy in the Mediterranean at present. 7 boats in the last week have been pipped [torpedoed and sunk] between Malta and Marseilles alone. The “Mooltan” wh. started a week before we did was nailed I think just off Marseilles—one man killed by the explosion. The P & O have lost 9 boats although most of them pretty big. Mongolia, Moretan, Salgetta, are the 3 last. We passed Kaiser-I-Hind yesterday escorted by 2 Jap. Destroyers.18 We have only one but all the

16 British India boat. Personal communication from John Rugg, Naval Architect, Lloyd’s Register. 22 June, 2003. 17 Alexandria, Egypt. 18 Despite the name looking German, it was actually the name of a type of butterfly. The Kaiser-I-Hind was specially designed for the London-Bombay trade. Used for troop transport in the First World War, she was struck by a submarine’s torpedo in the Mediterranean, in March 1917 but the warhead failed to explode.

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crew appear to have field glasses and I don’t think they will miss much and they seem very keen . . . I was awfully sorry to read that Willie Segundo was killed in the Warspite explosion—804 killed.19

Dr. Segundo was both a friend and a colleague. The Christophersons and Willie Segundo’s parents remained lifelong friends. Solicitous as always, he suggested Joyce play a game of golf every day and also that she “might buy a spade and dig in the sand.” For women like Joyce in the war it was a case of “they also serve who only stand and wait.”20 Later, in the Second World War and living in England, she was able to contribute by working with the St. John Ambulance Association.21 By 10 August Christopherson was living at his in-laws’ home, 25 Upper Wimpole Street. Your mother and father and everybody have been most kind. The only reason that I do not care about staying here is that I have to rush about so much that it is like making use of it simply as a convenience as am out pretty well all day and often to meals. I am glad that Noel [Noel Somerset, married to Joyce’s sister Barbara] has fetched up at Alexandria. He will be good company for you . . . I hope you will introduce him to the High Commissioner. Tell Symes that he is the Editor of The Morning Post and that will grease the wheels all right.22

Then, Travelling is all over 50% more expensive than before the war. Telegrams min. price 9d. Morning Post 2d. . . . I dined with Col. Bernard at the United Services Club last night. My best remembrances to Mrs. Bernard. . . . Your affectionate husband J.B. Christopherson.

Financial Secretary Bernard, a Maltese Catholic, was on the receiving end of a number of unpleasant epithets about his ‘Levantine’ origins by various members of the Sudan administration, including the Sirdar himself, who referred to ‘my Maltese Cross.’ Nevertheless Bernard was a highly successful financial secretary and succeeded in spite of these bigoted comments. Perhaps that is why he and Christopherson got

19 The Warspite, a super-dreadnought, a most powerful and sophisticated ship was in the battle of Jutland and took a number of hits. 20 John Milton—On his blindness. 21 Joyce was awarded a Medal by St. John Ambulance Association for successful completion of a First Aid Course, Home Care Course and a re-examination for First Aid. 22 G.S. Symes, later private secretary to the Governor General.

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along well. They were both survivors of administrative difficulties; for different reasons, they were both outsiders.

J.R. Newlove Carries On Christopherson would surely not have left his ground-breaking work at the Khartoum Civil Hospital had he not felt complete confidence in those carrying on this work. In letter of 27 July 1917 he wrote to Joyce about his assistant, Newlove: I gave Mr. Newlove . . . £2 for doing my typing and I think he was sorry that he had not bucked up and completed it. I am afraid that Mrs. Newlove has a very controlling influence in the establishment, she is firmly convinced that I visit Mr. Newlove in Cairo for the sole purpose of conspiring with him to get him out of bed, when she has got him nicely tucked in, she is firmly convinced that Mr. Newlove and I go shooting at Khartoum23 in order to conspire with him for an extra hour’s work at the hospital—however he is a good chap and would get on well if he did not consider himself an Admiral [sic] Napoleon.

In other letters the name of J.R. Newlove, the prime assistant, was conspicuous by its absence. In this letter information about his work is also conspicuous by its absence. John Robert Newlove was the invaluable assistant who had been making detailed notes on the bilharzia patients. Newlove also spoke good Arabic, a skill Christopherson lacked. Peter Ormerod has suggested that Christopherson managed only what was known as ‘kitchen Arabic;’ if so he would have relied considerably on his assistant.24 Newlove was also an excellent photographer, having been responsible for dozens of photographs for Balfour at the Wellcome Lab. As will be seen, Christopherson had started his work on the possibility of tartar emetic as a treatment for bilharzia in May 1917, but did not publish his first major paper on the topic until September 1918.25 Here he gave credit to two colleagues: “In conclusion I would thank Dr. Mustafa Izzedin, who has done so much of the work of injecting 23 This was probably target shooting. JBC belonged to two shooting clubs in Khartoum; there are several badges, awards perhaps, to that effect. 24 It is also documented that Christopherson was learning Beidawi and that he planned to dispense with a translator. Sud. A Pk 1909 p. 416. 25 The successful use of Antimony in Bilharziosis. Administered as intravenous injections of antimonium tartaratum (tartar emetic). The Lancet. (September 7, 1918) ii, pp. 325–27.

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these cases, and Mr. J.R. Newlove, who has carried out many of the microscopic examinations connected with the urine.”26 In spite of this minor glory it is likely that Newlove earned very little. When he died intestate in England in 1935, his wife was left a paltry thirty-eight pounds from his estate.27

The Commission Assembles On 20 August Christopherson had written: Another name has been added to the list Dr. Norman Walker of Edin[burgh], I don’t know him but I think he is a good man of business which is what we want. I see Freddy Taylor every day. I haven’t seen Watson Cheyne yet and I have not seen our Chairman Sir Francis Howard aet 70. I did not know him by name but the Daily News incidentally knows all about him as he is described as the Ladysmith Hero appointed chairman. Not to know Howard argues myself unknown I fear . . . it has suddenly turned cold and I am going to take some more warm things over to France . . . I had a nice wire from Col. Bernard at Harrogate congratulating me on my appointment.

Exactly how Christopherson landed this plum job is not explained. What is known is that reading his many certificates of qualification, all original and signed, and currently in my possession, I see he was known to Sir Rickman Godlee and Sir Frederick Taylor as far back as 1895 and 1897, as they were part of one or more of the boards that examined him and pronounced him fit to practice medicine. Either he made a good enough impression that they remembered his name, or they had kept an eye on his career, and perhaps even been in touch over the years. General Arthur Sloggett, Director General of the medical forces in Europe, certainly knew him from their Boer War days. These three connections alone may well have guaranteed the job. Joyce, as one would expect, knew all about his impending work on the Commission, she knew about ‘the list’; the public announcement was not for two more days. Then he wrote: “. . . I got a Telegram on Tuesday Aug. 21 telling me to attend the AGS Office Whitehall on Wednesday at 3 p.m.”

26

Ibid. There was no actual Will. The letter of Administration is correctly what I refer to. 27

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Shortly in another letter to her from ‘Greenhill’, the Ormerods’ country house near Winchester, he grumbled “. . . I had spent 6 days sitting on the office steps trying to deliver my letter from the High Commission to Sir Alfred Keogh . . .” Initially Christopherson was told to take civilian clothes but argued that it would be difficult for him to get about in civilian clothes, he was hoping for “some sort of temporary rank . . . but I should hope Major—however I am not expecting to be able to obtain anything nice since I came down in the Sudan I have had a good deal of work and very little good luck so far as my work is concerned.” A little bitterness crept in, due to the frustrations of dealing with the army, and memories of how badly things seemed to turn out for him in Sudan. By now he must have had reports, fairly successful and all interesting, on three of his bilharzia patients in treatment, and he must have learned of data being collected on another ten. This long letter to Joyce was also full of family news, the usual concerns about money and a reminder that his Will, “not changed since our marriage,” is in the safe in Khartoum. He noted that Colonel Bernard went to stay with their mutual friend William May, (Assistant Financial Secretary in the Sudan government) who had been best man at their wedding. “I saw Lord Ed. Cecil the other day in the Munitions building (Metropol) he is very anxious to go out to France but they say he is too old and he has his K.C.B.28 I wish I was suffering from the K.C.B. complaint. Well my best love and you need not pinch & screw, do what the others [are] doing.” Arrangements for this new venture with the Commission were initially mired in bureaucratic complexities. Upon reporting to the AGS Office,29 Whitehall, the following day, 27 August: I . . . found Sir Neville [sic] Macready there (AG) and Sir G.H. Makim, Sir F. Taylor, Sir Rickman Godlee, Sir Alfred Keogh, Sir Francis Howard (General). Styles [sic] and Battar, and found that I was going to be sent out to France as Secretary to the Medical Commission to enquire into the Medical arrangements. Of course it is a stroke of good luck and success and I hope that I shall be able to make a success of the job. I do not know what it is all about yet but there are so many civilians (16000 in the RAMC now) and they do not appear to be satisfied and questions

28 29

K.C.B.—Knight Commander of the Bath. A very distinguished award. AGS—Army General Staff.

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have been asked in parliament and after the Mesopotamia affair the war Council wh. appointed the commission got rather nervous.30

Underway Finally To Joyce, Christopherson wrote: “We leave for Boulogne tomorrow 28/8/17 and stay there until a program is made and then I expect on to G.H.Q and then for a good tour round. I shall come across many old friends I expect, Coutts possibly at Abbeville and Wang [Edward Wareing Ormerod, his brother-in-law], the Bishop [Gwynne] etc. Very many thanks for your last letter full of good advice wh. I will try and profit by.” Perhaps she was advising that he curb his tongue in this new venture. He can hardly contain his delight at the thought of having a responsible job, working with senior people, seeing old friends and enjoying a chance to regain his self esteem that had become rather battered in Sudan. While saying goodbye to the Ormerod family at ‘Greenhill’ he dashed off another letter to Joyce. I am off today by the 12.50 train from Charing X bound for Boulogne where we shall stay for a few days to arrange a plan of campaign. Afterwards I expect we shall travel all over. In 3 wks. or a month we shall return to England. I hope I shall make a success of my job it won’t be easy. There are a good many thorny questions to be looked into . . . This commission is making a bit of a stir in the profession and elsewhere.

Now he had pride in his situation and a new challenge—Joyce must have been relieved and happy for him.

France—September 1917 France on 6 September, G.H.Q Echelon.31 We arrived at Boulogne on the 1st the crossing from Folkestone was rough and wet—only one member of the commission was ill however.

30 Mesopotamia, generally the area known now as Iraq, had been a military disaster, with limitations of long-range motorized operations, scandals over medical shortages and problems of men fighting in heat of 50° Centigrade. 31 Echelon—Military. An arrangement of troops with units drawn up in parallel lines, but each somewhat to the left or right of the one in the rear, like a series of steps . . . Webster’s New College Dictionary 1961.

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chapter ten We should have started on our journey on Aug. 28th but it was so stormy that the boats were not sailing that day on account of the mines which break loose on a stormy day and it takes a few days to get the course clear again. They are giving leaves pretty freely now, I think 10 days. The weather has been too stormy for operations in the field it has also been so wet that a good deal of the corn and some of the hay has been spoiled wh. is rather a nuisance. We stopped here for 6 days visiting the Medical arrangements holding meetings in the hospitals and questioning people. It is difficult to get the hang of things at first it is so vast. We are staying now in the Hotel Dersaux[?] Not a very 1st class place, very dirty, and the attendance is very bad. It is pretty full and the difficulty in getting meals is very great. It is like a rabbit warren a great number of small rooms up all sorts of curious passages and the numbers are all given anyhow so that room 16 is next room 173. Nobody comes when you ring for hot water in the morning and no one dreams of calling one. I have a Clerk and Typist in one, he has a small room (bedroom) a long way off mine and he has to do his typing in his room, My room is my office and it is working under difficulties but it is war time. We visited Etaples on Sept. 4 & 5 it is the largest camp in France . . . We go to G.H.Q. today and beard the lions in their den—it is only 3/4 hr in motors from here. We return at night and go to Etaples again next day and then we leave here for Calais and from Calais we proceed to St. Omer and then on. It is very jolly motoring we go everywhere in cars. We have 3 at our disposal . . . We get very varied stories and it is rather difficult to arrive at the true state of affairs. Sloggett [ Colonel Arthur Sloggett who had been in command of the Imperial Yeomanry hospital S.A.] appears to be supreme over here and Keogh over in England and there is nothing between not even sympathy.32 Well I hope you are flourishing like a green bay tree . . . I wish you were here too but it is out of the question.

A week later he was still motoring around making daily excursions to . . . various headquarters of the army Corps, see hospitals, examine men and generally investigating. I have not been in the trenches yet, when we go near places being shelled we put on helmets and we always go about with gas masks around our necks in case of necessity. It is very hard work taking and keeping notes. . . . We did 6 hospitals here yesterday . . .

32 Sloggett is referred to by George Gask as ‘Naughty Arthur’ although this is not explained. Gask wrote that he did not appreciate him till later. Gask, p. 19. [I have another note, this time from a Sloggett genealogist, Brian Sloggett, who wrote “His nickname was said to be ‘Naughty Arthur’ because of his eye for young army nurses.” E-mail: 26 April, 2006.]

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‘Doing’ six hospitals in a day suggests at the very most a cursory inspection but no one seems to have remarked on this. From Christopherson’s comments on these first inspections the Commission’s work does rather look as though they were enjoying their jaunting around. I was not far from the trenches where young Asquith (Sudan) was,33 I wanted to go on but the Old General who is Chairman of the Commission was against it—I think he looked upon the proposal as savouring of holiday making . . . I dined with Gwynne last night, Turner was there too and 3 chaplains and Battar. Gwynne is very fat and is very popular he goes about doing a great amount of confirming . . . 34

Next he wrote: “Col. Shine ADMS here has had all his sons killed in the war, 3.”35 George Gask, another Barts man, was also in France and seemingly well-connected. He was also outspoken about a number of the medical brass including poor Dr. Shine whose dreadful loss seems to have made an impression on everyone. Gask wrote in his memoir, “Shine was a pompous little man, an Irishman of the old type of the R.A.M.C. He had not many brains, and a lively idea of the importance of his position, but he had lost his three sons in the War and when the bad bombing days come a few months later he showed himself to be a very gallant gentleman.”36 George Gask also met the Bishop. “I called on the deputy Chaplain General Bishop Gwynne of Khartoum, and came to know him fairly well, and dined with him once or twice. He was a genial soul, fat and cheery and not at all churchy! Waterfield of Port Sudan knows and likes him well.”37 A number of those who had served in South Africa in the Boer War were also in France in the Great War. Surgeon Hamilton Ballance turns up in George Gask’s memoir. A snapshot of Ballance was taken by Christopherson back in the Imperial Yeomanry Hospital days. [See

33 Arthur Melland Asquith (known as Ock) (1883–1939) Third son of Prime Minister H.H. Asquith. 34 Gwynne, Bishop of Khartoum, was a life-long friend of Christopherson. 35 Most likely, Col. James M.F. Shine. Info. Courtesy Colonel Iain Swinnerton. 36 George E. Gask, The Memoirs of Professor George E. Gask 1914–1919, p. 58. 37 Dr. Noel E. Waterfield who worked for Christopherson in Khartoum Civil Hospital and was also a Barts man.

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Chapter 3.] The forthright Gask has this to say: “. . . Hamilton Ballance of Norwich, now Consulting Surgeon at Etaples. He was a man of about 48, very worthy but rather dull.”38 On 23 September, 1917 Christopherson wrote: “At R-U-N We are at the place indicated above if you supply 2 vowels . . . [ROuEn]. . . .” Likely his correspondence was subject to censorship. He remarked in this same letter that Taylor and Godlee, colleagues on the Commission “are very pleasant but I think a little too old for a game of this kind. . . .” Then, “this is the anniversary of our wedding altho’ not the exact date and I am sorry that we are not spending it together however I hope you are having a good time and I wish you every good wish—health and happiness with my best love.” There was much more motoring, some in beautiful scenery near Arras, which only a few weeks earlier, was described by an unnamed correspondent in The Times: “Great numbers of clusters of cornflowers of a blue as rich and deep as the best garden-grown anchusas or delphiniums stand out as the aristocrats of the plebeian and vigorous world.” Also, sprinkled amongst the blue was the yellow of ragweed and mauve of scabious. “Partridges swarm, and in the rank growth get ideal cover for their young from the small sparrowhawks, the only enemy except shrapnel bullets . . . ’39 The writer, obviously a gardener, dreamed of filling in the shell holes and planting trees, “. . . a belt of trees from the sea to Switzerland, with broader tracts to mark the great battlefields . . . as a monument to the victims of the great war.”

Lord Knutsford Creates a Hiccup In early August 1917, Lord Knutsford,40 who sat on a hospital committee in England, sent a long letter to Lord Derby, Minister of War, that really set the cat among the pigeons.41 It began, “We have seen from

38

Gask, Op. cit., p. 71. Tuesday, 14 August, 1917. 40 Sydney Holland, Lord Knutsford, (1855–1931) Chairman of the London Hospital House Committee during the First World War. 41 Lord Derby (1865–1948) formerly Edward George Villiers Stanley, British Minister of War from 1916–1918. Initiated the ‘Derby Scheme’ a recruitment policy by which men could give their voluntary ‘assent’ to being called up if necessary: the government in turn promised to call up married men last. The scheme was dropped in December 1915 as it did not produce nearly enough men to satisfy army recruitment demands. 39

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the Mesopotamia report that very serious errors have been made in the organization of hospitals.” He claimed, perhaps as a veiled threat made under the guise of discretion, that he was writing to Lord Derby rather than raising his concerns in the House of Lords (where of course it would be in The Times the next day). He had two major complaints. The first was that a hospital site in France, abandoned by the Canadians as being unfit and therefore condemned (sewage ran back into the middle of it), had been given to the Americans and that this was now a unit under “the command of Harvey Cushing, the most distinguished surgeon in America and perhaps in the world.” The second was that hospitals at home in England had been depleted of doctors, and he thought that more doctors were being called up for France than were really needed. Next he wrote a rather peremptory note to the Minister of War for the British Army: Listen to This. In April of this year 6 or 7 Territorial Hospital units were sent to France from London and elsewhere. . . . Three Lieut-Colonels were attached to each and no one under the rank of Major. (This caused considerable ill feeling amongst men who had been serving in France since the war began). These units go to France, and not only found no Hospitals, but not even the sites chosen . . . And what excuse for putting the country to the expense of paying these officers of high rank so long before they were needed?42

He closed with an unfortunate comment about “careless organization” and used other words instantly noted by General Sloggett, the DGMS who was quick to respond.43 From GHQ Sloggett wrote to the A.G. [Adjutant General Sir Nevil Macready] beginning: “With reference to the attached letter from Lord Knutsford to Lord Derby which I see he commences by the magic word ‘Mesopotamia’ and ends by the appeal to ‘duty.’ ” Sloggett put the record straight: the site Knutsford criticized was never used by the Canadians; Cushing’s letter written 3 August (Cushing had also been sent a copy of Knutsford’s letter) was attached. Cushing, obviously keen to show that the Americans were not complainers and could put up with anything, replied: “I . . . am greatly distressed and amazed over the statements which . . . [the letter to Lord 42 43

WL RAMC 446/20. Director General Medical Services.

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Derby] contains. The Harvard unit (Base Hospital No. 5) came over here, as did all of the other units, hoping to be of service, and did not expect nor did they desire to be given soft berths.” He finished up by saying: “I think you need have no anxieties as to any mis-understanding concerning all this in America . . . As it is we have received unfailing courtesy and consideration at all hands and on all sides. I am particularly grateful for all that you have personally done for us.” On 4th August, Sloggett dashed off a more forthright handwritten note to Fowke:44 My dear Fowke, I really think at a time of pressure like this we should be protected at home from hysterical Gasbags like Knutsford . . . really we have other and more important work to do than the destruction of mare’s nests discovered by faddists. Yours A.T. Sloggett.45

As no more appears to have been heard on this score, life settled down to the daily grind of winning the war and Christopherson plodded on with his notes. The report of Dr. Cushing’s interview on 25 September 1917 at Hesdin runs to over three pages. There is no indication exactly who of the Commission were present at his interview, but Christopherson summarized the report, beginning diplomatically, “he [Cushing] has thought about it a good deal, and he has become more patient and more appreciative with . . . what is being done, and the longer he is here, the less he feels capable of criticizing and suggesting.”46 When pushed a bit, the American surgeon offered his opinion a bit more freely: “in any Medical Service . . . square pegs get put into round holes. . . . and men utterly misplaced in their jobs.” Rather oddly, he suggested a change of air and diet and he criticized too much time spent at meals, “. . . too much eating, and, perhaps, too much alcohol.” While granting that many changes for the better had been accomplished in the preceding two years, he felt that the present organization failed to make provision for keeping Medical Officers up to date in their line of work and thereby losing skills and wasting talent.

44

Maj. Gen. (Lt. Gen) G.H. Fowke of the General Staff. Information from Colonel Iain Swinnerton. 45 WL RAMC 4462/20. 46 Commission Report. WL RAMC 1165/2/4.

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The Work Dragged On and Life in London Became Increasingly Dreary Back in England on 30 September, 1917, Christopherson complained he had not received a letter from Joyce for a fortnight but perhaps “they are tracing my little footsteps in the mud over in France.” He stayed with his widowed mother in her London flat and was given an office at the Royal Society of Medicine47 for his work on the Report, courtesy of Sir Rickman Godlee who was president that year. “I have all my papers and documents spread out on a large table. I have a sergeant RAMC doing typing . . . and I’m after another typist to help . . . I am working about 10 hours a day to get all my material put in order.” He was in need of more clerical help and may have cast a thought back to the Boer War when the secretary of that commission had five stenographers. His efforts to get approval to hire more and better help took him traipsing building to building and from office to office. He described his efforts to amuse Joyce: In the mean time a flapper close by me having finished a 6d. novel she was studying began to write numbers on a pile of correspondence at a tremendous rate. The other girls were busy competing with a big teapot (brown) full of tea, and bits of cake and sweets wh. they appear to have found in their pockets. When Mr. Thwaites came back he gave me financial approval to engage a Typist at from 29s to 32s a week or 36s if she could stenog. at the same time and told me in an encouraging way to let him have an account of the money I had spent and come and see him again if I wanted anything . . . Well I do not know how long I shall be engaged on this Commission, I may have to write for an extension of leave. I should like, if it is possible, it to lead to something. . . . when I was in France I could not tell you or anyone where I was or what we were doing, everything is so secret.

During October, Christopherson also spent time dining with friends and inevitably hearing news of the deaths of many friends’ sons. When he could he visited the Ormerods, his mother, and two of his sisters, Caroline and Muriel. His youngest sister, Eva, remained trapped in Bangalore for the duration of the war.48

47

The Royal Society of Medicine was, and is still, at 1 Wimpole Street, London. Eva’s husband, Dr. E.T. Harris, brother-in-law to Christopherson, was a surgeon with the IMS and served almost four years in East Africa. [See Seventeen Letters to Tatham: A WWI Surgeon in East Africa Toronto, Keneggy West, 2001. A. CrichtonHarris]. 48

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On 8 October he told Joyce that we . . . rushed around France and had every minute of the day filled. We did 2000 miles in motors, the hotels were crowded and very poor by way of accommodations and it was most difficult to run an office. I was supposed to keep a record of everything that happened and an account of all the interviews and I had a shorthand writer who used to take rotten notes and sit up at night till 12 a.m. typing them out—I was engaged trying to put them together and making a record. I have also a number of memos and documents which I collected on tour wh. require indexing and filing . . . it is awfully difficult now to get any clerks—typists etc.

He began to feel the push as Taylor and Godlee are “all for getting the report out as soon as possible” and grumbled, “I am on no bed of roses.” Watson Cheyne “crocked up at [Le] Havre and had to break off and return by hospital ship . . . I am going down to see him . . . to talk about the report.”

The Curious Silence over Christopherson’s Important Discovery Despite his current work as secretary to the blue-ribbon Commission on Medical Establishments in France, and notwithstanding the pioneering work he had initiated back in May of 1917, Christopherson, in the winter of 1917–18, was gloomy. He was not alone in what had become for many an emotional and physical exhaustion under the grinding hardships of war, even though his circumstances were in some measure less miserable than those of others, and only one member of his family had died. He missed his wife; he worried about money, although it is hard to see why he would not have more than enough; and this interminable war never seemed to end. By November 1917 he was back in England, parking himself on his in-laws in Upper Wimpole Street or occasionally at their country house, as he tried to make sense of, and write up, the notes from France. It must have seemed an upside-down situation. Joyce was in the sunshine of Africa, staying with friends, golfing, and trying to pay her way when they would let her. And all the while Mr. Newlove, Dr. Hodson, Dr. Malouf and various other colleagues were supervising the medical trials of Christopherson’s devising, for treating bilharzia patients with antimony. Intravenous injections had to be given, injections that were dangerous and painful if done badly; adverse reactions such as nausea, coughing, vomiting, giddiness, mucus and blood in the urine, were likely.

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Data had to be meticulously kept over a period of at least thirty days as the cumulative dose, of what is in fact a poison, had to be cautiously administered a few grains at a time, and patients carefully monitored. Follow-up interviews to see if this could be considered a cure, as opposed to interim relief, were also necessary, although with nomadic peoples or those who were put off by the side effects, this was not always possible. If Christopherson felt out of the loop so far away, he had reason. Was Joyce kept fully apprised of his work in Khartoum? Perhaps not. Without her letters we cannot be sure, but from his letters to her one can at least conclude that he rarely, if ever, mentioned bilharzia or the hospital. This treatment, and Christopherson was soon to believe it a cure, was an important medical breakthrough. Perhaps his colleagues were sworn to secrecy and perhaps he was concerned that, unlikely as it seems in retrospect, the ever-vigilant army censor might take note. On the secrecy issue, it is hard to imagine that with as many as twenty patients and half a dozen or perhaps more, medical attendants, such a secret (if it was) could possibly be kept. The Report was taking more time than originally estimated owing to the difficulties of getting stenographic help and the lack of co-operation between some of the members on the Commission. Christopherson had asked for an extension of leave and then worried that he might not be paid for the extra time needed. On 21 November he wrote to Joyce: I shall not be able to go round England [inspecting British hospitals] with them after the trip to France is completed I am afraid. Altho I feel that I have not a great deal of interest in my job in the Sudan. . . . I wish I could get a job that I liked and wherein I could do well. I should be happy. I hope that this is not a very depressing letter and I trust that you are having a good time.

Missing Christmas with his wife depressed him further, but he was cheered in his usual generous way, and a little envious, to see that some friends had been recognized in the New Year’s Honours. On 6th of January he wrote to Joyce: “Old Horder 49 has been knighted—

49 Horder Thomas Jeeves, later Lord Horder (1871–1955) Physician at Barts 1912– 1936. A note from Peter Ormerod Sept. 2005 expanded on Horder “. . . altho’ slightly younger than JBC qualified ahead of him at Barts in 1896. He was knighted in 1918 and worked almost continuously at Barts becoming Assistant Physician 1912–1921 and senior physician 1921–36 . . . He would have been around Barts at the same time JBC and he was a junior colleague of my grandfather [Prof. J.A. Ormerod].”

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I am glad. Ballance50 too and Garrod, Tubby has got his CBE51—he will get his KCMG52 if he sticks to it. Tom Grylls [son of his sister Muriel] has got his MC.”53 He went on: Stiles, one of our commission has been knighted too but I do not think the event was connected with that work as he did none—he has done very good work as an Edinburgh Surgeon. . . . I had a nice letter from Watson Cheyne in answer to one of mine telling him not to work so hard—he had written to say that we should not meet again—He has been ill—he has angina pectoris (entre nous) and he thinks he may die like John Hunter did quite suddenly.54 He is very nice and I got on well with him. He is a strong man who has strong views and expresses himself in strong terms. He has a very large following amongst the profession.55 Godlee on the other hand is weak and has no views of his own. . . .

And so these 1917 letters, more than two dozen of them written to Joyce during Christopherson’s time in France and England, run on, the last showing his admiration his colleague Watson Cheyne, a man like himself, with strong views strongly expressed. In all these letters to his wife there are only two sentences about the continuation of trials on his important work, injecting antimony to treat bilharzia, at Khartoum Civil Hospital. On page six of a long letter to Joyce on 6 October he wrote: “I have not heard from Mr. Newlove very lately—I am afraid it is a case of out of sight out of mind.” This certainly implies he had been getting some reports from Newlove. It is hard to imagine that he would not be thinking about his work and whether other patients treated with tartar emetic would recover well. J.R. Newlove was the pathologist assistant charged with doing all the microscopic laboratory work examining urine samples from Christopherson’s bilharzia patients. This was a responsible job. Newlove had begun work for Balfour at the Wellcome Lab in April 1903; he later became Sanitary Inspector for Khartoum and then moved over to work for Christopherson at the civil hospital. Christopherson thought a good deal of him, and relied on him heavily to oversee important work on

50

Mr. A. Hamilton Ballance, Asst. Surgeon to the Norfolk and Norwich Hospitals. Tubby, Alfred Herbert, (1862–1930) spent many years on staff of the Evalina Children’s Hospital where he and JBC would have met. 52 KCMG: Knight Commander of the Order of St Michael and St George. 53 Grylls, Thomas (1893–?). 54 John Hunter, (1723–1798) father of British surgery. 55 In the end Cheyne lived until 1932, attaining a good age of eighty. 51

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the bilharzia/antimony trials. Further, he and Newlove co-authored four major papers and he acknowledged Newlove’s assistance in at least eight others. There were other medical colleagues involved with these trials too.56 In his October 15 paper of 1917 in the Journal of Tropical Medicine and Hygiene he wrote: “During the six months ending June, 1917, we (Drs. Izzedin, Maschoieff, and I) have been testing at the Khartoum Civil Hospital the . . . treatment for leishmaniasis [antimony injections] as it occurs in the Sudan.” This time period overlaps with the beginning of his testing antimony for bilharzia in May of 1917, although in this paper it was too early to mention his belief that antimony was also effective for bilharzia. He needed confirmation in the form of good data. Christopherson left Khartoum for England and France on 26 July, 1917, only two months after his ‘aha’ moment in the Civil Hospital. He was unable to return to Sudan until late January 1918. At least, if he did not hear much from Newlove, he had heard good news from another colleague, as he documented in the very first bilharzia paper, that of 7 September, 1918 in The Lancet: . . . Dr. V.S. Hodson, who very kindly continued the treatment of bilharzia cases with tartar emetic at Khartoum Civil Hospital during my absence in 1917, and afterwards at Atbara carried on a series of trials quite independently, sends me the successful results of the treatment of seven cases.57

From Joyce, who left Egypt and moved back to Khartoum, he hears of a rumour that his old nemesis, Dr. Crispin, was suffering from appendicitis. This, if true, might lead to the administration requiring Christopherson’s return to the job rather than, as he had hoped, to return to Joyce and take some leave. When I read the words in his November letter about his hoping to have ‘leave’ I found this curious. Apart from the need for rest and time with be with Joyce, why would he hope for ‘leave’ when he had serious and important work, his bilharzia trials, to attend to in Khartoum? Would he feel confident enough to leave it all to Hodson, Maschoieff and Newlove and just receive reports and analyze data? This verges on the careless and Christopherson was not a careless man. He was

56

The following are thanked for help in his absence. Mr. J.R. Newlove, Dr. Mustafa Izzedin, Dr. Ferid Masoud and Dr. V.S. Hodson, a British doctor, trained at St. Thomas’ Hospital (a training Christopherson considered almost as good as a Barts’ training). 57 The Lancet, (7 September, 1917), p. 327.

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a meticulous man and, like any scientist, had an eye to his future reputation. Currently there is no way to know whether he did discuss his exciting new work with Joyce. It seems highly unlikely that a couple so close would not talk about his hopes for success.

The Commission Report Work Became Onerous as Christopherson Strove to Please Everyone That the job of Secretary to the Commission was ‘no bed of roses’ was becoming even more evident. His overworked sergeant-typist left for a well-earned three-day holiday and the other typists, at only thirty-two shillings a week, were not up to the task. Godlee and Taylor were also working on the report and Cheyne was doing his own version; they did not quite agree and Christopherson wondered what would happen.58 A letter dated 6 October, from an unidentified writer to Colonel Stiles, was passed on to the Commission at large.59 It was from what we now refer to as a ‘whistle-blower.’ The writer, seemingly an older doctor, had been interviewed by Stiles at Trouville and was anxious to be taken seriously. He wrote: “Of course, you are aware that everything is “prepared” for you, and the pack is being reshuffled, as the Commission passes round, surplus cards are put up the sleeve, and exemplary hands are shown.”60 The writer also complained that ambulance trains, field ambulances and so on were poorly and inappropriately staffed. He finishes by saying “Why, if I like a Field Ambulance do I grouse and find fault? Because I am sent to Trains against my will, after nearly

58 Dr. George E. Gask, a surgeon who knew Cheyne and his work, wrote in his memoirs “I really believe that Cheyne did an infinity of harm in insisting upon the return to antiseptic treatment of wounds, and that without these strong comments from a leader in the profession, we should have returned to sanity more quickly, and have treated wounds earlier by a-sepsis and excision.” A Surgeon in France. (Cornwall: Liskeard Books, 2002), p. 11. 59 Re Stiles; there was a family connection here. On 6 October 1917 Christopherson wrote to Joyce: “Stiles the man I was with is a very well known Edinburgh surgeon. When a very small boy of 6 he was left with his 2 elder brothers with my mother for some time. My father had them in school at Moulton in Lincolnshire. My mother remembers them very well.” 60 Letter to Col. Stiles 2 October 1917 from person un-named. WL RAMC 1165/2/3.

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2 years at the Front, to act in a subservient position to young men, who have done nothing but O.C. Train[ing] or some cushy job at Home.” This letter supports the earlier opinion of Cushing, and even Stiles. Dr. Harvey Cushing became marginally involved with the Commission when he was among the group photographed at Hesdin in September of 1917, at the same time as he was interviewed. He was probably included in the photograph because of his reputation in international medical circles as a stellar neuro-surgeon. In his published diaries, Cushing mentioned this Commission only once by referring to a meeting on Sunday September 16, and he stated his opinion frankly: Commission to investigate the wastage of M.O.’s here for lunch while visiting Mendinghem. They arrived about ten minutes past one—were fed abundantly—left at ten minutes of two. I asked the C.O. whether anything was said on the subject of their quest. He replied that the only question put to him was whether the ambulance train standing on the track—it had been parted for them—was bringing patients or taking them away. Since these trains are only for evacuating patients, this was evidently something off the Commission’s beat. I had a chance for a few words with Stiles and asked him what it all meant:61 he admitted that they could do nothing more than send in a whitewashing report—“eye wash,” in short. I told him the work done here could be covered by just half the M.O.’s if they would use sisters or orderlies, as our team was doing, to give anaesthesia.62

In time the suggestion regarding using sisters or orderlies to give anesthesia was taken up. This could be construed as the seed for the later introduction of Nurse Practitioners. Unfortunately the idea died on the vine when the war ended. Nurse Practitioners only came into being in the United States in 1965, where training, built on the knowledge and skills of public-health nurses, was offered at the University of Colorado. Originally this was intended for rural and underserved areas of the United States. Britain did not follow suit and train Nurse Practitioners until 1991. The idea of Nurse Anesthetists also came from the USA when Agatha Hodgins, the founder of the American Association of Nurse

61

Lt. Col. S.J. Stiles. Harvey Cushing. From a Surgeon’s Journal. Toronto: McClelland and Stewart (1936), p. 205. Once again JBC is hard to find, since his name is incorrectly indexed: p. 250 rather than 205]. 62

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Anesthetist (AANA),63 went to France with the American Ambulance group to assist in the planning for the establishment of hospitals, and taught both physicians and nurses from England and France how to administer anesthesia. If Christopherson felt anything about a ‘whitewashing report’ he wisely kept quiet. Although Cushing also wrote that some of the C.O.’s friends were “itching to tell the commission a few things” just why no one spoke up is not explained.64 Were the high command determined to keep the lid on the press, the parliamentarians and the public? It was mandatory that the morale of the British public be supported at a time when the lists of the dead and injured grew daily in The Times. Christopherson, not known for diplomacy and reticence, has nothing to say on this score. In his letter of 20 October, he described life in London; rain, fog and cold, then when “a take-cover signal is given, policemen go round on bikes and shout it out, everyone makes for the tubes, many people sleep in the tubes wh. are full of women and children and the whole thing is uncanny, a bugle goes when everything is all clear. We shall have to bomb German towns and no mistake about it. It is the only way out of it.” His remarks were oddly prescient of ‘Bomber’ Harris’s retaliatory bombing of German cities in World War Two. The noise of policemen shouting was not the only disturbance. The Times of 15 August 1917 reported that whistling for taxicabs “which went on in the daytime in various parts of London . . . was especially troublesome to the sick and wounded in the hospitals . . . an order prohibiting this practice in the County of London was proposed.” A chorus of ‘hear, hear’ followed this novel suggestion. A day later, on 21 October, Christopherson sent Joyce a birthday telegram, rather terse compared to present-day birthday wishes: “Many happy returns. Christopherson.” Joyce was thirty. Always generous and pleased when colleagues had good news, he wrote to tell her that their friend William May “may be going to Mesopotamia as Financial Secretary. He does not quite know yet. He is very pleased and so am I; he deserves some good luck.”65

63

The AANA is the professional association representing more than 30,000 nurse anesthetist nationwide. (USA) www.aana.com/about/history. 64 Cushing, Op. cit., p. 206. 65 Major May landed work in Mesopotamia with the legendary Gertrude Bell.

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Joyce remained stuck in Egypt. The shipping lanes were becoming increasingly more dangerous. “U boats sank more than a hundred ships last month [May].”66 As was to happen so often in his life Christopherson, this time in his role as Secretary of the Commission, found himself in the middle of a difficulty. On 4 November 1917 he wrote: My dearest old Joyce, I am sorry to leave you so long by yourself but I don’t see what’s to be done with this awful war on. Yesterday I cabled for an extension of leave in order to complete this report which how ever does not seem to approach completion and the Commission has only done France. It has England to do yet but I don’t think I shall be able to do England with it. I have had very hard and somewhat anxious work I think the Secretary does so always on these occasions. It was decided that Watson Cheyne who is writing one—quite different from the Godlee Taylor construction and Battar instead of writing one with G[odlee] and T[aylor] is engaged cutting theirs to pieces and favors Watson Cheyne’s and I must say that I favor Cheyne’s. The old general who is chairman is not going to allow any report to go out which suggests interfering in any way with administration and is helping G and T to write theirs. I have tried to draft something which embodies all three, but I don’t think Godlee and Taylor will have it. Cheyne won’t sign G and Ts and the Generals [sic] Battar will not unless it is considerably altered and Styles [sic] and Walker have not seen it.

Life in Wartime England In the same letter he included accounts of life in wartime England: Food is getting very hard to procure. Often no tea then a few ounces only, no sugar, treacle. Everything only sold in small quantities and at double the charge before the war. I wish America would buck up and let us see what she could do in the air and I should like to see America or Japan over Russia.

The Report was becoming burdensome and was still not finished. “I have not heard yet whether extra leave has been granted, I cabled Nov. 3rd.” (the day before writing). On the 9th November he attempted to cheer Joyce up with news of home and the people he ran into at the Royal Society of Medicine but finished on a sadder note: “I wish we 66 Henrietta Heald, Ed. Chronicle of Britain. (London: JL International Publishing. 1992), p. 1053.

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were together. I think the outlook [for the war] appears black—you know what I have always thought—but now is the time to fight for all we are worth—I only wish we had K[itchener] with us. My best love. Your affectionate husband, J.B. Christopherson.” Then, obviously in response to Joyce’s [inferred] mention of Crispin, he made a frank reference to his old rival for the Director of the SMD job, a dispute that still rankled from the birth of the Department in 1904: “Crispin was never a good friend, I never felt that I could depend on him and it seems like fate that he should be ill and so make it difficult for me to have leave. However I am very busy and am not enjoying myself much and after all what with one thing and another C[rispin] has had a good deal [of trouble] himself.” Earlier, when Dr. Crispin worked in Port Sudan, he had suffered personal tragedy. His wife died in childbirth, and the baby also died. This may or may not have been what Christopherson was referring to. Be that as it may, in such a small European community such personal tragedy would soon be known to everyone.

The Report, Finished at Last Christmas 1917 had come and gone, the Report was finally finished and Christopherson signed off. Some of the economies suggested in the Report were put into effect—dentists were given better and muchneeded status, and a number of nurses were trained to administer anesthetics thereby releasing many physicians for other work. Curiously this extensive and much-requested Commission Report was never published. As Ian Whitehead wrote in Doctors in the Great War, “. . . the War Office, in deciding not to publish the report, ignored one of its principal recommendations: that there be greater collaboration and exchange of information between the civil and military authorities.67 In so doing the War Office missed a valuable opportunity to allay the fears of medical men; continued calls for publication of the report throughout 1918 demonstrate that suspicion of the military remained strong.”68 The latter comment only serves to underline a per-

67 Historians wishing to consult the Report must look in the Wellcome Trust for the History of Medicine, London or in The National Archives, Kew. 68 Ian R. Whitehead, Doctors in the Great War. (Yorkshire: Leo Cooper, 1999), p. 79.

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vasive problem between military and civil physicians such as bedeviled Christopherson and his friends in Khartoum over the years. Then on 6 January, 1918: “My dearest Old Girl, I am beginning to see when or about when I shall get out now.” And on 10 January a second letter: “I am not quite sure of my day but I have obtained a W[ar] O[ffice] indulgence passage from Taranto [Italy]—Egypt and I shall have to make my own way down there . . .” Although Joyce’s letters to her husband, and there must have been hundreds, have not survived, there is no hint from his responses that she ever complained. It was just not done; backbone was the order of the day and this the Christophersons, their friends and colleagues had in abundance.

Passage to Africa and Joyce Getting a passage was a lengthy business. Christopherson also wanted to bring out ‘a ham and 1/2 a Stilton and 1/2 an American cheese,’ a present from his mother-in-law, but felt a twinge of conscience when he considered how many people have very little food, and hoarding was something he disapproved of. Transporting food, exporting really, required permission from the War Trade Food Controller. For some reason he says nothing about the problem of keeping meat and a Stilton cheese cool, the latter which would have surely announced his arrival. Meat is very scarce. None to be had yesterday and very little the day before. Fish very expensive cod 2/6 a pound (ordinary price 8d) compulsory rationing must come in for some things or else there will be nothing . . . One cannot tell what will be the outcome—if we can stick to it for a few months longer we shall win this war but it will be victory for labor and democracy and it will mean that the old order of things has altogether changed.

He was right about the old order; his upper-middle-class world would never be quite the same. Servants, expectations, class hierarchy, the social boundaries and ‘knowing one’s place,’ all began to change after the Great War. I have not heard yet whether they will pay me for the time I overstayed my leave. Stack has referred the matter to the council of secretaries.69

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Gen. Lee Stack, now Governor General of Sudan.

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chapter ten I think he deals with most things in this way. I have not heard whether they will give me an increase this year. The council of secretaries have however turned it down. I feel that I have been in the country quite long enough, but I should like to leave it with credit and with the recognition that I had done useful pioneering work out here and consideration—above all things I could make my pension up to 400. I have written to Godlee asking him to bear me in mind if he gets an opportunity—I do not like doing so but I think it is the way that it is done generally, and I haven’t received much encouragement lately out here so it would be nice to get something. I do not expect anything will materialise.

Joyce must have been dismayed to get such a letter. The ambiguous mention of the council of secretaries having ‘turned it down’ may refer either for an increase in salary or, pay for the extension of leave for what was most prestigious and important work. The news made him despondent, and added to the feeling that he was being passed over and unappreciated. It reduced him to asking Godlee’s help in getting some recognition. In fact in 1919 he received the award, Commander of the British Empire, an important recognition, so perhaps Godlee did put in a good word somewhere. And so back to Khartoum, to his wife and the promise of the end of the Great War, and to his work on the use of antimony injections for treating bilharzia.

CHAPTER ELEVEN

THE ‘AHA’ MOMENT AND CONSEQUENCES

Zeitgeist in the First Half of the Twentieth Century The importance of the British Empire, and the need to maintain the health of Europeans who lived and worked in the tropics, bred urgency in the field of ‘medicine for the warm climates.’ This, of course, was true for all the colonizers with their hands on Africa. There was a need for a better understanding of tropical diseases, parasites and disease vectors of all kinds, and of such creatures as snakes and scorpions. To access and disseminate knowledge and experience, medical practitioners needed to communicate with one another. This need generated letters, journals, and conferences. There was healthy and sometimes sharp controversy, as well as gossip, and there were priority disputes, as commonly found in tropical medicine as they are in any other area of science. As discussed, Christopherson ran into the problem of ‘who published first’ with Dr. J.E.R. McDonagh in September 1918. Medicine in the tropics was a relatively unexplored field and there was opportunity in unknown territory. That there was more to discover meant there would eventually be more to contest. Some of the most important and urgent work centred on malaria. In 1898, Ronald Ross “. . . discovered the developmental cycle of the parasite, leading to transmission, within the mosquito . . .”1 by dissecting an Anopheles mosquito and discovering the plasmodium in its stomach. For this achievement he was awarded the Nobel Prize for Medicine in 1902. His was a controversial award. Four months after Ross announced his success three Italian researchers, Grassi, Bignami and Bastianelli2 refined this work and “. . . discovered that only the Anopheles mosquitoes transmitted the malaria parasites of humans.”3 Naturally they felt the prize should have been theirs. In fact Alphonse Laverin, a French army doctor, had

1 2 3

Robert Desowitz. Tropical Disease. (London: Harper Collins 1997), p. 198. G. Grassi (1854–1925), A. Bignami (1862–1929) and G. Bastianelli (1862–1959). Desowitz, Op. cit., p. 198.

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accomplished the basic research by discovering the malaria parasite within the red blood cell, in 1880. Often treatment, and occasionally cure, preceded a full understanding of cause; the causes of many more diseases remained to be discovered. Physicians working thousands of miles and weeks away from London had many disadvantages: physical conditions were particularly miserable—sand got into everything, and the heat (sometimes 100–116 degrees) along with the torment of a variety of ‘eaters’, as Christopherson characterized insects, murdered sleep. More importantly, they were the last to receive the journals; unless on home leave they could not attend meetings and hear the papers given at the Royal Society. They could not so easily bring in a colleague for a second opinion; and equipment, and hospitals—many merely mud huts in the first years—were vastly inferior to those in England. It was decades before reliable X-ray equipment reached Sudan, although it had been available in at least one privately endowed hospital in the Boer War.4 Well-trained (and for this Christopherson means ‘British’) nurses in Sudan were few in the early years of the Condominium; the first arrived only in 1908.

Priority and the Role of ‘Chance’ There are two stories of how Christopherson discovered that tartar emetic could cure bilharzia. One, written by Sir Philip Manson-Bahr reads: Later in that year [1917] he was back in Khartoum, where he found several cases of kala-azar who were also infected with bilharziasis—Schistosomia haematobium. Having learned of Sir Leonard Rogers’ discovery of the specificity of antimony (tartar emetic) in the treatment of kala-azar in Calcutta in 1914, he followed suit, but was surprised to see the schistosome eggs disappear also from the urine, until the cases were cured of both diseases. He also made the pregnant observation, which has since been many times confirmed, that the appearance of the eggs is changed

4 This was most likely because of the cost. The IYH field hospital [see ch. 9] had been lavishly funded. The Sudan Medical Dept. was always cash-strapped.

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chapter eleven by antimony and that they no longer hatch in water. To Christopherson must therefore go the credit for this notable discovery.5

The second, as presented by Christopherson himself, is that having become aware of the curative power of tartar emetic in cases of leishmaniasis, he decided to try the same remedy for bilharzia and found it to be remarkably effective. Here we have two types of success: one, an intelligent recognition of an unanticipated outcome, and the other, an intelligent hypothesis—if tartar emetic worked for kala-azar, perhaps it will work for bilharzia. Although Manson-Bahr wrote the above as an obituary, he had earlier consulted Christopherson in a private letter about this same version, for inclusion in his forthcoming history of the London School of Hygiene and Tropical Medicine. Christopherson never questioned or corrected this version. Either he preferred it or he simply could not remember exactly what had occurred thirty-six years earlier. That his methods involved microscopic examination of faeces and urine in the assessment of treatment was the result of meticulous preparation. The bilharzia eggs he saw that day in May 1917 were dark in colour which established that the eggs were dead and dying, not simply some contaminant. This observation of the state of the eggs led to an instant leap to the thought that the antimony injections, effective with leishmaniasis (kala-azar), had also killed the bilharzia eggs.

The Attribution of Priority Regardless of what led him to it, was he the first to make such an observation? The claim to priority depends upon the criteria one adopts for deciding that priority exists. As Howard Markel wrote: . . . behind almost every assignment of scientific priority stands a towering list of vexing problems. Should the attribution be based solely on who published a finding first? Does the venue of publication matter? What about those investigators who work at institutions or in arenas that are not in the mainstream of scientific inquiry or part of elite academic medical circles?6

5 6

Nature. (Vol. 176. Aug. 27. 1955), pp. 377–78. H. Markel. New England J. Medicine vol. 351. (30 December, 2004), p. 2792.

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These were the problems that threatened Christopherson’s personal success. Despite his widely acclaimed treatment, the priority debate was a major concern that dogged him off and on for the rest of his life. To an outsider the question of ‘who published first’ might look trivial, but in the dog-eat-dog world of scientific or medical investigation, and in these particular circumstances, it claimed the attention of both Christopherson and McDonagh, on and off, for years. Queen Victoria’s reign and the Edwardian era, up to the First World War, were periods of extraordinary scientific endeavour; names could be made, and everyone knew it. But things are rarely cut and dried. All this obviously worried a modest man like Christopherson but in retrospect one can see that in 1918, he was the only physician successfully treating schistosomiasis patients and gathering real evidence. There were changes in medical education at the beginning of the twentieth century. As the emphasis moved towards laboratory work, it became imperative for individual physicians to own a microscope. Between the days when most physicians had little to do but to diagnose and comfort the patient, and today, when general practitioners diagnose, hold the hand and comfort the patient while awaiting results of lab tests, physicians had to do their own work. Christopherson was vocal in labelling the microscope as essential for medical work in the tropics: “. . . a doctor who cannot himself intelligently examine faeces and translate into practical values what he sees should not be doing medical work in the tropics . . . He is groping in the dark.”7 Gradually, as more formally peer-reviewed, and therefore relatively reliable publications were dispatched by post to distant corners of the empire, there were inevitably more reliable conclusions. Naturally the time lag in disseminating information meant that those working on the same or similar diseases would not know immediately if another researcher had found the answer first. There were bound to be disappointments. The first report of the first case of some disease, parasite, or ‘cure,’ found in a particular area far from London at that time might be by a telegram to the BMJ or The Lancet, to be followed up with at least a letter if not a detailed paper.

7

J.B. Christopherson. BMJ (19 April, 1919), p. 481.

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In this chapter, I give a short history of the use of antimony in medicine and examine the use of tartar emetic specifically as an effective treatment for parasitic diseases. In tracing this story I uncovered evidences of misperception of dates, forgetting of dates, or underreported priorities of specific treatments that had been attributed to others. It would appear that many people do not read correctly, forget what they have read, and reconstruct history to become part of accepted dogma. Even today there are papers that present incorrect dates of the events that I discuss here. Christopherson, in The Lancet on 7 September, 1918, published the successful results of a group of thirteen young male bilharzia patients. Over the next months and years he published twenty-four papers and letters on the use of tartar emetic for schistosomiasis. His work—at the beginning of the twentieth century—was a result of the zeitgeist coupled with ‘a prepared mind.’8

Antimonial Compounds and the Therapeutic Range The antimony compounds used as medications in the second decade of the twentieth century were: Antimony Potassium Tartrate and Sodium Antimony Tartrate, the latter a pentavalent compound still in use for some types of leishmaniasis. Tartrate is the name for a chemical compound, in this case a salt of more than one component. Compounds of some of “these heavy metals are [still] widely used and effective drugs for cancer chemotherapy.”9 The trivalent compound antimony potassium tartrate, also known as tartar emetic, is more toxic than the pentavalent compound. The crystals of tartar emetic are very soluble in water and the faint metallic taste is “easily masked by the presence of other flavours. . . . The compound was readily available . . . [and] cheap . . . an ounce cost 2 pence in 1897 . . . pharmacists ordered it by the pound . . .”10,11 However, even if administered by those generally

8

L. Pasteur, (1822–1895) famously said: ‘Chance favours the prepared mind.’ Jacalyn Duffin, and B.G. Campling, Therapy and Disease Concepts: the History (and Future?) of Antimony in Cancer. Vol. 57 (Oxford U. Press 2002), p. 63. 10 John Emsley. The Elements of Murder: A History of Poison. (Oxford: Oxford U. Press. 2005), p. 218. 11 The cost of antimony tartrate as a medication– 2d./oz. One troy ounce has 240 grains, so the cost of 30 grains is 1/4 penny, or a farthing. Therefore, the cost of JBC’s average total dose was less than one farthing. 9

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considered qualified it could, and occasionally did, result in death. Initially, a beneficial outcome was not easily predicted. For any pharmaceutical agent there is a smallest dose that has a therapeutic effect, and a largest dose that will not injure or kill the patient. Between these two is the ‘therapeutic range.’ The dose prescribed must be within this range to be both reasonably safe and reasonably effective. Near the upper margin the risk is a function of the patient’s condition, weight and age.

Christopherson Documents His Treatment in Cases of Leishmaniasis In August 1914, Christopherson published a paper documenting two cases; one on naso-oral leishmaniasis (espundia), the other on what he described as the ‘true Oriental Sore (Cutaneous leishmaniasis).’12 Espundia is a hideous and cruel disease that, left untreated, causes dreadful deformity of the nose and lips. In some cases it is severe enough to eat away the flesh until the nose and mouth collapse altogether. As with all varieties of leishmaniasis, the sandfly is both the host and vector. No specific treatment is mentioned in his 1914 paper, probably because recent news of Rogers’ and others’ success with injections of tartar emetic (antimony) had not yet reached Sudan. When he was able to read of the success of Leonard Rogers and perhaps of others in Italy and in South America, on Oct. 15, 1917, he published a second paper: Notes on a case of Espundia (Naso-oral leishmaniasis) and three cases of Kala-Azar in the Sudan treated by the intravenous injection of Antimonium Tartaratum.13 Through this work he was building expertise in administration of the antimony dosage and collecting data with respect to different categories of patients’ tolerance to what is, essentially, a poison. In other words, as we would say today, he was determining the therapeutic range. He began: “During the six months ending June, 1917, we (Drs. Izzedin and Maschoieff, and I) have been testing at the Khartoum Civil

12 On a Case of Naso-Oral Leishmaniasis (Corresponding to the Description Espundia): and on a case of Oriental Sore, both originating in the Anglo-Egyptian Sudan. Annals of Tropical Medicine. Vol. 8. (1914–1915), pp. 483–495. 13 Kala-azar, general leishmaniasis, is a hideously deforming ulceration that destroys the orifices of the nose and mouth. The vector for kala-azar, the silvery sand-fly (phlebotoms argentipes) was only determined in 1942.

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Hospital the above-named treatment for leishmaniasis as it occurs in the Sudan.”14 In a paper written 1 July, 1917, but published in October 1917 when he was in France, he described the three forms of Leishmaniasis: Cutaneous—oriental sore; Muco-cutaneous—naso-oral (or Espundia), and General—kala-azar (infantile and adult), this last being the most fatal of all forms.15 Certainly the espundia case—his patient—was in an advanced state. This man had suffered the illness for four years before coming for treatment and his face had virtually disintegrated, yet, as photographs showed, the treatment demonstrated marked improvement in a very few weeks. On June 8, 1918, in The Lancet, he published again, his experience with intravenous injections of tartar emetic for oriental sore. As always, he cautioned: “It must not be forgotten that antimony is a cumulative poison and although eliminated by skin, kidneys, and mucous surface . . . its use is not without danger. Our practice is to inject carefully small quantities, gr. 1/2 to 1 1/2 daily, giving a day or two’s rest and reducing the dose if toxic symptoms intervene.”16

Leonard Rogers—His Use of Antimony Rogers’ pioneering work, on which Christopherson relied, was done in India where kala-azar and other tropical diseases were also common. From 1896 onwards Rogers had considered several possible treatments for kala-azar. He tried leucocyt-increasing drugs and vaccines, organic acids given orally and sodium bicarbonate intravenously, then he tried the new arsenical drugs, all without significant success. Finally in 1913, hearing of a “report of the cure of a doctor from sleeping sickness by 14 N.B. He does not mention trials he is currently conducting for antimony in cases of bilharzia. 15 J.B. Christopherson. “Notes on a case of Espundia (Naso-Oral Leishmaniasis) and three cases of Kala-azar in the Sudan treated by the intravenous injection of Antimonium Tartaratum.” Trop. J. Med & Hygiene. No. 20 Vol. XX. (15 Oct. 1917), pp. 229–236. 16 JBC used tartar emetic (antimony potassium tartrate) in 1917 but moved to antimony sodium tartrate by 1920. He discusses this in only one paper. [See App. B. #45] Three editions of Goodman & Gilman, The Pharmacological Basis of Therapeutics, 1955—endorse the trivalent (APT) as being more effective than the pentavalent AST; 1965—“use in identical fashion”; 2006—“trivalent eventually . . . replaced by pentavalent antimonial derivatives.” (NY; Macmillan, McGraw. etc.).

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the intravenous injections of the trivalent antimony salt, tartar emetic,’ he began to experiment with antimony.17 In 1915, after various interruptions by riots in Calcutta and the like, Rogers used tartar emetic intravenously on a number of kala-azar patients, this time with solid success. As he wrote delightedly, “Nearly twenty years’ researches were at last rewarded . . .” Only shortly thereafter did he learn that he had been beaten to the goal by two Italian doctors (G. di Cristina and G. Caronia) in February 1915 and, to make matters worse, even before that by “a Brazilian doctor, whose paper I had not seen . . . so the main credit would in any case belong to him . . .”18 In keeping with his reputation, Rogers was generous in giving credit to his rival although in writing his book his generosity did not stretch to naming the young Brazilian, Gaspar Vianna, (1885–1914). Neither did he name the Italians, in spite of the fact that his autobiography, Happy Toil, is peppered with names. In 1912, Vianna successfully used antimony (tartar emetic) in cases of leishmanial ulcers on the face and nasal mucosa caused by L. brasiliensis.19 Vianna’s life was tragically short; he died aged twenty-nine. In 1962 he was remembered; Brazil issued a stamp to commemorate his work on this particular leishmaniasis.20 Curiously neither Christopherson nor Rogers was seen as a good public speaker; Rogers spoke too fast and was hard to follow.21 Christopherson, wrote his friend Philip Manson-Bahr, “. . . spoke with a rather hesitant manner and, on that account, was not a very good lecturer, but he could dissimulate his little stammer with a pleasant and infectious laugh.”22 Rogers and Christopherson met at meetings when home leaves coincided and later in retirement living in or near London. As Christopherson’s letters testify, the two men continued a collegial friendship.

17 Leonard Rogers. Happy Toil: Fifty-five Years of Tropical Medicine. (London: Frederick Muller Ltd. 1950), p. 114. 18 Ibid. p. 116. 19 A.R.D. Adams & B.G. Maegraith, Clinical Tropical Diseases (Oxford: Blackwell Scientific Publications. 4th Ed. 1966). p. 167. And, G.O. Vianna: (Anais do 7 Congresso Braslileiro de Medicina e Cirurgia 1912), 4. p. 426. 20 J. Association of Physicians of India. Vol. 51. (August, 2003), 1. 21 J.S.K. Boyd, Biographical Memoirs of Fellows of the Royal Society. (London: Royal Society. 1963), p. 261. 22 The Lancet. Obituary. (30 July, 1955), p. 256.

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After Leonard Rogers’ death, it was revealed that he had really felt very strongly about the treatment he had endured in India, and that he saw it as vindictive and deliberately engineered. An envelope ‘to be opened after my death’ (now in the archives of the Wellcome Institute) revealed many typewritten pages detailing his Indian experience with a frankness he had earlier felt he could not use. He wrote here that he had been “Deprived, without notice, of ten beds my colleages [sic] had lent me for researches on the treatment of kala-azar.”23 He also mentioned more than once, ‘the Barts gang,’ a clique of doctors trained at Barts who, as he saw it, considered themselves superior to those trained elsewhere and acted accordingly.24 He believed that the enforced delays cost him the chance to be first with the antimony treatment for leishmaniasis. To be beaten to the post by a few weeks, after twenty years of work, was a galling experience. I can’t help wondering if Rogers spoke of this to his friend Christopherson whom he knew to be a Barts man.

The Scent of Success Although Christopherson’s first experiment using the antimonial injections to treat bilharzia was in May 1917, he was far too cautious to publish any results until he had a number of cases under his belt. Finally, in The Lancet, 7 September, 1918 he published The successful use of Antimony in Bilharziasis. This first important paper cited results with thirteen patients who harboured the parasite Schistosomum haematobium. Here he wrote: After trying and confirming the conclusions of previous workers on the use of intravenous injection of Antimonium Tartaratum (tartar emetic) in cases of oriental sore, internal leishmaniasis, and naso-oral leishmaniasis (espundia) as found in the Sudan, in May 1917, I commenced at the Khartoum Civil Hospital to treat Bilharziasis (vesical and rectal) by the same drug. The treatment of bilharziasis up to the present has been altogether palliative and unsatisfactory. It has baffled all attempts to find a satisfactory remedy. Time was the sole hope of a cure, but as time takes years . . . to effect a cure, and in the meanwhile the patient is running no small risk, to

23 24

WL. PP/ROG/A.1. p. 3. Rogers trained at St. Mary’s Hospital, London.

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chapter eleven say nothing of the pain and inconvenience of repeated attacks of cystitis and the debilitating effect of loss of blood, anything which promises even alleviation is to be welcome. There is no doubt that antimony given as intravenous injections of tartar emetic considerably interferes with the bilharzia and suspends its activities, even when it does not actually kill. My own opinion, based on the cases treated during the last year, is that antimony (antimony tartrate) is a definite cure for bilharziasis, and that the intravenous injections of tartar emetic kill the Schistosomum haematobium in the blood and render it harmless.25

Here, without doubt, is Christopherson giving the basis for his trying tartar emetic on his bilharzia patients. He simply says, “I commenced . . . to treat Bilharziasis . . .” He does not say the patient had more than one parasite. In other words, he saw and credits what others had success with, on one disease, and decided to try it on another.26 He suggested a course of injections lasting from 15–30 days and detailed each of his thirteen cases. Tartar emetic was administered directly into the bloodstream in the usual way, but occasionally into the dorsal vein of the penis where it is conspicuous, in the intent to reach “the portal venous system in which the bilharzia worms are located.” Much later, in 1947, he wrote to a colleague saying that this method was not effective and that he “. . . began injecting antimony tartrate into the veins of the antecubital fossa. This was successful and in 1917 [his memory slipped here; it was later on in 1919] I was able to publish the cure of 70 cases of Bilharzia by intravenous Antimony Tartrate, chiefly cases picked up at the Gordon College, Khartoum.”27 Boys from the College could be monitored. They were brought to the hospital, treated as outpatients, then taken back to the college. In this way a full course of treatment could be completed and good data gathered. He concluded: In confirmation of the extremely satisfactory results I have obtained during the year in the intravenous injection of antimony (tartar emetic), Dr. V.S. Hodson, who very kindly continued the treatment of bilharzia cases with 25 J.B. Christopherson. “The Successful Use of Antimony in Bilharziosis.“ The Lancet, (7 September, 1918), pp. 325–327. 26 He reiterates this information in November of 1920 following a demonstration of technique at the Royal Free Hospital, London: “After treating with success all three forms of Leishmania in the Sudan and confirming the conclusions formed elsewhere with regard to Leishmania we commenced at Khartoum, in May, 1917, to treat Bilharzia with Antimony Tartrate . . .” Magazine of the Royal Free Hospital, L.S.MW. p. 11. 27 Letter to Dr. A.H. Harkness, 10 March, 1947 in possession of the author.

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tartar emetic at Khartoum Civil Hospital during my absence in 1917, and afterwards at Atbara,28 carried on a series of trials quite independently, sending me the successful results of the treatment of seven cases.29

Once again he thanked his colleagues, Dr. Mustafa Izzedin and Mr. J.R. Newlove (his pathology assistant).

Christopherson’s Dosing Method At first glance one is surprised that Christopherson makes no mention of the weight of his patients as he moves into a relatively unknown treatment regimen. He was a clinician not a research scientist. For guidance he has only what he has read, probably in the Indian Medical Gazette, of Leonard Rogers’ work using tartar emetic in the treatment of Leishmaniasis.30 He knew the dosage Rogers used but does not know what Rogers’ patients weighed or how old they were. He had no animal models of the effects of heavy metals: his infected patients served as his experimental subjects. Nor does he have a complete understanding of the concentration needed in human body tissues or fluids to sterilize or to kill the parasite that causes bilharzia. He could have gathered useful information by weighing his patients, then measuring the amount of excreted tartar emetic as a function of time after each dose. He did neither of these. Instead, each ‘treatment’ was an experimental trial aimed at finding each patient’s maximum dose acceptance by a progressive increase, and continuing the maximum tolerable dose until the parasite was sterile or dead, or the patient, still alive, had no further excretions of parasite ova. His published papers taught his readers how to repeat his experiment, and admonished them to do it with great care because of the intrinsic hazard of the medication. What these papers lacked was how to estimate the amount of tartar emetic required to kill the parasite using the weight of the patient as a guide. In consequence, everyone had to repeat the experiment. In Appendix ‘A’ I look at the list of

28

Atbara, a city on the Nile, about 200 miles north of Khartoum. The Lancet, (Sept. 7th 191), p. 327. 30 L. Rogers, Preliminary Note on the Treatment of Kala-azar by Tartar Emetic Intravenously, and Inunctions of Metallic Antimony. The Indian Medical Gazette. (October 1915), p. 364. 29

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patients, those whose ages were listed, and use this information to calculate dosage. I like to think that Christopherson would have found this interesting and informative.

Success as Seen by His Colleagues One would imagine that the medical department would have taken up this success and collaborated to learn more about the basis for its efficacy and the dosages employed. Christopherson was unable to be consistently hands-on with the trials himself until his return in February, 1918. His assistants had gamely carried on while he was in France. At the same time his old adversary, Dr. Crispin, now had the post of Director of the Sudan Medical Department, the post from which Christopherson had been removed in 1909. It is to be hoped Crispin never alluded to this, but even so, the memory of what might be seen as a disgrace, would have hovered cloudlike, unspoken. Lastly, the prestigious Wellcome Reports, written and edited by Balfour, were no longer published after Balfour left in 1913, not that Balfour would have published anything by Christopherson. Had these been continued they might have included Christopherson’s work, as he was known to get along with the next two Wellcome Lab Directors. There can be no doubt that both Crispin and Balfour must have read what Christopherson published in the standard medical journals, yet they had nothing to say about his remarkable results, which constituted an important success on their own doorstep. The major paper, “Laboratory and other notes on seventy cases of bilharzia treated at the Khartoum Civil hospital by intravenous injections of antimony tartrate” was published in J. of Tropical Medicine and Hygiene, July 15, 1919.31 This documented his success with a much larger group of patients. It was an important breakthrough for a disease that had wrought havoc on millions of people. Christopherson wrote carefully, warning against the careless use of such a potentially dangerous drug, a warning he repeated in many other papers on the subject. The safe dosage for any particular patient had yet to be fully determined.32

31

J. of Trop. Med and Hygiene. (No. 14, Vol. XXII), pp. 129–144. In re body weight. The failure to note body weight can be a problem when trying to determine dosage. 32

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Based on his paper this treatment guaranteed a one-hundred-percent ‘cure,’ meaning something that killed both eggs and worms, but in fact one could not rule out re-infection and it was too early to guarantee long-term success. It must be said that it would have been difficult to distinguish relapse from re-infection, the physician would have to rely on the veracity of the patient’s report. Even then some bodies of water would contain higher numbers of infected snails, or perhaps none. It was impossible to know with certainty. Had he been writing eighty years later he might well have published in Science or Nature. This news would have been taken up immediately by science writers in all the major newspapers, for their weekly science review, as a warning to travellers. In his case, a year later, in early summer of 1919, The Times of London ran a small story, six column inches on page eight. The headline was spectacular: AN EGYPTIAN PLAGUE DEFEATED. NEW CURE FOR BILHARZIOSIS (By our Medical Correspondent)

This described ‘the last chapter in the conquest of a great plague of Egypt’ and continued with a bit of the history, and mentioned Leiper and Bilharz and the role of antimony in curing kala-azar. Christopherson’s role was not exactly starred. The success, as attached to his name, was more or less implied where he was quoted from the Lancet as killing the parasite in situ and later the embryos in the eggs so that the patient is cured ‘and cannot propagate the disease.’ After such a headline one might have imagined some laudatory words for the physician who achieved “the most striking results.” In fact, this brief article leaves one to suspect that the writer had heard about the priority dispute and decided to avoid trouble by being deliberately vague. It is unlikely that most British had even the slightest idea what bilharziasis was, so this squib of an announcement passed with very little notice. The following day, the 25th June, in The Times, a small item turned up describing a proposal by a Dr. Sambon for a “floating school of tropical medicine.”33 This did produce a response—the very next day. Sir Andrew Balfour, by now Director-in-Chief of the Wellcome Bureau of Scientific Research in London, had spotted this and was quick to

33

Sambon, Louis Westenra (1864–1931) Lecturer at the Manson School.

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11.3. Front and 11.4. Back, of Case Sheet No. 10, part of the group in JBC’s major paper.

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point out that “the proposal he [the anonymous medical correspondent] describes as being advanced by Dr. Sambon is not a new one.” Balfour claimed he had advocated such an idea back in 1908, again in 1910 and sounded annoyed that his idea was now being presented as something new. In fact, although Balfour had advocated a floating laboratory, nothing has turned up anywhere about a floating medical school back in those early days. Further, Balfour said not a word about the recent breakthrough for bilharzia mentioned in The Times only two days earlier, that he must surely have seen. On 28 December of 1918, Major C.J. Wiley A.A.M.C, of the Australian Dermatological Hospital, Egypt, having read Christopherson’s paper, wrote of his experience in treating one case in Cairo, in 1916. Major Wiley described in detail the care they took with their patient, a washerman, who worked at the hospital and whose progress they could follow. He and his colleagues gave ten injections of one grain in “100 c.cm of sterile normal saline into one of the veins of the Antecubital space at intervals of a week.” The patient appeared to recover completely and was observed free from the disease for months afterwards. Major Wiley reported that ten injections of tartar emetic effected a complete absence of symptoms. “[I]n the light of other evidence being brought forward, the facts tend to support the view of the favourable action of tartar emetic in bilharziasis.”34 Note, the dosage used by Wiley is small relative to that used by Christopherson and Rogers, but over a longer time, and appeared to be successful. Here is a case of a physician’s writing to endorse the use of antimony on the success of his one patient, but again, like McDonagh, not having continued the work. It was known that bilharzia was rife in Egypt, therefore Wiley had access to many potential patients and the circumstances to continue the work, yet he did not. Christopherson’s success agrees with Wiley’s success. Wiley’s patient was treated in 1916, about a year ahead of Christopherson’s patients, and unfortunately Wiley does not say what gave him the idea to try antimony. He was tactful enough in his short letter to the BMJ not to claim priority. If one considers one successful trial ‘priority,’ this he accomplished, at least ahead of Christopherson. If one considers introducing the success to the medical fraternity, he did not.

34

British Medical Journal (28 December, 1918).

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There is no word of Christopherson’s reaction to this, but he may have felt it was a two-edged sword. On one hand this confirmed his discovery although curiously with a significantly lower dose. On the other hand, the timing was such that here, presumably indisputable, was someone else who might have claimed priority, but did not.

Christopherson Defends Himself On April 19, 1919 he published another article, this time in The British Medical Journal. This appears to be in response to some veiled criticism of his bilharzia work suggesting the possibility of tachycardia as a reaction to the drug.35 Christopherson made short work of dismissing this and used the opportunity to discuss other parasites that may plague the bilharzia patient at the same time. In doing so he again emphasized the “routine examination of the faeces in hospitals in tropical countries. However irksome and unpleasant, such examinations are absolutely necessary for the diagnosis and treatment of tropical diseases.”36 Then, wearing his scientist hat, he sought to emphasize a subject close to his heart. A Helminthologist should be part of the establishment of every hospital in the tropics, and he should be here to assist the doctors to carry out their own examinations. Few doctors know enough about the examination of faeces by microscope to make their knowledge of any practical value, how can they, since they never practise it?37

The Lancet of 14 June, 1919 carried a lengthy and detailed article on thirty of Christopherson’s cases: “Antimony Tartrate for bilharziasis: A Specific Cure.” The following month he published another paper (fourteen pages), this time in The Journal of Tropical Medicine and Hygiene,38 and co-authored by his pathology assistant, J.R. Newlove. This paper details seventy cases, surely enough to nail his success as 35 Nothing has been identified so perhaps this was conveyed in a private letter or in a conversation. 36 J.B. Christopherson. “Antimony Tartrate in Bilharziosis and Tachycardia” BMJ, (19 April, 1919), pp. 480–81. 37 Ibid. 38 J.B. Christopherson and J.R. Newlove. “Laboratory and Other notes on seventy cases of Bilharzia treated at the Khartoum civil hospital by intravenous injections of antimony tartrate.” The J. of Tropical Medicine and Hygiene. (15 July, 1919), pp. 129–144.

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the pioneer in the treatment of bilharzia. Perhaps in this instance it was. Years later, in 1948, studies on schistosomiasis japonica in guinea pigs, in the Philippine Islands, treated with tartar emetic, showed that some of the intestinal helminths had not been killed and that some guinea pigs suffered relapses.39 The dosages were not reported in my source nor is it suggested that guinea pigs might not be the most suitable model for humans. Farley suggests that “. . . the old view that the disease could be completely cured by injection of antimony was no longer warranted.”40 This certainly does not square with the thousands of bilharzia patients who have been pronounced ‘cured,’ for decades, after a course of tartar emetic. The editors of The Journal of Tropical Medicine and Hygiene in the issue of July 1920 set side by side an “Original Communication” by McDonagh (who certainly did claim priority) and another by Christopherson, on the vexatious subject of priority for bilharzia treatment. McDonagh’s letter established in the first paragraph how “[I] . . . treated my first case of bilharziasis with . . . tartar emetic in 1911.”41 Neither physician mentioned the work of the other nor did anyone mention Major Wiley’s single success. It had slipped by Christopherson’s notice that with a name like McDonagh, this physician also might well also belonged to the ‘Scottish race’ with “all the splendid critical qualities . . . which have made its scientific work so valuable. . . .” as he had earlier remarked when writing of another physician, Dr. Innes.42 At that time he had conveniently forgotten his earlier diatribe in 1908 against “that canny Scot” Balfour and the “Scottish race.” Fortunately this last was in a private letter.

39

John Farley. Bilharzia: A History of Imperial Tropical Medicine. (Cambridge. Cambridge U. Press. 1991), p. 165. n. 24. 40 Ibid. 41 Were McDonagh’s first use of antimony for bilharzia an invention and had he then claimed a patent, his bid would have failed. As David Alsebrook, a patent attorney explained “The standard of enabling discloser is whether the invention, and the best mode of carrying it out known to the inventor at the time of filing, are disclosed in sufficient detail to permit an ordinary person skilled in the discipline to carry it out without having to guess or experiment.” E-mail 7 Jul, 2007. McDonagh, with his sketchy-two-and-a half lines declaring success, allows no one to repeat or further this particular work–there was no enabling disclosure here. 42 The Lancet (11 January, 1919), p. 79.

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The Lancet, on 11 October 1919, published two papers by other physicians on the subject. Drs. Low and Newham,43 began their paper on a series of cases by saying: “One of us (G.C.L.) published in May, 1919, the details of a case of bilharzial disease treated by the new method of intravenous injections of antimonium tartaratum (tartar emetic), first proposed by McDonagh and subsequently amplified and carried out on a large scale by Christopherson in Egypt.” They may have thought they were being circumspect in saying “first proposed by McDonagh and subsequently amplified etc.” In fact McDonagh asserted that he ‘used it’ he did not just ‘propose its use’. Low and Newham’s paper reads as though Christopherson had amplified McDonagh’s work. Of course this was not the case. They should have accepted that Christopherson never read McDonagh’s book since he said so in his letter in the BMJ, 11 January, 1919. However, as though to mollify Christopherson, Low and Newham claimed that they felt it advisable to publish their cases at once, “as they confirm Dr. J.B. Christopherson’s . . . experience in every way.” This line of comment was repeated with yet another error added in the seventh edition of Clinical Parasitology by Craig and Faust (p. 554 footnote) “The use of tarter[sic] emetic as a specific therapeutic in vesical schistosomiasis was first advocated by McDonagh in 1918 and demonstrated on a large scale by Christopherson in the same year.” This footnote did a disservice to both doctors. McDonagh claims to have first used the drug in 191244 (he later wrote it was 1911)45 and it was not McDonagh’s work that Christopherson ‘amplified,’ but his own. Years later in April of 2004 an article in the World Journal of Gastroenterology, one reads “Another milestone was the introduction by McDonagh (1918), of antimony as an antibilharzial agent, and the popularization of the drug by Christopherson (1918) in Egypt.”46 These slips, and there are many similar ones, demonstrate that errors become compounded when researchers neglect to go back to the source for information.

43 George C. Low, Physician, Hospital for Tropical Diseases, London. H.B.G. Newham, Director, London School of Tropical Medicine. 44 Letter to the Editor: The Lancet, (14 September, 1918), p. 371. 45 J. Tropical Med. and Hygiene. Vol. XXIII. (1 July, 1920 No. 13). 46 Abdel-Rahman El-Zayadi. “Curse of schistosomiasis on Egyptian liver.” World J. Gastoenterology (15 April, 2004), pp. 1079–1081.

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Sometime after I had written the above, a colleague read the two McDonagh letters: the first in the Lancet 14 September, 1918 and the second in the J. of Tropical Medicine and Hygiene of 1 July, 1920, and pointed out a discrepancy. Immediately I understood that McDonagh had suffered a slip of memory from the first to the second. In the earlier letter he had described how he had tried three preparations: (1) tartar emetic intravenously in doses of 1.0–1.5 gr., dissolved in 5 oz. of water, to avoid thrombosis, twice or three times a week: (2) antiluetin intramuscularly and intravenously alternately, beginning with 0.025 g. and ending up with 0.2g.: (3) colloidal antimony, both intravenously and intra-muscularly, in doses of 0.5c.cm. to 2.0 c.cm. of a 0.2 per cent. Emulsion. Alternate intramuscular and intravenous injections have given better result than using only one route. Both antiluetin and colloidal antimony appear to be more efficacious than tartar emetic [author’s italics]. . . .”

Twenty-two months later he stated: I have used three preparations of antimony: (1) tartar emetic, (2) antiluetin, (3) colloidal antimony, and although all three have much the same action, tartar emetic is the drug for choice [author’s italics] as being the most convenient to use.47

Doubtless the second is the one he remembered. Like so many, he never bothered to check back, and relied on the memory of what was most convenient. If we return to McDonagh’s original publication we find he used against bilharzia the three antimonial preparations he used to treat venereal diseases; he mentions that, as quoted before, “. . . I have had great success in treating cases of bilharzia with injections of antimony . . .” He continues by stating that “. . . colloidal antimony is. . . .exc ellent . . . can be injected both intravenously and intramuscularly.” As Major Arthur Innes wrote of Christopherson in 1919, “. . . nor had anyone [else] the courage to adopt the truly heroic dosage which is necessary to affect the bilharzia worm and its ovum.”48 It is not surprising that Christopherson’s letter, years later in 1947, to his colleague Dr. A.H. Harkness took issue with the connotation of the word ‘introduce’: . . . in no sense of the word did he “introduce” the treatment to anyone in the world—neither to the 6,000,000 bilharzia cases in Egypt (at that time

47 J.E.R. McDonagh, The Treatment of Bilharziasis with Antimony. J. Trop. Med. & H. Vol. 23. No. 13 (1 July, 1920). p. 165. 48 Arthur Innes. Letter in BMJ (13 September, 1919), p. 340.

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estimated amongst the 13,000,000 population), nor did he “introduce” it to the doctors working at the time in Egypt. Nor did he “introduce” it nor broadcast it nor make it known to the profession generally, by recording it on any of the Medical Periodicals, Lancet, B.M.J., Medical Times etc . . . The only two men who might conceivably claim to have introduced the Antimony tartrate treatment to the whole professional work are Broden and Rodhain, two Belgian doctors who, whilst working on the Congo [1906?], injected into the veins of some desperately serious cases of sleeping sickness . . . About this time, 1915, Leonard Rogers was successfully treating Kala-Azar in India, with Antimony Tartrate and I, about this time [1916] —no doubt influenced by Leonard Rogers work in India, I started injecting Ant. Tartrate in Leishmania.49

Years later, in February, 1954, Christopherson was reminded by his friend Manson-Bahr of the latter’s visit to Khartoum Civil Hospital back in 1919. He and Dr. John Anderson, Prof. of tropical medicine in Hong Kong, and Dr. Ferguson of Sydney, Australia, had travelled to Khartoum to verify what they had heard and thought to be fantasy. This supports Christopherson’s assertion that McDonagh had not ‘introduced’ the antimony treatment to anyone. My dear Christo, In answer to your last, your dear wife is perfectly right. I came to see you in Khartoum with my dear old friends John Anderson (Major RAMC) and Major Ferguson (Major AAMC) in March 1919. We brought with us as an excuse for the journey (which was really to see you and hear about Bilharzia treatment) a number of guinea pigs for the laboratory at Khartoum. If you remember we also saw Chalmers and one of his assistants whose name I cannot remember, and the Russian with the unpronounceable name [Dr. Maschoieff ] who was engaged in describing bogus protozoa, and your Mr. Newlove. I do not remember who it was who came to see you in 1917, but I have recollections of someone who visited my lab in Palestine and told me what we thought at the time, to be fairy stories of the antimony treatment of bilharziasis. I was afterwards made to swallow my own words. I have completed your biography for my history of the school and I have for the sake of posterity referred briefly to your epic victory over Balfour—He did several of those silly things in his life—actions which were really quite absurd. I have done over half the work on this now and I am endeavouring to make it accurate, instructive and I hope, entertaining. I have been back from India for one week and my ears are still buzzing from overmuch flying.

49

Copy of a letter to Dr. A.H. Harkness 4 February, 1947. In author’s possession.

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chapter eleven Please give my fondest regards to your wife and take large slice of good will for yourself from myself and your many good friends who still frequent 149 Harley Street. Your ever sincerely, Philip Manson-Bahr.50

Christopherson, shortly after writing what can only be described as a rant to his colleague Harkness, followed up with another in similar vein to Dr. Ogier Ward.51 These letters were in regard to a paper for the Royal Society of Medicine that Dr. Ward had written in November 1945 titled Some Surgical Aspects of Bilharziasis (Urinary). Christopherson picked up the same problem he had addressed in his Harkness letter. “On page 2 you write ‘until 1912 when treatment by sod. Antimony Tartrate was ‘introduced’ by Macdonagh [sic] and by Christopherson in 1917 . . .” On the back of the envelope in which he stored these two letter copies, (intended for the archive in Khartoum) he added a note (“Awful impertinence! When he only had one case!”) about Chalmers and Castellani’s Manual of Tropical Diseases where “Macdonagh [sic] is cited for first using Antimony for bilharziasis in 1912 . . .” In fact, McDonagh claimed later that he had twenty-three cases; five were intractable cases of gonorrhoea, some relapsed, and eleven he had lost sight of. He claimed that at least nine were successful and had not relapsed.52 Curiously, for someone so anxious to be recognized for this work, the details remained unpublished, and he remained annoyed. As late as 1934 he wrote a short note to the editor of The Lancet to remind readers: “I was the first to use tartar emetic in bilharziasis . . .”53 Further, this particular work of McDonagh’s is not cited, by which I mean that there is no mention of it, with appropriate page and publication date, in any of the usual journal articles. His name does appear occasionally in later years as having ‘introduced’ antimony but this is always followed up by Christopherson’s name. Needless to say this was a situation that irritated both of them.

50

Manson-Bahr to JBC, 13 February, 1954. JBC and Ogier Ward had earlier published together. 52 Letter to the Editor. The Lancet, (14 September, 1918), pp. 716–17. 53 J.E.R. McDonagh. “Tartar Emetic in Bilharziasis”. Letter to the editor of The Lancet. (31 May, 1924.), p. 1130. 51

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Other Drugs Were Tried There were no successful standard treatments for any form of bilharzia until 1917. Earlier, in 1912 H.B. Day and Owen Richards, of the Kasrel-Ainy hospital, Cairo, were moved to investigate Salvarsan for use against bilharzia “first, by the desire to test a new drug” and by then having seen “in various scientific and lay papers a definite assertion that it cured the disease.”54 Since that claim had been endorsed by none other than Nobelist Professor Ehrlich, this must have appeared to be a worthwhile effort. In the end, their investigations proved fruitless. Their article ended: “We . . . conclude that salvarsan as a remedy for bilharziasis is absolutely valueless and that it should not be used or recommended for this purpose.”55 Day (and many others) went on in future years to value and advance Christopherson’s work with tartar emetic for bilharzia, contributing a number of papers on this subject. Another possibility, emetine, was discussed in the pages of the BMJ in the 1920s.56 Its use was much endorsed by Balfour two years after Christopherson’s major antimony papers, possibly as an alternative to Christopherson’s claimed treatment. I counted a series of twelve letters in the BMJ on the subject from 23 October, 1920 to 21st May, 1921 and an addendum of two letters published much later, in 1926. The series began with a letter to the editor from S.J.D. Esser in the Transvaal asking about a reported discussion at Cambridge where Dr. Balfour mentioned that certain practitioners in Egypt preferred the action of emetine in bilharziasis to that of antimony. “. . . Can Dr. Balfour inform us if emetine is injected also directly into the veins? . . . If it is just as efficacious as tartar emetic, then a drug less toxic than the latter has already been found.”57 Balfour replied to Dr. Esser’s letter the next week. “I append a list of references to papers dealing with the use of emetine in bilharziasis, both in Egypt and elsewhere. It is evident that the drug has been given a considerable trial, but possibly sufficient evidence has not yet been adduced to warrant its substitution for antimony.” Balfour was hedging a bit here as he also urged more 54 H.B. Day, & O. Richards, “The treatment of Bilharziasis by Salvarsan.” The Lancet. (27 April, 1912 ), p. 1127. 55 Prof. Paul Ehrlich, 1908 Nobelist for his discovery of Salvarsan as the cure for syphilis. 56 Emetine: The principal alkaloid of ipecac. Stedman’s Medical Dictionary. (27th Ed.), p. 582. 57 S.J.D. Esser, “Emetine in Bilharziasis.” BMJ (23 October, 1920), p. 645.

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trials for emetine. Alternatively Balfour was a victim of a false attribution of causality to the common emetic effect, or may have created it for himself. Christopherson must have watched these columns with interest to see what would happen next. Dr. A.H. Harkness jumped in on 11 December of the same year, 1920, saying he had tried emetine and not found it successful. He therefore endorsed and “recommends antimony tartrate or sodium antimony tartrate intravenously rather than emetine confident that the latter is not likely to produce the same local and general improvement in health . . .”58 Next, in February of 1921, F.O. Lasbury and R.B. Coleman published a long paper on 1,000 cases of Bilharziasis treated by Antimony Tartrate. They found that “quite small doses spread over a considerably longer period of time, cure the disease the main point being the cumulative effect of about 20 grains of the drug.”59 One can imagine Christopherson’s smile of satisfaction as Balfour’s name drops out of this discussion and endorsements for his treatment roll in. Perhaps most importantly an editorial article in the BMJ of April 1921 summed up: We seem now to have the story of bilharzia disease complete . . . the value of treatment of the disease by intravenous injections of antimony tartrate is now well recognized by medical opinion, and the results are so excellent that in Egypt sufferers are spontaneously applying for treatment in large numbers. . . . Recently the Minister of Health for South Africa, Sir Thomas Watt, informed Dr. Christopherson that the authorities intend to bring the antimony treatment of bilharzia to the notice of all concerned.60

In the BMJ, May of 1921: Medical notes in Parliament, there was further endorsement of Christopherson’s work: Mr. Doyle asked, on May 12th whether the Min. for Pensions was aware that Dr. Christopherson’s antimony treatment was now accepted as a certain cure for bilharziasis: that the Australian government, after segregating all returned officers infected in Egypt, had completely stamped it out by this method of treatment . . . 61

Christopherson could well have said: “I rest my case.”

58

A.H. Harkness, BMJ (11 December 1920), p. 890. R.O. Lasbrey and R.B. Coleman. “1,000 cases of Bilharziasis treated by Antimony Tartrate.” BMJ (26 February, 1921), pp. 299–301. 60 BMJ Editorial Article (2 April, 1921), 501. 61 BMJ (21 May, 1921), 753. 59

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This was not quite all; there was another drug, Fouadin (stibophen), named in honour of King Fuad, that got some play in the journals. Fouadin achieved some popularity and was administered even in 1944 to Dr. Claude Barlow, one of those brave experimenters who insist on infecting themselves to test certain treatments. “Ten months after infection, he was treated with Fouadin, this caused a fever, nausea, wheeze and cough. The numbers of eggs excreted were reduced greatly, although the drug did not eradicate the infection completely”62 wrote Helminthologist David Grove. Fouadin was also promoted by Dr. Mohammed Khalil who became Director General of the Endemic Disease Section of the Rockefeller Foundation Egypt in the 1940s. In the end antimony tartrate was preferred by the majority and remained so for several decades. As late as 2 November, 1934 Christopherson wrote to his wife, with some pride: . . . I am engaged reading a monograph or treatise on Bilharzia for review for the British Med Journal. It is written by an Egyptian doctor and I am interested to see that he does not recommend Fouadin in fact he scarcely mentions it. Aly Pasha Ibrahim is quoted saying that “since its introduction into therapy in 1919 by Christopherson this heroic medicine (Tartar Emetic) conquered the whole Schistosomiasis (Bilharzia) regions in a way that has not been achieved by any other remedy etc. etc.”63 So that is satisfactory. Well I think that my work has stood the test of time 1919–1934 is a long time for any remedy to hold its own, without any modification in drug or technique . . .

Regrettably this review has not been found. In fact, as will be seen, the tartar emetic treatment for schistosomiasis lasted considerably longer, and was used for bilharzia as late as 1960 in some parts of the world.

Writing for a Medical Journal in Early Twentieth Century Christopherson’s style of writing is inimitably his own, in all his papers. He not only frequently named his patients, he described them and their

62

David I. Grove, A History of Helminthology. (Wallingford: C.A.B. International. 1990), p. 210. 63 Elected Dean of the Medical Faculty and Director of Kasr El-Aini Hospital in 1929.

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illnesses with a spectacular lack of what would now be termed, political correctness. For example, in the above mentioned Espundia paper he wrote of one patient: “The man was naturally a dull, insensitive sort of fellow, and one would not expect him to be an accurate register of the physiological effects of the drug.”64 Despite such a gratuitous comment, it was not at all the case that Christopherson lacked empathy for his patients; on the contrary, he had a reputation for concern and tenderness for all of them. Christopherson’s plain-spoken, even rash, commentary, cannot go unremarked. Since the editors of major journals thought fit to print it, we may take it that this form of expression, if not the norm, was at least acceptable. Until the 1960s it was not uncommon for editors of the individual science journals to do their own reading and selections. The result was not as rigorous as having peer reviews by those in the particular specialty; medical journals followed a similar pattern.65 Historian Ruth Richardson suggested that the timing of many of these papers—right at the end of, or just after, the First World War—may account for this. Physicians had mostly either been called up or had volunteered, those left behind had increased work loads and little time for reviewing. In July 1919 the opinionated Christopherson penned his thoughts on The Effect of Bilharzia on Physique and Character: Bilharzia probably is accountable more than anything else for the indolence of spirit, want of character, and the backward condition of development of the Egyptian peasant (fellah), and, as he as a class includes 90 per cent of the population, one might almost venture to say, the Egyptian nation. . . . Many are the deaths, but time cures the majority of cases of bilharzia at present, although it may take ten years or more to do so: during all this time the man is losing blood, and spreading infection broadcast. It is quite probably that the sallow, dirty complexion, the anemic mucous membranes, and poor physique, the apparently patient, unambitious temperament of the modern Egyptian fellah is due largely to schistosome infection, and one might also add the utter lack of enterprise, initiative, ambition, and the lack of almost every positive quality which contributes to the estimate of character, good or bad.66

64

Notes on a case of Espundia, Op. cit., pp. 229–236. Commentary on this subject from Prof. A.J. Meadows in personal communication 14 September, 2006. 66 J. of Tropical Medicine and Hygiene (15 July, 1919), p. 141. 65

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He continued and as he wrote one can imagine his having a basket of adjectives at his side ready to sprinkle liberally in every sentence as he warmed to his subject. One comes across Egyptians amongst the more fortunate classes who are not affected with bilharzia, prosperous, and by no means wanting in initiative or commercial enterprise, and one would naturally venture to think that the docile, dirty, slovenly patient though not unindustrious, but unenterprising, unambitious, short-sighted, miserable fatalist one associates with the type [sic] Egyptian, would be a very different person were he minus the parasites, particularly of bilharzia (and ankylostoma and T. nana) which are at once an overwhelming physical, mental, moral and economic handicap, who more than anything else have kept him shackled by invisible chains, and have retarded his civilization. Ninety per cent of the population of Egypt have not advanced in civilization since the days of the Israelites of the Old testament. . . . It is almost certain that Egypt will never be able to take her proper place among the nations of consequence until she has got rid of the parasites which are poisoning her blood and consuming her energy.67

If he had to defend his writing, he would surely say that he was making a forceful point, amounting to propaganda perhaps, regarding the urgent need for treatment for so many thousands of poor Egyptians debilitated by their parasites. Treatment—his treatment—would result in healthy men, would be to the advantage of the state and empire; and would save both money and personal misery all around. He proceeded to use the treatment in his own clinical practice and with success. On October 15 of that year, Christopherson reported on two deaths of leishmaniasis patients treated with antimony: “. . . looking backward . . . [these were] so unsuitable for the treatment that I hope by publishing them I shall draw the attention of practitioners not yet conversant with the remedy to the class of case which is unsuitable, and where it is useless—and may be worse than useless—to attempt the treatment.“ Two of his severely ill patients having died, he candidly noted that in these two cases, “. . . death was hastened by the treatment.” Of one he wrote: If I had such a case again I should hesitate to try the remedy—the case was too advanced—unless I could get efficient nursing, such as one finds at St. Bartholomew’s the Great in London, but which one cannot as yet aspire to at St. Bartholomew’s the Less in Khartoum . . . . his case was too

67

Ibid. p. 141.

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chapter eleven far advanced for the treatment: in other words, he was so weak that he could not stand the depressing [physiological] effect of the antimony tartrate.68

This was not to criticize the nurses he had finally engaged to work in Khartoum, but rather to point out that the facilities in Khartoum were not yet up to London standards. He warned other practitioners, time and time again, about the risks inherent in the use of tartar emetic: It might be thought from the writings of skilful and experienced workers that the treatment is easy, sure of success, and free from danger. These ideas may cause less practised triers to think that the treatment does not require judgment, careful attention to detail, and intelligent practice. Kala-azar in the Sudan occurs chiefly in districts where there are no dispensaries, few hospitals, and the medical officers of which have not always had the advantage of special training in laboratory methods.69

At the time there was no suggestion of asking patients to give formal consent; how much explanation and, or warning, was given before an experimental drug was used is not documented. Institutional Review Boards were far in the future. Christopherson advanced a practical explanation to physicians: The Sudanese people likewise, although confiding and amenable in the first place, are timid and easily discouraged by non-success, and are naturally apt to think that if a patient dies under treatment the treatment necessarily is not good, so that this is not a method of treatment which may be recklessly adopted without careful consideration in a country such as the Sudan.70

He was not alone in this observation. Dr. Leonard Bousfield wrote of his difficulties when he went out to Sudan in the very early years, given the cultural prejudice, not just against western medicine at the time, but in particular against women’s being seen by a male practitioner.71 Bousfield, then something of a greenhorn, was asked to attend a local chief’s wife who was reputed to be dying in childbirth, a situation that had been in process for three days. A Syrian doctor was kind enough to explain to Bousfield that the chief was known for his dislike of the British, and knowing that his wife would shortly die, had summoned

68 69 70 71

Ibid. p. 231. Ibid. p. 233. Ibid. Leonard Bousfield, RAMC (1876–1956).

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the doctor in order to blame him.72 Bousfield did not take this path on his own. He consulted the local governor who agreed that the success of a new doctor in a region depended solely on his initial reputation. This of course would reflect directly on the British Administration as a whole. Faced with a moral dilemma he delayed making a move and heard, with relief, that the woman died half an hour later.

The Research Moves Ahead In December of 1920 the first meeting of the newly formed tropical medicine section of the Royal Society of Medicine met at the Wimpole Street headquarters. It was well attended by all the luminaries of the field. Christopherson, now permanently living in London, demonstrated his method of treatment of bilharziasis by means of intravenous injections of sodium antimony tartrate and exhibited microscopic specimens. In March 1921 a paper appeared in The Lancet by Prof. H.B. Day with an analysis of 1,000 cases of bilharziasis who had undergone outpatient treatment.73 Prof. Day endorsed, and paid tribute to, Christopherson’s concerns for keeping track of patients. In most cases the patients did not have to be in bed, they could usually be out and about; the problem faced was getting a patient back to the hospital or clinic for further treatment, or for samples of urine or faeces to be examined. Time meant loss of wages that poor patients could not afford. Now that the general success with tartar emetic was seen to be indisputable, Christopherson and others moved to considering attacking the disease on a larger scale and turned to the prevention of infection. In the BMJ of April 1921 Christopherson suggested using mobile hospitals with laboratories attached. He planned for the destruction of the molluscs in their habitat, and for education of the Egyptian fellaheen. In fact he had been hammering at this multi-pronged assault for some time. He felt that since children were initially the most affected and vulnerable, and tended actively to spread the disease, their education along with treatment would be the place to start. This was his plan, a plan very little different in scope from those proposed today.

72 73

Bousfield, Op. cit., p. 72. H.B. Day. Physician at the Kasr-el-Aini Hospital, Cairo.

11.5. New Khartoum Civil Hospital opened in 1909. JBC and his staff.

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CHAPTER TWELVE

ON THE PRACTICE OF MEDICINE, SUDAN 1902–1919

One might be tempted to call the present day the period of the apotheosis of antimony in the department of tropical medicine. —J.B. Christopherson

Part One: The Diverse Medical Environment, Both Western and Local In the days before the gold standard of double blind, randomized, controlled trials, doctors had to invent as they went along. They would have learned the signs and symptoms of most common diseases along with a set of remedies that may or may not have worked on a relatively few diseases. In England, the infectious illnesses that afflicted the general population were well-known. Phthisis, smallpox and cowpox, scarlet fever, measles, along with various venereal diseases, were dealt with largely on a rest and wait basis. There were no antibiotics; there was vaccination for smallpox but not for measles or scarlet fever; many, particularly children, worsened and died under the doctors’ care. For bacterial or viral illnesses (even if those terms were not known to every physician in the late 1800s), medical care without antibiotics was just that—care. Warmth, rest, some nostrums of the day, and possible reduction of pain with opium or alcohol were all that were available. The tropics had different medical problems. There were more parasitic diseases. Worms burrowed under the skin, and lived in the eye, or the bladder, liver or rectum. The causal agents could be sometimes seen with the naked eye. Whatever remedies had been discovered and proved were the results of adventurers’ wandering about in the dark, medically speaking. The tropical diseases were very likely to be caused by worms and other parasites that were impervious to the human immune system. Some remedies were discovered by observing what the indigenous population of a region did, occasionally with considerable success. Christopherson and his colleagues, in true Victorian/Edwardian enthusiasm, enjoyed investigating local practices.

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There was precedent; one might stumble on another quinine—from the bark of the cinchona tree—that had been a native South American specific against malaria for generations. By the late eighteenth century it had been rapidly taken up as a prophylactic and cure in Europe and in the tropics, and saved many lives. Such ‘miracle drugs’ are still being discovered. For example, a treatment for ovarian cancer, Taxol, was found in 1962. The plaque erected in the national park where the discovery was made reads: Discovery of Taxol Near this location on August 21, 1962, Arthur Barclay and a team of botanists from the U.S. Department of Agriculture collected bark of the Pacific Yew, Taxus brevifolia Nutt. Drs. Monroe Wall and Mansukh Wani, of the Research Triangle Institute, North Carolina, under of contract to the U.S. National Cancer Institute, isolated Taxol from that sample. Since 1990 Taxol has been the drug of choice for treatment of ovarian cancer and is widely used in the treatment of breast cancer. Presented in 2002 by the USDA Forest Service, National Cancer Institute and the American Society of Pharmacognosy on the 40th anniversary of the collection. Taxol is a registered TM of the Bristol-Myers Squibb Company

At the other end of the spectrum of medico-scientific work was the investigation of inorganic heavy metal compounds for the treatment of parasitic diseases. This was a reasonable sequel to Ehrlich’s work. Until Ehrlich discovered a medical use for arsenicals and delivered salvarsan to the world, winning the Nobel Prize in 1908 and making medical history, there had been no effective treatment for syphilis. The story of salvarsan is an intriguing one. It had been overlooked when it was the 606th substance to be tested against syphilis. When it was later reexamined and found to be effective, 914 more variations were made in an effort to produce an easily administered treatment. It remained the recommended therapy for syphilis until the introduction of penicillin forty years later. What salvarsan did, aside from curing syphilis, was to open up, as possible and legitimate, the idea of using heavy metal compounds for a variety of diseases and an acceptance of the fact that the non-botanical ‘elements’ might kill not only bacteria but also parasites.

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What Happened Next? In 1912, at the seventh Brazilian Congress of Dermatology, Dr. Gaspar Vianna made a startling announcement: he had used tartar emetic as a successful treatment for Leishmania cruzi.1 As early as 1896, Rogers, in India, had become interested in finding a treatment for kala-azar (leishmaniasis). Over many years he tested a large number of candidate remedies including Salvarsan; all were unsuccessful. He then tried various acid preparations, vegetable derivatives, and finally antimony tartrate, which had been successful against sleeping sickness. In each case, if there was no prior use to guide him, he started with small doses and increased the dosage until either the patient became sicker or the disease was cured. In spite of its being a poison, antimony tartrate, carefully administered, neither killed nor seriously discommoded a patient who did not have a concurrent serious illness (pneumonia for example), and it cured the leishmaniasis. Rogers published his results showing the dosage regimen and the change in symptoms, as well as the reaction of the patient. What he did not appear to do was to record the weight of his patients. As a result he was unable to calculate the necessary concentration of chemical in the blood of the patient to destroy the parasite. Rogers reported that he injected 1 cc. of a 1 percent solution Then “rapidly pushed it up to several cc, when I found it more convenient and quite safe to use a 2 percent solution and to give the injections every 2 or 3 days, gradually increasing them from 2 cc up to 10 cc as long as nausea and epigastric pain are not produced, and I have seen no injurious effects from these doses.”2 Muir, whose article was published in the same issue and adjacent to Rogers’ paper in the Indian Medical Gazette, also reported using tartar emetic on adult kala-azar patients after reading Cristana & Caronia who used it on infant kala-azar patients.3 Muir wrote: “I have never seen a specific work a more rapid and striking result in any disease.” Unlike Rogers he started with a dose of 4 cc and “increased each time 1 G. Vianna, Comunicado à Sessão de 24 de abril de 1912, da Sociedade Brasileira de Dermatologia. Boletim da Sociedade Brasileira de Dermatologia. 1:36–38, 1912. 2 L. Rogers. Preliminary Note on the Treatment of kala-azar by Tartar Emetic intravenously, and Inunctions of Metallic Antimony. Indian Medical Gazette. (Oct 1915), pp. 364–65. 3 G. Di Cristana & G. Caronia. The Treatment of Internal Leishmaniasis. J. Trop. Med. & Hygiene. (Vol. 18 15 May, 1915.), p. 118.

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by 1 cc up to 10, unless there are signs of nausea, when it should be decreased by 1 cc and then gradually increased again.”4 He did not state the concentration of the volumes he injected. The practice of the time was ‘evidence-based’: Rogers and his collaborator, Hume, in the BMJ 26 February, 1916, state: “One of us, L.R., early in 1915 commenced the use of tartar emetic intravenously in the treatment of kala azar on the strength of its previous use in sleeping sickness.” [Author’s emphasis] And Christopherson, in 1917, commenced the use of tartar emetic intravenously in the treatment of bilharzia on the strength of its previous use in kala-azar. When Christopherson started using antimony tartrate he knew from Rogers’ and from Muir’s work approximately what dosage a patient could tolerate and what the side effects were likely to be, and the total amount required to kill the leishmania parasite.5 This work was possible in part because the use of antimony had a history in tropical disease at this same time. C.M. Wenyon, an editor of the review journal Tropical Diseases Bulletin, publicly acknowledge the success of Vianna’s treatment and that of the two Italians, Dr. Cristina and Dr. Caronia (earlier mentioned) and adds that they must be given credit of priority “. . . even though the possibility of employing the drug [tartar emetic] in kala azar [sic] had previously been in the minds of most people having any knowledge of the disease.”6 It had also been in the minds of others for use in sleeping sickness, where it was found to kill the trypanosomes in rats around 1910 and naturally was tried shortly after, in humans. There was a clear chain of events here. Christopherson converted Rogers’ doses into apothecary measure, characterizing his dosing in grains of active chemical rather than cc of a solution with a concentration of 1 or 2 percent. A 1 percent solution has 1 part of solute per 99 parts of solvent. A grain equals 64.8 milligrams. Christopherson’s (maximum) 3 grain doses of tartar emetic were 194.4 milligrams, sufficiently close to Rogers’ 200 mg doses. Christopherson acknowledged his debt to Rogers, but even if he had not, it would have been clear that his choices of chemical, of route of administration, of initial and progressively increased doses, must all have come from his careful reading of Rogers’ papers. 4

E. Muir, FRCS. The Treatment of Kala-azar with Tartar Emetic. Indian Medical Gazette (Oct. 1915), pp. 365–66. 5 Ibid. 6 C.M. Wenyon. Tropical Diseases Bulletin. (Vol. 6. 1915. August 30 1915), p. 222.

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After his first thirteen successfully treated patients, Christopherson published his observations in The Lancet in May 1918. He continued treating patients in a similar manner, and a year later, in July 1919, (as discussed in chapter eleven), he and J.R. Newlove published a major paper with the results of their first seventy patients.7 By now he knew that a successful outcome was dictated by the length of the treatment. Some patients who left his care early were also cured, insofar as he was able to track them down for information. The seventy patients were a treatment project, not a research project, so as cure succeeded cure the data sheets show he recorded fewer and fewer detailed data. The medicating of patients was becoming routine and as the numbers grew so did Christopherson’s confidence in what he was doing. We must assume he felt that detailed documentation was not needed as long as the name of the patient, and the total antimony dosages were shown. Thirty-three patients out of the seventy, did have their ages noted. I can only say that the various different handwriting examples on the hospital data sheets suggest that some clinicians or assistants bothered to fill in the box at the top marked AGE and others did not. A few other details would have been useful for modern analysis—in particular the patient’s weight and general physical condition. That the last twenty-three of the seventy patients reported were outpatients, and that they tolerated this treatment well enough to be out and about, suggests that he was quite confident of his treatment. His failure, like that of Rogers, to record the weight of the patient, makes it difficult to assess the relationship between cumulative antimony load and parasite survival. Such a relationship would have been invaluable in assuring what doses were the least required to accomplish the goal and remain non-injurious to the patient. A reasonable assumption is that the weights of his patients in the range of eight to twenty-five years would be highly correlated with their ages. There were no obesity issues with young people then. John Senders8 and I have recalculated the daily dosages, total dosage divided by the duration of treatment, for each of the thirty-three patients whose age is noted in his major paper of 15 July, 1919, including the thirteen patients described in his

7

J. Trop. Med. & H., (No. 14, Vol. XX11, 15 July, 1919), pp. 130–144. John W. Senders, Prof. Emeritus, U of Toronto, who is responsible for the calculations and writing up of same. 8

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first paper on the subject in the summer of 1918.9 The best fitting line of daily dosage as a function of age has a slope of 0.044 gr/day/year. The correlation between patients’ ages and daily dosage is +0.6. The correlation is derived for a sample of 33 pairs of data. Like any sample taken from a larger population, it is likely to be different from the correlation that would be found if the entire population had been used in the calculation. We have computed that we can be 95 percent sure that the real value of r in the whole population lies between 0.34 and 0.86. If our sample had been larger, we could have been more precise. So the dosing regimen, based on the state of the ova appearing in the patient’s urine (examined every day), is appropriately modulated by the patient’s age. Had Christopherson plotted his raw data as a graph of ‘cumulative dose in grains divided by treatment time in days’ as a function of age, it would have been immediately apparent that the best fitting line (even if by visual approximation) would have told him the correct dosing regimen as a function of body weight. This would, in turn, have permitted him to specify the dose even for a very young child or for persons whose weight was significantly different from his older patients. (See Appendix A) Christopherson seems not to have used any statistical analysis; a visual examination of the data tables and a comparison of means were probably all that were available to him. There is nothing in his reports to suggest that he ever thought about it. Pearson’s product-moment correlation (PMC) was published in 1896.10 Tests of significance came into existence with the work of Gossett, but it is highly unlikely that either work would have been read by Christopherson.11 He experimented but had no specific design, controls or analysis. His design was the careful approach to the upper bound of the therapeutic range. The untreated members of the population were his controls; the presence or absence of ova in his patients’ urine, and their survival were his outcomes for analysis. During the course of treatment those who were infected and not treated remained disease ridden. He published his results and the rest is history. The treatment was taken up by virtually all who had access to the articles in The Lancet, The Journal of 9 J.B. Christopherson & J.R. Newlove. The Cure of Bilharzia Disease by the Intravenous Injections of Antimony Tartrate. J. of Trop.Med. & H. (16 June, 1919), xxii. pp. 113–114. 10 K. Pearson, “Mathematical Contributions to the Theory of Evolution. III. Regression, Heredity and Panmixia,” Philosophical Transactions of the Royal Society of London, 187. (1896), pp. 253–318. 11 Gossett. (Student) The Probable Error of a Mean. Biometrika (March 1908).

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Tropical Medicine, the BMJ or, who were informed in a personal way in conversation, or by letters from colleagues. For more than fifty years, it was the treatment for schistosomiasis (as discussed earlier, salvarsan achieved similar long-term success for syphilis). Decades later, antimony tartrate was supplanted by more palatable drugs synthesized in the laboratory, that had the desired effect.12 Despite the enormous differences between modern practice and that described above, some commonalities are notable. The modern emphasis on “evidence-based medicine” was not needed. Christopherson practised it as did Rogers and Muir. Their treatments were evidence-based; the evidence was, appropriately, the reported dosing regimen used by earlier physicians and investigators. Christopherson’s task was to use, insofar as possible, the methods and doses that others had used before him, and to observe his patients carefully as they proceeded through the dangerous, or, as some said, ‘heroic’ course he had laid out. The evidence of the efficacy of the treatment was seen in the microscope. Had he today proposed to do what he did, he would never have been able to begin—and this would have been true of many of those early physicians. In his case he was the senior physician in the two civil hospitals, so no one was looking over his shoulder. Many of his first patients were Egyptian soldiers or young men from the Gordon College. As he pointed out, the students could be controlled and followed up. They were students whose disease was caught early, who were young and in better general health. In more than one paper he commented that some of the Egyptian soldiers harboured as many as six different parasites. He suggested these other parasites should be seen to first, before beginning the antimony treatment. Although there were no deaths among those first seventy patients, Christopherson continues to point out the dangers of using antimony. He had trained and instructed well, and the results were the proof of both his own care and that with which his assistants followed the procedure in his absence. He was always careful to thank his junior colleagues, something they must have appreciated when they saw their names in print.

12 In the early 1970s Metrofinate was found to be a cure for urinary schistosomiasis, Oxamniqine for intestinal, and finally, Praziquantel for all forms. The latter had no side effects. Lillian Beck. et al. Replacing oxamniquine by Praziquantel against Schistosoma mansoni infection in a rural community from the sugar-cane zone of Northeast Brazil: an epidemiological follow-up. Mem. Inst. Oswald Cruz., Rio de Janeiro, (Vol. 96, 2001).

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Indigenous Medicine and Notes for the Book That Never Happened The Christopherson files in the Durham University Sudan Collection hold a great many papers testifying to his interest in the indigenous population. He was fascinated with language, tattooing, tribal markings, cultural habits and of course, medicine. In gathering information he was assisted by his local Syrian, Egyptian, and Sudanese medical associates, and particularly by Dr. Zaki, the Egyptian physician who had been so helpful in the early days. Charles Armbruster, his life-long friend and a celebrated Amharic scholar, was also interested. As late as October 1934, in England, he was still planning to finish his Sudan Illustrated Book of Diseases, presumably as a culmination of all this earlier work. To accomplish this he felt, as he wrote to Joyce, that he should delay his final move from their London house to their country home, in order to be near a medical library. Sadly, in the end, he was deflected from the project and all that remain are uncoordinated notes.

Christopherson Sends Out His Survey Questionnaire Back in March of 1908, a year that had become most trying, he remained much enthused with the subject of local medicine and cultural practices. From his base in Khartoum he sent a letter to twenty local, i.e. nonEuropean physicians, men who reported to him and who worked mostly in the outlying districts. This survey asked five detailed questions. The answers were intended to be relevant to each man’s particular area: tribal markings, earth-eaters, tattooing, circumcision of female children and finally, native remedies, surgery, appliances, splints etc. He suggested that sanitary barbers, midwives and patients would be useful sources of information. His letter gave no hint of why he wanted this information. There was no explanation that this might be the foundation for a book, or that each man would be recognized for his contribution that must have taken an inordinate amount of time. Perhaps the idea had been broached earlier. Unfortunately, this file in the Durham Archive is incomplete. Most questions were probably fully answered as there are pages clearly from the middle of some responses, and loyalty to Christopherson and the SMD would have elicited a good measure of compliance.

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The first questions, on tribal markings and tattooing, got a great deal of attention. Significant effort must have gone into writing these reports; all of those colleagues surveyed are represented in the file, if only with one page. Female circumcision, a controversial subject that has dogged Sudan and many African countries for years, was either not answered or, perhaps, kept in a separate file that has not been found. The Durham Archives also hold an unpublished and undated paper written by Christopherson (probably around 1910) with the title: Native Peoples of the Sudan.13 This contains ‘Extracts from Wright’s lectures on “Comparative Grammar of Semitic languages 1890” and some additional thoughts from his linguist friend, Armbruster.14 Much of the information must have come from the answers to this first part of his survey. The document does present some rather fanciful ideas but Notes on Medicine in the Sudan is a five-page paper and his discussion, of medicine in the first decade of the century, is of more practical and historical interest. It would have been a good basis for his proposed book.15 He begins asking the question: ‘. . . what . . . natives do when they are ill?’ He then classifies the people to whom the Sudanese will go to for aid: The Bassir or Bone setter; The Halak or Muzaeen or barber bleeder; the Fakeer or the Koran Reciter, and lastly, The Daia or Midwife, and considers their work. Thanks to the input of his local colleagues, this was now a subject about which he knew a great deal.

The Bassir or Bone-Setter “The Bassir” he wrote, “is usually engaged in some agricultural occupation when there is no bone setting to be done. Simultaneously he cultivates the soil and sets bones. His professional reputation depends entirely on his results which are sometimes very creditable.”16 The Bassir also practiced cupping, something else that interested Christopherson, but he noted that even though a man could afford to be cupped every six weeks, ‘as often in fact as we have our hair cut in England,’ he thought that the old women of the village were better at the job.

13 14 15 16

SAD 407/9/8–14. Not found in any published form. SAD 407/6/15–20. Ibid. SAD 407/6/15.

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He saved a few choice words for the Fikir [sic] who could most likely read and write but was “an ignorant man at bottom—A Charlatan and corresponds to a ‘Christian scientist’ in England.”17 A text may be written with the ink on a piece of paper by a Fakir and eaten by the patient, or it may be written on a board with chalk and the writing washed off and the dirt solution drunk. Or it may be written on paper, the paper burnt, the smoke inhaled and the ashes eaten etc. There, I think, are the chief stock-in-trade remedies of the Fiki [sic].18

His Conclusion for his 1908 Annual Report of the Sudan Medical Department, the last one written by him in his post as Director of the Department was as follows: . . . may I add that the rapid yearly increase in the number of out-patient attendances at all the Civil Hospitals would appear to be a gratifying indication of growing confidence of the natives in a Government Institution. The more remarkable from people who, to say the least, are very prejudiced against Turkish (Europeans) methods and who have their own medical system and the above implicit faith in their Bassir with rude instruments and simple herbal remedies, Fikis with charms and texts and the Exorciser with drums and accompanying pandemonium.19

Midwifery Midwifery, as reported by Drs. Ghose and Saagh from Port Sudan: “If delivery is delayed, the patient is given ground dhurra with butter then two men make her sit up and give her a thorough shaking. . . . onion put in the vagina is supposed to increase the labor pains.”20 The lack of western trained midwives in Sudan remained a serious problem for many years until, in 1921 a pair of sisters—midwives— Mabel E. Wolff and her sister Gertrude L. Wolff arrived and successfully set up a clinic and trained local women. Christopherson, who had left before the advent of ‘the Wolves’ had very little to say about local midwives, simply that they were “women who can neither read nor write, but who brag and boast and lie about their prowess like Mrs. Gamps in other parts of the world, but at the same time they may be skillful

17 18 19 20

SAD 407/6/16. SAD 406/6/17. SAD 1908 Sud.A. PK 1561 GRE. p. 242. SAD 407/2/46.

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through practice”. He added: “It is a curious fact that in some places there are Sudanese men who act as midwives and are very clever at the work. They are called to difficult cases and often with successful result. They attend only women whom they cannot lawfully marry, (according to Koranic Law).”21

Cataracts Cataracts and other eye complaints have always been particularly prevalent in Africa, and cataract surgery has been performed since before the time of Christ. Dr. Sooadi at Halfa wrote that “cataract extraction is a familiar operation among the natives. It is an operation done in secret, using what is known as the ‘golden needle’ which is reality a narrow knife but one that no one is allowed to see. He concluded by saying “. . . at the end of which the patient’s operation is either successful or otherwise . . . The operator’s fee is never less than 100 dollars together with a slave girl, or boy, as a present. The operation is always done in secret, and no one is allowed to witness it or even have a glance at the knife.”22 In fact a ‘satisfactory result’, the folding down of the cataract, often called ‘couching’, meant that the patient could see light, but could not focus, as there were no variable optics. In order to see images, the patient needed eye-glasses, the type referred to years ago as having ‘Coke-bottle’ lenses.

Amputations Amputations make for rather a frightening and grisly tale as Dr. Zughayr, the M.O. at El-Obeid explained, “Natives use their own swords for amputations by cutting off the limb with one cut and then dipping it in hot fat in order to stop bleeding. When the patient is timid they take him in the Tukle [kitchen] and order him to put the limb to be amputated out through a little hole in the Tukle: The surgeon then does his operation outside while the patient cannot see him.”23 This treatment is likely to result in death by shock, wrote one physician.

21 22 23

SAD 407/6/19. SAD 407/2/5. SAD 407/2/27.

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Christopherson’s own notes on amputation have this to say: “It is not considered proper to enter Paradise minus a limb or Organ . . . The operation would only be performed after every other available remedy had failed and on the advice of friends . . .”24 Yet we now know that some people do tolerate pain better than others, or perhaps it is that they know how to distance themselves psychologically from pain. The Sudanese have the reputation of bearing up very well in excruciating situations. Dr. William Byam wrote the following anecdote recalled from his time in Sudan in 1910: I remember one old man being most indignant when I wanted to inject his tongue before removing a portion of it. He asked if I thought he was a woman and insisted on the operation being performed with his sitting in a chair. Having protruded his tongue, he made no other movement until I had finished the job; neither did he utter a sound.25

At least two other doctors, writing in their published memoirs, discussed the stoicism of their Sudanese patients: Dr. C.E.G. Beveridge who went out fresh from medical school in 1925 and wrote the delightful little book Allah Laughed,26 and Dr. Peter Abbott, whose reminiscences of life in the Sudan Medical Service were of twenty years later, in The Doctor’s Tale.27 In describing their fascinating time in that vast country, where initially they spoke none of the local languages and had very little experience, even in their own profession, both wrote of the extraordinary fortitude of their patients in the face of severe injury. With equal enthusiasm both doctors wrote also of their affection for the Sudanese, a people known for their courtesy and generosity.

Earth-Eating The question of earth-eaters yields only two answers in the survey file. Both responding physicians could claimed no first-hand knowledge; one felt that any stories he heard were not reliable. There must have been other responses as they are cited in Christopherson’s 1910 paper: Earth-Eating in the Egyptian Sudan, where there is a lengthy (for the

24

SAD 407/6/15. W. Byam, The Road to Harley Street. (London: Geoffrey Bles 1963), p. 83. 26 C.E.G. Beveridge. Allah Laughed. (Melbourne: The National Press. 1946). 27 Peter Abbott, ‘The Doctor’s Tale’ in Sudan Canterbury Tales. Ed. D. Hawley. (Norwich: Michael Russell 1999), p. 94. 25

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time) and wide-ranging list of footnotes—something that underscores his research in both the anthropology and the history of medicine.28 His own two cases, a man of about fifty-seven, the other a boy of thirteen, turned up in poor physical shape, at Khartoum Civil Hospital. They claimed to have been addicted to eating earth for many years; the boy for eight of his thirteen years. Earth-eating, although as Christopherson noted “[this] has more anthropological interest than medical,” can produce ulcers of the mouth and tongue, constipation, and the risk of introducing parasites into the system. He summed up his thoughts on Bossars, Fakirs, Hallageen and Daiers not uncharitably: . . . unassisted as they are by modern aides [sic] to diagnosis, and knowing nothing of the requirements of latter day medicine, they still possess, with practice and with their alert observation and varied pharmacopoeia, a not inconsiderable armament of effective medical knowledge . . .29

This rather tolerant and thoughtful observation is followed by an afterthought on the following page that reflects the tenor of the age: The Mohammedan Religion has never done anything in the World except engender a selfish peace of mind to the individual and a total disregard for other peoples feelings. It breeds wars for nations by its intolerance. It has never invented anything, nor am I aware that any Mohammedan has initiated peaceful work of any kind at any time. It is the opposite to the Christian Religion of Charity, Peace, diligence and Usefulness.

Christopherson’s knowledge of history let him down with respect to both the Muslims’ achievements in mathematics, ophthalmology and optics, and to the infamous work of his fellow Christians—the Inquisition and the Crusades for a start. It is almost certain that he had many Muslim friends and acquaintances among his assistant medical men, yet he thought nothing of writing in such a manner.

Scorpions—Large and Venomous The Sudan Medical Department Annual Reports in the Condominium’s early years list scorpion stings as a significant concern. Omdurman was home to a large number of these poisonous creatures. 28 J.B. Christopherson, “Earth-Eating in the Egyptian Sudan,” J. Tropical Med. & Hygiene. (1 January, 1910), pp. 3–7. 29 SAD 407/6/19.

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The 1902 Report of the Omdurman Civil hospital states that children suffer chiefly from simple continued fever and gastric disorders, adults from dysentery and syphilis and that there is practically no malarial fever. Then: “It is worth noting that 230 cases of scorpion stings were reported at the hospital. 220 recovered, and 12 proved fatal.”30 In the 1903 Report the number was down to “146 cases of scorpion stings, nearly all children, 2 of whom died.” “Dr. Niklawi of Omdurman . . . has had as much experience as any doctor I know in the Sudan of Scorpion Stings . . .”31 wrote Christopherson. An Egyptian colleague, Dr. Niklawi, wrote a twenty-three page painstakingly detailed monograph on scorpions and treatment of scorpion victims. He shows a table with a total of 1,100 cases of scorpion poisonings between 1901 and July 1905. One thousand and twenty-three were cured and there were seventy-seven deaths. “The commonest cause of death in Omdurman is Scorpion sting” added Christopherson. Niklawi’s treatment, apart from the usual lancing and bleeding, consisted of injections of brandy, sometimes mixed with aromatici, digitalis and a diaphoretic.32 Brandy injections were used sparingly and cautiously, and pronounced successful even on children as young as one year. Niklawi details, agony by agony, with horrific precision, the action of the scorpion poison on the human system. From the initial sting to the beginning of numbness as the body temperature begins to fall and the heart weakens, the breathing becomes difficult and the jaws convulse. “There is a drumming in the ears and the upset stomach throws out its contents in the shape of a foamy fluid . . . The body grown colder as mental and physical forces fail . . . the victim loses the sense of touch and perception altogether. At the same time, the tongue is paralysed, the cornea insensitive and finally death ensues.”33 In 1908 Omdurman Civil Hospital reported only 139 cases of which no fewer “than 41 cases occurred in one month . . . April 1908. The AntiScorpion Serum of Dr. Tod has been used with very favourable results and the natives are said to have confidence in its efficacy.” Niklawi took the opportunity for some self-congratulatory lines and a chance to give a nod to his seniors: 30 31 32 33

SAD 407/6/20 [The numbers do not add up correctly, a slip no doubt]. Sudan Medical Report. SAD 1908 Sud. A PK 1561 GRE p. 229. Diaphoretic—an agent that increases perspiration. Scorpion Report. SAD 407/2/5.

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Since its occupation of the country, the present govt. was aroused to the danger of scorpion sting which was of an alarming frequency, particularly at Omdurman. Hence the obligatory bringing of the victims to the C[ivil] H[ospital]s or calling for the doctor at home . . . Proper medical aid is extended to all indiscriminately and the people of this country can almost claim literally a right to be counted civilized [in a medical sense] on account of the knowledge they have acquired as to the proper treatment of diseases and the laying aside of the old charlatanism administered by quacks and magicians. This state would never have been arrived at, within so short a time had it not been for the solicitous care of H. E. the Governor General and the [energy displayed by the medical officers] of the Medical Depts.34

Niklawi’s final section described a local plant known to the Sudanese as ‘Scorpion-root’ (Irk-el-Akrab) “the properties of which deserved to be studied and established scientifically.”35 A scorpion, touched by this root, is found to be temporarily paralyzed and such faith is put in pieces of wood from this plant that many Sudanese carry a sample around. Niklawi claims to have personally witnessed the effect, although his medical training prevents him from any definitive scientific statement. He concluded his paper enigmatically with the words: “And God, the Almighty knows better.” One other item on the subject of scorpions turned up—but much later—in 1951. Dr. Mansour Hasseeb of the Stack Medical Laboratories, Khartoum, kept a scorpion in a sealed glass jar for two hundred and forty days.36 No food or water was added although after forty-eight days the scorpion ‘gave birth’ [sic] to ninety-nine little white scorpions. Twenty days later all baby scorpions were gone, presumed eaten by their mother who died six months later.37 There is no doubt about it, the scorpions found in Sudan have stamina.

34

SAD 407/2/7 p. 11 with Christopherson’s handwritten additions in italics. SAD 407/2/12 p. 21. 36 The Stack Laboratories were built in honour of Major General Sir Lee Stack, Governor-General of Sudan, assassinated in Cairo in 1924. It was here that the Wellcome Tropical Research laboratories were moved in about 1927. 37 Mansour A. Hasseeb. “A Scorpion in Captivity”. Sudan Notes and Records. Vol. 32. Part 2. December 1951. 35

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The Kennedy Affair Having weathered his own storms in 1904, 1908 and 1911, in 1918, when he had returned from his stint in France and taken up his work in the two civil hospitals, Christopherson could look with a dispassionate and slightly amused eye on someone else’s difficulty. This troublesome event, known as ‘the Kennedy Affair’ lasted on and off from 1914 through to 1921, and eventually turned into very serious and public fight. The central issue dealt with water levels and water flow of the Nile. Water, the lifeline for both Egypt and Sudan, was always a shared problem affecting the general populations of both. Naturally this long drawn-out case was duly reported in the press. The British wanted to believe there was enough water, even at low levels, to irrigate their Gezira cotton-growing scheme in Sudan. This was a scheme which inadvertently encouraged the immigration of infected snails via the irrigation channels, and the spreading of bilharzia as a result. Lt-Colonel M. Ralston Kennedy Pasha, director-general of public works in the Sudan government, believed there was not enough water. He also charged that data presented to support the opposite scenario had been forged by Sir Murdock MacDonald, the under-Secretary of State and adviser to the Egyptian Public Works department. Kennedy took his own measurements to support his contention and was joined in this venture by Sir William Willcocks, an old adversary of MacDonald. Historian Robert Collins, who devoted a full chapter to this incident in The Waters of the Nile, pointed out that by 1914 hydrological records had long been ‘sloppy at best, incompetent at worst.’38 The controversy began in confusion and became more entangled, vicious, and personal over the next three years. Some months before Christopherson left Sudan for the last time he watched the scene from the sidelines. I believe he would have noticed some parallels to his own earlier situation. Much was said out of spite, and people lined up on both sides of the Willcocks–Kennedy versus MacDonald fight. In this case there was the 38 R.O. Collins. Waters of the Nile: Hydropolitics and the Jonglei Canal, 1900–1988. (Clarendon, Oxford U. Press and Markus Wiener, Princeton, 1990), p. 119.

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potential for more serious public consequences than with the Phipps– Balfour versus Christopherson trouble which had been more contained. The Kennedy affair, as it was better known, was heard before a ‘court of discipline,’ with an ex-officio judge, Judge Booth presiding.39 Christopherson’s 1911 Court of Enquiry was not made public and was not reported in the press. The papers from Christopherson’s hearing, well documented as having been seen and handled privately by at least a dozen people, have vanished. The papers from the Willcocks– Kennedy vs. MacDonald hearing are available, but the crucial data record that stood at the centre of those charges, also vanished mysteriously. According to Collins, desperate searches were undertaken, but the papers were never found. In the end, in the autumn of 1920, Willcocks and Kennedy were charged with “willful criminal libel and sedition” before the Supreme Consular Court of Egypt. In January 1921, before the trial could begin, Kennedy fled to France. He died four years later. Willcocks was found guilty of ‘defamatory libel against MacDonald’ but, as a distinguished and elderly man, was placed on probation, and lived out the rest of his life in Egypt. In contrast, Christopherson survived his contretemps. He had a heavy workload and his letters show a gloomy frame of mind, and now he had to answer to Dr. Crispin, as Director of the Sudan Medical Department, the post that had been his back in 1909. In December, 1917 he wrote to Joyce: I am sorry for Kennedy—It is a pity that he is so domineering—he also talks too much. I do not think that he will improve matters much by legal actions and he must remember that whether he will pay his own costs, the Government would probably pay the other party. It is a hard world but an administration like the Sudan wants a man to accommodate himself to the rules of the ruling authorities—and it is of no use ramming his head against the Government Stone wall.

This last was something Christopherson had learned the hard way. He had always dug in his heels and refused to accommodate himself to the ruling authorities. This is an admirable stance if you really are right, even so the consequences can be miserable and often expensive.

39 Probably similar to a Grand Jury in the US where an investigation is held to see if there is enough evidence to proceed further.

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In Christopherson’s life they certainly took a toll as excerpts from his letters show. In mid-February, Joyce had the chance to join their friends, Mr. and Mrs. Charles Page, for a trip down the White Nile. Page was a British Marine Engineer and an official with the Steamers and Boats Department.40 That the Christophersons were not together was fortunate; his letters made possible the documentation of some of his private thoughts during the few weeks prior to their final departure from Sudan. On 25 February, 1918 he wrote to Joyce with the latest Khartoum gossip, laced with his own opinions, of course: Kennedy is being tried by Court of discipline. Mrs. K[ennedy] has not come up. I think he is a considerable worry to Stack and Bernard.41 . . . I feel that I am very much in the background and cannot get on with my honorable friend [Crispin] at the head of the department. I feel very like picking up the fragments, cutting the losses, collecting as much pension as possible and packing up the portmanteau for the return journey home. There does not seem to be anything to be done up here with C[rispin] on top. He blocks everything so far as I am concerned and his ideas are not mine nor his ways mine. I wish I could see my path clear. I have written to Watson Cheyne [and] I have written to Acland asking him to help me to get something. I heard from Godlee the other day a nice little letter—friendly enclosing a typewritten letter of thanks for the war council for the report sent to all the members. I wish they would publish it.

His next letter, written on 2 March, shows his becoming more and more disaffected with his professional life in Sudan, and Wingate in particular: My dearest Joyce, . . . All are pawns and they may be and are easily sacrificed except a few whom master [Wingate] hurries on and has crowned . . . they have a certain amount of fun on their own account but master may sacrifice even these if he likes. Kennedy is not so easy to down as most people. Sterry, Midwinter, and Fielden [sic] are sitting on him. He objected to Feilden because F has told him some time ago that if he had his way he would kick K out. He objected to Crowfoot because C had told Grabham that they would get K this time (in a confident voice this was said). Objec-

40

Page, Charles Herbert (1866–1938) British Marine Engineer. In 1901 he was Assistant Director of the newly constituted Steamer and Boats Department for the Sudan government. 41 Governor-General Lee Stack (1919–1924, acting from 1917).

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tions were not allowed, neither was K allowed to have a friend or legal assistance or stenographer. Willcocks arrived tonight (1.3.18) he and K have put their heads together over the dam and W says that the people of Egypt will be left without water. Master who is ready so support anybody and everybody and is ready to give anyone away, has sent Willcocks up and Bernard and Stack and Macdonald [sic] are out for blood and so it goes on. It must be great fun to sit in the Royal Pavilion watching these gladiatorial combats—some of the actors making this Roman holiday are bound to get killed—Master doesn’t care. . . .

His requests for pay increases over the last few years had been refused. In November, the Sudan administration stopped his pay for the excess time he had worked on the Commission Report: he had exceeded the time allowed. His resentment grew as he wrote on 2 March: My application to be paid like the other officials whilst doing war work has gone to [Lee] Stack. The report is also with him also the letter from the War Council thanking the Commission. My application for an increase in pay has not been granted yet at any rate. If I were in favour there would be no difficulty with either. It is a disheartening country to work in—my work now is a toil. All are pawns and they may be and are easily sacrificed except a few whom master [Wingate] hurries on and has crowned these they have a certain amount of fun on their own account but master may sacrifice even these if he likes.

Two days later (5 March) in a third letter he wrote: “Kennedy is still being tried—it has so far lasted a week . . . I have often told you that there were 3 rogues in the Sudan. K says that the other two know that he knows so much that they daren’t touch him etc. etc.” And one last depressing letter a week later: I have not heard yet whether they will pay me for the time I overstayed my leave. Stack has referred the matter to the council of secretaries. I think he deals with most things in this way. I have not heard yet whether I shall get an increase this year. The council of secretaries have however turned it down. I feel that I have been in the country quite long enough, but I should like to leave it with credit and with the recognition that I had done useful pioneering work out here and consideration—above all things I could make my pension up to 400.42

Yet they both stayed all through the hot season, with Joyce sometimes at El Obeid where it was a little cooler. Christopherson was tied to his

42

Letter to Joyce: 11 March, 1918.

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12.1. JBC’s home in Khartoum, No. 3 Virtue Villas.

two civil hospitals and busy fending off trouble from time to time as his letter to Joyce on 13 August describes: Bousfield [Dr. Leonard B] is very angry officially because I wrote and said that to erect mosquitoe [sic] proof wards and M. nets in my hospital was a confession of failure. He got the Sanitary Board to pass a resolution— without saying anything to me—to make my wards mosquito proof and to use nets. The Board passed it but the P.M.O. said they had not enough wire netting and what they had was more wanted in the outstations.

Bousfield, an ally of Balfour from earlier years, and a man who had not been sympathetic to Christopherson’s methods, was still sparring when opportunity arose. But this was a small irritation. In sum, Christopherson had had enough. Some who have read his story wonder why he stayed so long where the climate and working conditions were so difficult and where the personal battles were so trying, when he could have had the comfortable life of a consultant in England. I suggest that the challenge was important to him, and that the patients in his bilharzia wards and treatment clinics constituted work that was central to his professional life. He was devoted to the work he saw as worthwhile and, having invested

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so much of himself in Khartoum, he simply never gave up until forced to by ill health. In 1919, sick again with peripheral neuritis,43 he and Joyce made the decision. They left for England. Years ago it was traditional to send telegrams to the ship when someone embarked on a voyage. When the Christophersons arrived at Port Sudan on 10 June, 1919, a sheaf of telegrams awaited them. All constitute a testament to his popularity, to his friendships with local medical men, to his steadfast service to the community, and all serve to belie the spiteful barbs of those few civil servants who appear to have made a habit of vindictiveness. Two of the telegrams sent from Omdurman, one from Dr. Atiyah and wife, and another from Nassib Haddad: ‘a speedy recovery happy journey and long life and prosperity.’ Six more telegrams were written and handed in at Khartoum. F.E. Chesterman,44 and old friends, missionary doctor T.A. Lambie, and Major Elderton, sent ‘best wishes,’ Dr. Nikolawi, a long time collaborator, became quite emotional and wrote: “My heart will never forget you . . .’ Drs. Izzedon, and Haddad, who had also worked with Christopherson from early days, sent kind words, and one signed, ‘Dawa,’ the Arabic word for “medicine” or “drug,” sent a long appreciation:45 On your retirement I send you this telegram to mark my appreciation of all your valuable services and work. The department from its inception to present condition owes much to you and your scientific work is crowned by your care of bilharzia. I hope that your health will shortly be entirely restored and on behalf of self and colleagues offer you and Mrs. Christopherson all good wishes for long life happiness and prosperity. Dawa.

43

Sometimes called peripheral neuropathy. F.E. Chesterman, Senior Clerk in the Medical Department. (died in 1920). 45 “ ‘Dawa’ has been used as a telegraphic address for the Ministry of Health for a very long time, since SMS. So, I think the sender must have been the highest authority in SMS i.e. the Director, which translates as ‘Medical.’ ” E-mail from Dr. Ahmed Adeel to author. 22 June 2007. [Although perhaps not Dr. Crispin!]. 44

CHAPTER THIRTEEN

LIFE AFTER SUDAN—THE VARIED LIFE OF A LONDON CONSULTANT

To the surprise of all his friends he took up the specialty of pulmonary diseases and became consultant to the London Chest Hospital, Victoria Park. —Sir Philip Manson-Bahr

The few who knew details of Christopherson’s Sudan experience were unlikely to have been surprised at his shift in medical specialty, although they might have been surprised that he would choose pulmonary medicine. Sidestepping the ever-present sparring and squabbling that characterized the London School for Hygiene and Tropical Medicine, where some might have expected he would find a home, was probably seen as a fortunate move, in retrospect. While still retaining his interest in tropical medicine with part-time employment at the Special Bilharzia Clinic, Ministry of Pensions, he embarked on a new career with a grand new address for his consultant’s rooms.1 Life at 29 Devonshire Place (around the corner from Harley Street), his handsome Georgian house in the heart of London’s powerful and influential medical neighbourhood, was an achievement to be proud of.2 He sent a photo of his house to his brother Arthur in Australia.3

Life in London between the Wars Despite many social changes that occurred in England between the wars, physicians still earned respect, their decisions were seldom questioned and presumably, surgeons buried their mistakes. Keeping up appearances, living in a Georgian house in Devonshire Place W1, was an expensive undertaking. In Christopherson’s letters to Joyce

1

Consultant’s offices/surgeries, are referred to as ‘rooms’ in England. In order to buy this house he borrowed money from his mother. 3 He dates the house from 1770 and notes on the back of the photograph that the maid, Roots, is on the pavement along with Joyce and an Australian friend. 2

13.1. 29 Devonshire Place, London, taken by JBC Oct. 1933.

13.2. 29 Devonshire Place, taken by the author in 1994.

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there are constant allusions to concerns about his overdraft and other money worries so that one wonders how they would have managed to educate children had they had any. When, in the summer of 1920, the Sudan government resolved to improve pensions, Christopherson’s increased from £430 to £580, enough to “pay rates, taxes and other unpleasant charges.” The Christophersons were modest about the help they proffered to members of the family but various remarks have come to light indicating that a number of relatives received financial aid, some on a regular basis. Examples include Arthur in Australia, for whom life was always a struggle, and sister-in-law Emmie, widow of his brother Evelyn, a man who dressed in overalls like a worker and ‘married a woman old enough to be his mother.’ Occasionally he helped out some of his nephews who managed to over-spend their allowances. Perhaps his most time-consuming involvement was as senior advisor for the family, something which took him all over the country to meet with this person or that one; in particular, when he was entrusted with the irksome responsibility of being trustee or executor for a relative’s estate. The Dentons, his mother’s family, came from the north-east. Uncle Dickie Denton, the brother closest to his mother, lived in Harrogate as did Aunt Leila along with her companion; Leila had been mentally unstable from childhood. Christopherson, Joyce, and her sisters all developed an interest in taking the waters at the Harrogate spa and were much cheered when they managed to interest Dr. Ormerod in the idea. The Harrogate trips meant any Denton family business could be discussed at the same time. Not too far away across the Pennines, on the northwest half of England sat the old family home, Colton House, near Ulverston in the Lake District, where in August of 1919 (shortly after their return from Khartoum), Joyce accompanied her mother-inlaw for a visit. At one time this house was owned by the kindly (but eccentric)4 vicar of Caton and his wife, the couple who had raised Christopherson’s father, the Reverend Brian. There are snapshots of Christopherson’s sister Eva with her sons, Peter and Ben, on a family picnic in the surrounding countryside.5 In 1919 Christopherson wrote to Joyce at Colton: 4

He was known to have an obsession with time and to get out of bed in the middle of the night to check that the many clocks in the house were chiming accurately. 5 In 1974 the counties were reorganized and north Lancashire became part of Cumbria joining Cumberland and Westmorland.

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chapter thirteen I did not wish her [mother] to pay for your journey, we can afford ourselves the luxury some times of doing a thoughtful action without wanting to draw up a business like account for out of pocket expenses. Mother has done so much for us and would do so much both for you and me, that I am disappointed that I cannot do more for her now that she is old, to make her life a rest and a pleasure. Bernard turned up today.6 He missed yesterday. I don’t think he looks particularly well. He tries like a good many of the people to get too much in to a lifetime.

There are many references to his mother in Christopherson’s letters, he seems genuinely fond of her, addressing her as ‘my dearest mother,’ although she was seen by others as sharp-tongued and a snob. It is not known what Joyce really thought of her, perhaps she just learned to get along. Another Caroline, Christopherson’s younger sister and a generally exasperating woman, was married to Herbert Chappel, a henpecked man but liked by everyone. This might indicate the source of Joyce’s remark years later, ‘I detest the name Caroline.’7 While her husband worked long hours Joyce spent a good deal of time at the Ormerods’ country house near Winchester away from the heat of London’s summer. She was close to both her parents and Diana.

Professional Work Christopherson, still only in his early fifties, was very active and still publishing in the BMJ, The Lancet and the Journal of Tropical Medicine and Hygiene. By 1927 he could count a total of twenty major articles on bilharzia and a number of notes and letters. During this period, while also working as Assistant Physician to the City of London Hospital for Chest diseases, he wrote a lengthy and important article for The Lancet’s series of Special Articles contributed ‘by invitation only’.8 His days were filled seeing private patients at his rooms, patients at the Chest hospital and the Masonic hospital, and attending to his regular Bilharzia clinic at the Ministry of Pensions where he often treated men who had been infected years ago in the Boer War. In a paper and demonstration given at the Royal Society meeting in 1920, he discussed two such patients noting that “Of Boer war cases these are about 500

6 7 8

Sir E.E. Bernard earlier, Legal Secretary of Sudan. Personal communication from Christine Ormerod. The Lancet, (24 May, 1924), i. pp. 1071–2.

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now in England, drawing pensions. If they were cured, as they might be, they would be spared much discomfort and the country would save £10,000 a year.”9 In 1924 he was elected to the prestigious Athenaeum Club where he found meals of the sort he enjoyed (good puddings) at a price he approved of. Here he could meet a number of like-minded people, some from Sudan days and many a bishop with whom he indulged in discussions on another of his favourite subjects, the church. Another item passed down to me from his nephew Peter Ormerod’s cache of memorabilia was a blue-covered report from the inauguration of the Ross Institute & Hospital for Tropical Diseases, Putney Heath, London. This was opened by H.R.H. the Prince of Wales on 15 July, 1926, with considerable fanfare, and lengthy speeches by Sir Charles McLeod, Her Grace the Duchess of Portland and Sir Ronald Ross. With speeches over and bands playing, tea was taken on the lawns by the six hundred and thirty-seven who had accepted the invitation. Christopherson and Joyce were present of course, as were Dr. Andrew Balfour and his wife. One may imagine the polite but curt nodding of heads as these two couples passed by one another at the tea tables. Occasionally there were medical meetings to attend, and, having earlier been elected a Fellow of the Hunterian Society, Christopherson became the Hunterian Orator for the year 1932. This was a considerable honour, not as grand as the knighthood he felt had eluded him, nevertheless an important honour bestowed by his own medical community. The Hunterian Society, established in 1819, was named for the pioneer John Hunter—father of modern surgery—to celebrate his name and enliven ‘the medical life of this [London] metropolis and contribute greatly to the breadth of professional interest . . . in the most amiable of environments.’ In this case the ‘amiable environment’ was the Great Hall of the Apothecaries Society, London on 25 February. ‘Amiable’ hardly begins to describe the stunningly impressive Great Hall. Here the Irish oak panelling dates from 1671; at one end there is a carved oak screen, at the other, a minstrels’ gallery. The massive central twenty-four-branch candelabrum was presented to the Society by the Sheriff of London in 1736 and the walls are hung with enormous

9 J.B. Christopherson, Demonstration of the Technique of the Intravenous injection of Antimony Tartrate in Bilharzia Disease. Royal Soc. Of Medicine Proceedings. Vol. 14. pt. 3 (1920–21).

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portraits of former Masters of the Society. The monthly dinners with good food and wine, which preceded the talks, must have been lively affairs and they continue to this day. Christopherson’s topic was Chronic Bronchitis and its relation to the Involuntary Nervous System. In thanking the committee for the honour he began by saying “It is a formidable office for anyone to approach, and the one consolation I have this evening is that since John Hunter was no orator, I may at any rate in this respect modestly follow in his footsteps.” Christopherson had other aspects of character in common with the great Dr. Hunter: both were both outspoken and intolerant of fools. As Wendy Moore wrote in her 2005 biography, “Hunter was not the type of man to curb his language for the sake of harmony or to nurture change through gentle persuasion.”10 Christopherson would have enjoyed preparing for this night; he loved history and began by mentioning Celsus11 before moving on to the Hunter brothers, William and John, describing John as the “superman in medicine of the eighteenth century . . .” He carefully linked his subject back, weaving to and fro from diseases and medical practitioners in history to the situation in 1932, all along admitting that his paper asked more questions than it answered. For example, King Edward VII died in 1910 from chronic bronchitis, as did several of his ancestors but ‘was this due to an hereditary or diathetic cause?’

Nomination for the Nobel Prize for Medicine Back in late December of 1919, George Wherry, Christopherson’s old professor from his Cambridge days, had written to their mutual friend, Charles Armbruster, now living in retirement in Mallorca Christopherson did not come after all. I sent you his latest note and wish him success in London, he will have to watch the knackers very carefully at first. In confidence I had a note on my opinion as to the gift of the Nobel prize [for Medicine]—and put his case before the donors though I have little hope to influence them the foreigners usually pull the strings—Sir Ronald Ross took it—several thousands and would come in very handy for Xto but Lord the chances are very small.

10 Wendy Moore. The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery. (London Bantam Press. 2005), p. 225. 11 Aulus Cornelius Celcus, the great Roman physician.

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Koch and Ehrlich and such “create an atmosphere” which tells, and foreigners snap up such prizes of money especially. No harm in my claim, and if I could have made a collection for Xto in London it might have scored. I have no means of knowing, the other voters in our profession of surgery being with God, the vote came to me this time.12

And on the 27 April from his home, No. 5 St. Peter’s Terrace, this grouchy old professor of surgery wrote to Armbruster again, Christopherson has sent me change of address—29 Devonshire Place but I don’t know whether this is consulting rooms or also dwelling place . . . [it was both] Having the opportunity this year I sent his name and an account of his work to the Nobel Prize Committee. It will do him no harm and if others have done so may bring him a large sum of money—Being in Cambridge, a narrow world, has prevented me from meeting those who might help . . . I do not know whether any other Englishman Doctors ever gained this against foreign claimants. They gave me a vote as representing surgery here in the University, a sort of Deputy Professor for the time being. I can hardly realize what Cambridge is now like—the crowds, and cars—motor bicycles with “men” and young naval officers bursting with energy—Women charging at the press and filling up our lecture rooms and labs—they will get what they like and profound distrust flows into my soul. We want money badly—women only are benefactors to women at the present time—Forgive this grouse—and God love you. Yours ever G.E.W[herry]13

The nomination was acknowledged by the committee in 1920. Sigmund Freud was also nominated that year. Like Christopherson he was unsuccessful. In Freud’s case 1920, was the fifth try and over the years Freud received thirty unsuccessful nominations. The 1920 prize for medicine did indeed go to a foreigner: August Krogh, a Dane, for the “Discov-

12

Prof. G. Wherry to Charles Armbruster 21 December, 1919. Had I not been staying in Cambridge in 2007, I would not have made the effort to find No. 5 St. Peter’s Terrace, given that Prof. Wherry is a minor character to the story, but the day was sunny with a light breeze and the idea of finding the home of this rather grumpy man presented itself as a challenge. St. Peter’s Terrace is not featured on all Cambridge maps. It sits in hidden splendour beside the Fitzwilliam museum but set back from the clamour of the busy road by a lawn, a shrubbery and black iron railings. This handsome row of classically proportioned Georgian houses, perhaps seven or eight at most, speak of substance and a sense of their owners having ‘arrived.’ Surgeon George Wherry had only to step out of his door a few yards to reach his place of work. His complaints about women and student noise would pale beside the current state of things. His home and its neighbours are currently student lodgings and his hospital is now the popular and rather noisy Brown’s restaurant. 13

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ery of capillary motor regulating mechanism.” This was fundamental research so perhaps it was hardly surprising that such a discovery would win over the cure for bilharzia, a disease that affected predominantly indigenous people in tropical Third World countries. Again, this time in 1924, Christopherson experienced another flurry of excitement when the idea of a nomination for a Fellowship in the very prestigious Royal Society was floated by Sir Ronald Ross of malaria fame.14 This idea also failed to bear fruit. Ross, unfortunately known as one of the most unpleasant men in medicine, wrote to Christopherson on 16 June, as acknowledged by the recipient and answered post-haste on 17th. Christopherson seems not to mind the dubious personal reputation of the proposer as he answered: “Thank you for your kind letter of June 16th. No one is putting my name in for the Royal Society this year. I cannot tell you now proud I should be if you were to put my name down and propose me, I could not have a more eminent sponsor than you.” In some respects this last remark can be seen as correct. Christopherson is asked for suggestions for a seconder and listed a good many names in the tropical medicine business with whom he was familiar finishing his letter by writing: “. . . what a mercy it is that there is a limit of 100 words.”15 A second letter is held also by the LSHTM archives, from Christopherson to Ross explaining the old McDonagh priority problem: He [McDonagh] says (in the Journ. Of Trop. Med. July 1st 1920) that he first used Antimony for a case of Bilharzia in 1911. He records this not until 1915. And then apparently in a book on the biology and treatment of Venereal disease . . . Macdonagh [sic] then claimed precedence, resumes injections on some bilharzia cases and got the same results that I had done, the details of which I had published.16

Perhaps not enough people were found to nominate, or perhaps the nomination was turned down. A number of nominators are needed if one is to be proposed for FRS. No more was heard on the subject.

14 Note from Peter Ormerod. 26 January, 20009: “There is a big difference between the Royal Society and the Royal Society of Medicine. The former was founded in 1660, its Fellows were [and still are] at the cutting edge of new scientific discoveries . . . Virtually any medical person can belong to the Royal Society of Medicine and decide which Section to belong to.” 15 JBC to Sir Ronald Ross 17 June 1924 LSHTM Ref. 86/044. 16 Ibid. Ref. 86/045.

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Autumn of 1928 and Due Recognition 1928 was a particularly good year. He was a successful consultant in an elegant area of London and now he had been elected President of the Royal Society of Medicine’s Section of Tropical Diseases and Parasitology. That year he was clearly in his element. He was by then, as his old friend Sir Rudolph Slatin once wrote to him, ‘the sheikh of bilharzia.’ On 13 November, at the Society’s meeting, he gave a paper and led the discussion on “The Special Uses of Antimony.” This was a lengthy paper, reciting the history of antimony, beginning five thousand years earlier and painstakingly moving up the centuries and referencing the various uses. These five closely typed pages must have caused him to spend many hours in a library. He marked a turning point: The use of antimony as an internal therapeutic remedy dates from the first half of the sixteenth century when the famous German physician, Paracelsus (1490–1541) introduced a complex antimonial preparation for internal use—Mercurius Vitae. Mercurius Vitae, which did not contain mercury, marks an epoch in the therapeutic history of antimony.17

Eventually, bringing the topic up to date, he reviewed the more difficult recent experiments undertaken by Broden and Rodhain in the Congo, who discovered the intravenous method of administering the substance.18 En route to this success a number of patients had suffered the miserable effects from subcutaneous injections (severe sloughing and abscesses) or from oral medications (severe vomiting). Christopherson’s friend and colleague, Dr. George Carmichael Low, had recorded all this in his 1916 ‘useful paper’ on “the history of the Use of Intravenous Injections of Antimonium Tartaratum.”19 Dr. Low also endorsed Christopherson’s priority publicly at the Royal Society meeting, as did his friend Manson-Bahr. Whether McDonagh was present is not known. Professor Sir Aldo Castellani was present and made a bid for recognition: “I have been interested in antimony therapy for a number of years and, so far as I know, I was the first to introduce it in the

17 J.B. Christopherson. Discussion on the Special Uses of Antimony. R. Soc. Proc. (Vol. 22. 1928–29), pp. 560–2. 18 In fact L.G. Rowntree & John J. Abel, in the J. of Pharmacology & Experimental Therapeutics Vol. 2. 1910–911 had considered antimonials “well adapted for subcutaneous or intravenous medication.” 19 G.C. Low, p. 102. Soc. Trop. Med. & H. (Dec. 1916), p. 38.

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treatment of kala-azar.” There was some truth in the remark although there is no recorded comment or rebuttal of his statement. The Journal of Tropical Medicine and Hygiene of May 1915 published a letter by Castellani to say that having used a mixture of tartar emetic, sodium salicylate, sodium bicarbonate, and potassium iodide for yaws with some success, he decided to try this on a kala-azar patient who had been ill for many months. In fact he tried this mixture and two others: second, intravenous injections of a solution of tartar emetic and liquid Fowleri [Sodium arsenate], and thirdly, intravenous injections of tartar emetic. His conclusion states: “The improvement was remarkable. I am inclined to believe that the drug which had the greatest part in causing the rather striking improvement was tartar emetic.”20 He never followed this up so he had no definitive proof that tartar emetic was the effective agent. Here is yet another vague success story that was never carried forward for further research. Claiming such unconfirmed success years later did not carry much weight.

Christopherson—Women, and Women in Medicine For an Edwardian, Christopherson was ahead of his time on the subject of women. He helped a number of women in medicine, to ‘give them a leg up’ as he once put it. This included writing a Foreword for Nursing Sister Freda Wilson’s 1925 article, in the Journal of Tropical Medicine. Her paper on the treatment of yaws could be assured publication with Christopherson’s name attached.21 Sister Wilson worked with the Universities Mission to Central Africa (UMCA), something dear to Christopherson’s heart; he had been on their medical staff for many years and liked to attend their London meetings.22 There is a footnote to this article; even had it not been initialed by Christopherson I would have recognized his frank style:

20 Aldo Castellani. Brief note on the treatment of a Case of Kala-Azar. ( J. Trop. Med. & H. Vol. 18. 15 May, 1915), p. 112. 21 Yaws is a tropical infection of the skin, bones and joints caused by the spirochaete bacterium Treponema pertenue. Wikepedia 2007. 22 The UMCA was “. . . a mission society of the Church of England which drew on the Anglo-Catholic, High-Church tradition.” wrote Justin Willis in The Nature of Mission Community: The Universities’ Mission to Central Africa in Bond. Past and Present. No. 140 (Aug. 1993), p. 136.

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Yaws is a disease confined to the tropics. In its clinical manifestations it closely resembles syphilis . . . It is not venereal but is contracted by simple contact with another case. Travellers and writers after visiting African countries are apt to pronounce that people are eaten up with syphilis or rotten with the same. They are wrong in making this stupid and immoral implication. It would be truer to say that a large proportion of the natives in many parts of Africa were disabled by the easily curable disease called yaws, which is mistaken over and over again for syphilis.—J.B.C.23

The historian of medicine, David Arnold, concurred with Christopherson’s view, writing that such ‘misdiagnosis’ was “. . . a revelation of missionary doctors’ presumptions about African promiscuity.”24 Another friend of Christopherson’s, both enthusiastic and well connected, was parasitologist Dr. Annie Porter. In 1924 she, with his endorsement, showed a film at the Royal Society meeting demonstrating the stages of biological development of the bilharzia worm and a South African doctor administering intravenous injections of antimony tartrate.25 She then exhibited specimens of South African molluscan hosts of schistosomes, and plants on which the water-snails fed and lived. All was warmly appreciated by the attending luminaries and Sir Leonard Rogers offered the vote of thanks. In May of 1939 Christopherson wrote to Joyce from the Athenaeum: “I called on Dr. Annie Porter at the Zoo today, she really is most interesting, she has a good . . . post at the Zoo and shewed me round . . . she anesthetized fishes and operates on them. Prof. Fantham—her husband was a very good friend of mine.”26 In October 1942 he dropped in on Annie Porter again and learned some gossipy news about old friends: . . . she is working at the zoo and is full of chat. She told me all about Julian Huxley and the Secretaryship at the zoo. Dr. Sheffield Neave is temporarily Acting Secretary. Horder and his wife are friends of Julian

23 Notes by a Nurse on the Treatment of Yaws (Framboesia) with Novarsan. By Freda Wilson, Nursing Sister attached to the Universities Mission in Central Africa) Introductory remarks by JBC. (Medical Examiner to the UMCA) J. Tropical Medicine and Hygiene. (1 December, 1925), pp. 424–426. 24 David Arnold. Ed. Imperial Medicine and Indigenous Societies. (Manchester: Manchester U. Press. 1988), p. 8. 25 J.B. Christopherson, Proc. Royal Soc. Sect: Trop. Disease & Parasitology. Vol. 18. Pt. IV (1924–25), p. 26. 26 Letter written 24 May, 1939. Her husband was Prof. H.B. Fantham of McGill U. Montreal, Canada.

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chapter thirteen Huxley and his wife.27 Horder was not elected on to the Council and he has resigned his membership and is no longer even a FZS . . .28

In 1934, Christopherson co-authored two papers with Dr. Marjorie Broadbent on the subject of asthma and respiratory disorders.29 In July 1935 he wrote to Joyce saying : “Dr. Broadbent turned up to day . . . She is not going to work in London. Her father wants her at home. She has not enough cheek for a successful woman doctor.” A sad commentary on a woman unable to stand up to a parent, or perhaps just dutiful. In November 1928, Christopherson, in his new post as president of the Tropical Disease and Parasitology section of the Royal Society of Medicine, enjoyed the opportunity to give the President’s Address. His opening remarks were an appeal “for women doctors for the colonies, especially for the additional and important social and educational work amongst women and children . . . Africa is a fascinating field where there are many medical problems still awaiting solution.”30 From this he moved on, continuing for five pages with his well-trodden theme; the sad case of the Egyptian fellaheen, a population still riddled with parasites and thereby unable to perform well either in their own interests or in the interests of their country—and implicit—the British Empire. In his opinion, “firmly-held religious opinions are apt to impede the sanitarian and the native religious question has to be sympathetically considered . . . ‘Natives’ inhabiting tropical countries take medicines very well, but they take hygiene very badly.”31 In the summer of 1930 he had the opportunity to address the Naval, Military and Air Force and the Tropical Disease Section of the Congress of the Royal Institute of Public Health, Portsmouth. His subject: The Motive in Women’s Dress in the Tropics. One imagines he thoroughly enjoyed writing this and that he would surely have consulted Joyce for her first-hand opinion. Christopherson and Joyce were both people with a sense of practicality, not given to show nor following the ‘despotic

27

T.J. Horder, later Lord Horder (1871–1955) Physician at Barts 1912–1936. Fellow of the Zoological Society. 29 M. Broadbent, & JBC. Ephedrine and pseudo-ephedrine in asthma, bronchial asthma enuresis BMJ. (2 June, 1934), pp. 978–79. And: M. Broadbent & JBC. A new method of approach in certain respiratory disorders in elderly persons. British J. Physical Medicine. (Vol. 9. 1934), pp. 77–80. 30 J.B. Christopherson, A National Outlook on Tropical Medicine. Proc. of the Royal Soc. Of Med., Section Trop. Diseases and Parasitology. (Vol. 22. Pt. 1. 1928–29), pp. 1–6. 31 Ibid. p. 2. 28

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dictates of fashion,’ yet with an acknowledgement of what is socially appropriate. Christopherson loved the Church and he knew the bible well. He began his lecture remembering Genesis 3 verse vii (Adam and Eve in the Garden) immediately opining that modesty has very little to do with motive in dress, then or now. Rather, he claimed, it is self-preservation and sexual attraction that dictate clothing. Self-preservation equated with protection, and sexual attraction equated with adornment. His time in Sudan and his interest in ethnography, tribal markings and the like, allowed him to show photographs and expand on the practicality of the ‘native’s’ dress. The second half of his lecture moved to a forceful advocacy for considerations of health and convenience. In other words utilitarian clothing; there existing nothing on the market designed for ‘women in the tropics’ that would suffice, he suggested that women might shop in a men’s store. Better still, a store run by a man who has lived in the tropics so that women can ignore the spurious advice of their well-meaning but ignorant friends. He was particularly cheered by Sir Alfred Munnings’ portrait of ‘Miss Baron on Magpie’ shown at the Royal Academy that year. Miss Baron was riding astride! A photo of Miss Amy Johnson also drew his approval, she is standing beside her plane wearing shorts ‘like the man’ in the photo. “The emancipated woman aspires to compete with men, and in order to do so must dress as men do in conformity with her task.”32 At a later meeting of the Royal Society, in April of 1930, when discussion of women’s clothing in the tropics was considered, all by men of course, Christopherson was the only physician present who suggested that women wear trousers as a ‘great step towards malaria prevention.’33 His final point had to do with occupations and behaviour of women in the tropics. Here he mentioned the ‘small and enlightened proportion of women who go to the tropics in good health and do not spend their entire time in amusement . . . inspired wives of Government officials . . . teachers, nurses and medical women of the missionary societies . . .” He deplored the empty-headed women with no interests, “. . . who smoke and drink too much and dress so inappropriately in diaphanous underclothes and . . . silk stockings . . . trousers are not the 32

J.B. Christopherson, “Motive in Women’s Dress in the Tropics”. J. of Trop. Med. & Hygiene. (15 July, 1930), p. 205. 33 Report on the Royal Soc. Proc. Section Trop. Med. & H. BMJ (12 April, 1930), p. 708.

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perquisite of the male sex, the bifurcate garment is, par excellence, the dress for both sexes in outdoor life in the tropics . . .” He also squelched the popular notion that women were more susceptible to insect bites by suggesting rather that their inappropriate clothing left them vulnerable to being bitten, particularly in the evening when more insects were abroad. His last exhortation was that “women in the tropics should break away from the fetish of ‘Government House’ Standards in dress.”34 I wonder whether earlier, when that stickler for protocol, Lady Wingate, had dictated the standards of dress in Khartoum society, Christopherson may well have been heard to express such unguarded notions. If so, this would certainly have been another black mark against the outspoken doctor.

News from Khartoum and the Death of Slatin’s Wife After so many years in Sudan, it was natural that Christopherson would retain an interest in the country. His friend Charles Armbruster was back for a visit to Khartoum in February 1920 and sent a kindly note: My dear Xo, This house and town are very full of memories of you. You are much missed here. I am writing again very shortly. [The letter, if it existed, has not been found] Yrs in haste CHA.

Rudolph Slatin wrote to Christopherson on 25 April, 1920 and again on 12 June, from France where he had been hoping to help represent Austria at the Paris peace talks of 1919 (in the end not actually negotiating but used unofficially in some of the communications). 25 April, 1920, Bern My dear old Christo—Very many thanks for your kind lines . . . I have been a few days at Genevre and succeeded to make with the aid of the Int. court of the R[ed] + at Ginevre arrangements about the repatriation of our prisoners from E-Siberia—the first thousand is all ready on its way Home from Vladivostock. I congratulate you on your new Home—May God bless it—you and your dear wife—the little Diabolo—and may kind providence always keep grief away from you.

34

Christopherson, Op. cit., p. 207.

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I think I wrote you that my poor sister Leopoldina broke her hip and she is laid up now for more than 6 weeks our Doctor wants at least 8 weeks more to get able to move . . . I shall send them yours and Mrs Christo’s best Salaams. Of course if I came to London you shall see a lot of me—perhaps more as you like? but I am not sure if I shall be able to return soon to your beloved country. Please convey my kindest regards to Prof Dr. Ormerod and your mother in law—and sister in law who I hope are all well and flourishing. . . . Your ever old Saladin.35

Sadly, beginning in June, Slatin commenced on a series of letters to the Christophersons about his wife’s serious illness, probably cancer. She had undergone three operations in two years and although the last seemed to have been successful she lived only another twelve months. Finally, on 27 June, the very morning after his wife’s death, Slatin sat down and wrote to his friend: “My dear Christo, The unavoidable happened, my wife passed away peacefully yesterday at 10 a.m.36 Given Slatin’s concern for Christopherson during the Serbian episode, his affectionate nickname for Joyce, the kind messages passed on to the senior Ormerods and the letters written immediately upon the death of his wife, it is odd to say the least, that their friendship is not remarked upon in any of the memoirs written by those in the administration. Surely not all can have felt intimidated or perhaps at personal risk for mentioning the name of this remarkable doctor who they must have known? Slatin certainly had the ear of Wingate yet there is no mention either of his mentioning the problems of the Sudan Medical Department with the Sirdar. Slatin was a loose cannon but few would cross him, in part because of his extraordinary resilience during the reign of the Mahdi, but also because of his intimate relationship with Sir Reginald Wingate. Christopherson’s public appreciation of his old friend Slatin took the form of a personal recollection of Slatin’s involvement with the British Serbian medical unit. This little treasure came my way via Christopherson’s elder brother’s family in Australia. It is an eight-page booklet entitled: Slatin Pasha: A friend of the British Red Cross Units in Serbia, A Brief Account of his Career by J.B. Christopherson.37 The 35

R. Slatin to JBC 25 April, 1920. SAD 453/702/8. R. Slatin to JBC 27 April, 1920. SAD 453/702/12. 37 It is actually a reprint from the British Serbian Units (British Legion) Bulletin No. 23. February, 1933. 36

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title really stands as both witness and answer to the question that Mr. (later Sir) James Berry posed in 1916—who and what was behind the fairy godmother department that effected his unit’s escape from Serbia? Christopherson wrote: The creditable part which Slatin played in the Great War has never been adequately stated. It was owing to Slatin’s influence that the captured British Red Cross Units were returned home after being interned for five months only in Serbia, whence they had an interesting journey in 1916 through Serbia and Hungary to Vienna, where passports were given for home. The members of the Berry Mission will remember Slatin meeting them at the station in Vienna: His introduction to Sir James and Lady Berry, giving them details of the arrangements made for the journey to England; how he came early next morning to bid them auf wiedersehen, laden with boxes of chocolates for the nurses. How infectious was his gaiety on that occasion!38

Dr. Zaki, His Old Friend from the Very First Days in Khartoum In the autumn of 1927 Christopherson, perhaps feeling isolated from some of his old friends from the Sudan era, wrote to Dr. Zaki, the Egyptian physician who had worked with him during the difficult days of the 1903 small-pox epidemic. In December Dr. Zaki replied with affection and gratitude: My dear Dr. and old friend, I was very much delighted to receive your very kind and pleasant letter of 8-1-27 which has carried me 25 years back where all that was in this country in its elementary stages. Your letter reminded me of the efforts and gallant deeds of our dear late Hassan Eff. Labib and Mitalai Nicklawy Bey, who is now having a practice in Cairo and is enjoying a good health. Your kind words and memoirs have affected me very much and I look backward to the last pleasant years with great rejoice and happiness, and I feel I must tell you that all the success we the three of us had was almost due to your co operation and guidance and I admittedly say here that the success of the Medical Service in the Sudan is largely due to

38

“At the opening of hostilities in 1914 Slatin, who certainly had a great many loyalties to consider, patriotically remained in Vienna declining to be engaged, in the military sense, on any front where British troops were engaged. He was appointed Director of the Austrian War Prisoners’ Aid Department.” JBC.

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your unestrained [sic] effort, energy and loyalty to duty. I am very glad to have the pamphlet issued in South Africa on Bilharzia and take this opportunity to congratulate you on your efforts as it is due to you that the Bilharzia treatment is getting to be a universal one. With profound regret I mention that neither the Sudan nor Egyptian Governments have fully considered your pains and troubles in this direction but the whole world and the universal sufferers will always mention your name as their rescuer and saviour and this is enough for a man like you to obtain the wide World reputation. In conclusion I apologise for being so late in replying and wish you a very happy Xmas and new year. I remain, Your most obedient servant, H. Zaki39

This must surely have been one of the most heartwarming letters he ever received. It is held in the Sudan archive at Durham University, a testament to his friendship with his Egyptian colleague, arguably the most important local doctor in Sudan at the time.

1932—The Death of Sir Andrew Balfour Andrew Balfour had been a major figure in the tropical medicine business and in particular in Sudan. In 1913 Wellcome made a decision “to establish in London an institute for the study of tropical medicine and hygiene, not only for research but also for the training of students to be headed by Balfour. . . . who had wanted to expand further the Khartoum Laboratories but his health had deteriorated—including, ironically perhaps, from malaria, the scourge he had tried so hard to halt—and, as Wingate noted, he was over-worked and fraught.”40 Balfour, in later years, suffered from depression. Years of strenuous work in Africa had taken a toll, and doubtless, also by his unsuccessful struggles with Christopherson over the identification of the local spirochaete for relapsing fever. In late 1930 or perhaps in early 1931, he sought medical help in his native Edinburgh from Professor Bramwell reporting that he had been “suffering from insomnia and was greatly worried that he might have to resign his post.”41 On 5 January, 1931

39

10 December, 1927 Dr. H. Zaki Khartoum to JBC SAD 407/6/27. R.V. Rhodes James. Henry Wellcome, (London: Hodder and Stoughton. 1994.), p. 325. 41 The Times. 5 February, 1931. 40

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he was admitted for treatment for a nervous breakdown at the Cassel Hospital, Penshurst, Kent. His physician there had not noticed any suicidal tendencies and in fact, as he testified at the inquest, he had begun to reduce the treatment. On Saturday morning 30 January, Balfour was found to be missing from the hospital. A gardener, having been asked to search the grounds, found him that cold January morning. He had apparently hanged himself in the park, strangled by a sash cord. A sad end for so exceptional a man. Accolades poured in. Funerals were held both in London and in Edinburgh. Sir Andrew Balfour was eulogized as “singularly modest, generous and kind, but above all steadfast.” His legacy was huge and influential as exemplified by the monumental progress in the field of public health in Sudan. Christopherson’s name is conspicuously absent from The Times’s long list of distinguished mourners, many from Sudan. One wonders what he thought when reading of the death of his old nemesis, and whether the furious fight that ‘had reverberated up and down the Nile,’ as Manson-Bahr had put it, hastened Balfour’s untimely end at the age of fifty-seven. Balfour had received a knighthood, as might well be expected by one who had toiled long and successfully in the tropics. It might also have been expected that Christopherson would be honoured with a knighthood, but as his nephew, Peter Harris, told me: “Wingate’s wife, Kitty, stuck her nose in Jack’s hospital in Khartoum and he told her to clear out. That finished any expectation he might have had.”42

British Ambulance Service in Ethiopia—How it Began The years 1935 and 1936 found Christopherson volunteering with the British Ambulance Service in Ethiopia (BASE). With his African and tropical medicine experience and years of recruiting medical personnel and running hospitals in Sudan, he was well suited for the job. War had broken out in that vast land in the horn of Africa on 3 October, 1935 as a result of the Italian ultimatum to Ethiopia. Italy, like so many other countries partaking in the scramble for Africa, was determined to acquire a colony of its own. Although England was not

42

This story, while likely, is unsubstantiated.

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officially involved, a number of Englishmen who, having spent time in Ethiopia, and having an affection for the people, sought to help. A British surgeon, Dr. A.J.M. Melly, was actually in Addis Ababa on this date. It was his second visit to Ethiopia and although he had earlier dreamed of founding a medical school there, it soon became his mission to find medical help for the inevitable casualties of impending war. Unknown to Dr. Melly, a retired officer, Major Arthur Bentinck, formerly of the King’s African Rifles, who had been wounded on the Ethiopian border, was similarly concerned and also determined to take action. He well understood the vastness of the country and the misery bound to be endured by everyone, both civil and military. At that time there was no Red Cross Society in Ethiopia. Bentinck, in his hurry to assemble a Red Cross Unit soon learned that a do-it-yourself unit would not succeed. Emperor Hailie Selassie had first to subscribe to The Geneva Convention for the Treatment of the Wounded. This would secure the right to protection, but above all Ethiopia must form her own Red Cross Society. It is to his credit that Bentinck, after chasing all over Europe, quickly managed to secure all necessary permissions and deal with the interminable red tape. Shortly, back in London, Dr. Melly and Major Bentinck met and together they initiated a campaign to raise money for sending ambulances, medical supplies and medical personnel to the war zone. The Report on the British Ambulance Service in Ethiopia (BASE) committee credits these “. . . two unknown men possess[ing] of neither influence nor wealth . . .” with the birth of a successful, but relatively unsung, dangerous venture. Soon Lord Lugard, former Governor General to Nigeria, signed on to be chairman of the appeal and others, many of them churchmen, joined to help with fund-raising.43 During those early days, advertising in the newspapers, the best way to find private money, was proscribed in the belief that this might prejudice a last-minute chance for peace. Once the invasion began, a serious campaign for money could commence. Two small sub-committees were formed, one financial and one technical. Christopherson was appointed chairman of the technical group along with Major-General H.P.W. Barrow and Colonel W.L. Harnett. They were charged with securing medical, surgical and sanitary equipment for the ambulances. Choosing personnel came under

43 Lord Lugard; Frederick J.D. Lugard, (1858–1945) former Gov. Gen. of Nigeria, British soldier and African explorer.

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the responsibility of another sub-committee on which Christopherson soon served along with Dr. Oliver Atkey (similarly late of the Sudan Medical Service), and Col. G.M.C. Smith, retired from the IMS. Christopherson, by now sixty-seven, still had plenty of energy and plunged into this work with his customary zeal. Most of the administrative work was voluntary although some office workers were paid, and the personnel actually going out to Ethiopia received small stipends.44 The challenges were huge; medical equipment and medicines, food, clothing, language facility, modes of transport, maps, availability of local (i.e. ‘native’) drivers and porters, permissions to enter the country and various internal areas, were all issues for negotiation. Two emissaries were sent ahead in September of 1935 to send back information about the “military situation, local supplies and transport facilities . . .”45 One was Dr. T.A. Lambie, a very old friend of Christopherson. Lambie, an American missionary doctor, a man enthusiastic about Ethiopia, had gone as far as to give up his US citizenship in order to take Ethiopian citizenship, something that was to cause him trouble later in life. His input was vital to the group, and as Christopherson noted, he had a good knowledge of the roads. In his memoir, A Doctor Without a Country,46 Lambie reminisced about his collegial friendship with Christopherson back in his Sudan days, when he would save up his most severely ill patients and take them by river: . . . to Khartum to the Government hospital . . . [to be seen by] the very well-known tropical specialist, J. C.[sic] Christopherson, . . . the discoverer of the remedy for bilharziosis, that scourge of Egypt. Doctor Christopherson actually acted as if I were doing him a favour when I brought twenty miserable half-naked sufferers to him. They were admitted free of charge and given food and clothing and doctored and operated on, and the results were great. Not only that, but the Governor-general himself, General Sir Reginald Wingate, visited them and gave them wonderful robes to wear, making them the envy of all their neighbours when they recovered . . . 47,48

44

It seems highly unlikely that JBC was paid for his work with BASE. Report of the British Ambulance Service in Ethiopia Committee: British Red Cross Society, told in part by Dr. W.S. Empey and Dr. P.J. Kelly. Presumably edited by members of the committee. p. 23. 46 T.A. Lambie, A Doctor Without a Country, (London: Fleming H. Revell Co. 1939), p. 92. 47 Ibid. 92. 48 Lambie was a great asset eventually becoming executive Secretary of the Ethiopian Red Cross and physician to H.I.H. Haile Selassie. 45

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The ‘wonderful robes’ bestowed upon these Sudanese is the only example I can find of the Sirdar doing what today would be called public relations, using these men as ‘poster boys’ for European medicine, as opposed to his usual method of impressing the populace with glittering shows of force and majesty. The official final Report, published in June of 1937,49 lists the selected men with their rank and assigned position, eighteen to accompany the first unit and ten for the second. There is an implicit assumption that two ambulances would be available. However, the Report reads on page 222: “It was found that our stores were too much for our original sixteen lorries, so arrangements had to be made for the surplus to follow on local camions.” Further, Ethiopian transport planes were used to bring in three lorry chassis for conversion into ambulances. In other words the ambulances, three in number, were to be built on-site. The Report shows a photograph of one camp as a large operation, nothing like the Imperial Yeomanry Hospital camp at Deelfontein of course, but certainly significant. There were about forty tents and a vast Red Cross ground flag forty-foot square to divert Italian bombing attacks although this was not always effective. Initially the camp faced the challenge of feeding one hundred men—some eighty Kenya and Somali native dressers, drivers and camp followers—plus patients. After a massive bombing by the Italians on the BASE Red Cross site, on March 3, 1936, only seven of the original eighty Kenyan and Somali natives agreed to remain, and it was the Emperor who, on hearing of the problem, sent two hundred of his personal guard as temporary replacements. While this was going on, the irrepressible Dr. Melly confronted enemies other than Italian bombs; he was battling fleas, ticks, mud, impassable roads and rivers, and bands of shiftas, really bandits of varying stripes, some political, some not, but all dangerous. Melly had a tendency to irritate the committee by ordering supplies directly from home rather than through headquarters. Living on the front line of need was very different from watching the newspaper reports from the comfort of Red Cross headquarters. On 16 January 1936 Christopherson wrote to his wife:

49 Empey, W.S. Report of the British Ambulance Service in Ethiopia Committee London: British Red Cross Society. 1937.

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chapter thirteen Melly is again in the limelight what a fellow he is for tumbling into the papers photo and all. The Evening News has a picture of him and “an Irish doctor’ examining a patient I suspect the patient to be another doctor probably Scotch posing under the blanket at any rate Melly does not appear to be doing anything more than looking on. I am afraid Melly is an adventurer. [Christopherson came to think much more appreciatively of Dr. Melly in time.] A Scotsman, Montgomery, who was going out with one 2nd unit under Dr. Kelly disappeared on Friday last, he was heard of today from Glasgow his home he had fled—I think after he heard of the bombing of the Swedish unit.50 He had been enquiring at the Life Insurance offices whether he could take out a policy before he went to Abyssinia—the reply was unfavourable he thought and I think he funked—he fled up to Scotland and consulted his wife who I suppose said don’t run any risks for my sake and so he didn’t.

And on 3 February, he noted Melly in the news again; “I was terribly amused. One of the “news films” was the Red Cross Units in Abyssinia—Melly walking about with Haile Selassie—he certainly thinks ‘It pays to advertise.’” The second unit, headed by Dr. P.J. Kelly, followed three weeks later, and was deployed in a more northerly area. On 10 February Christopherson wrote to Joyce: I feel quite lost without Kelly coming in to afternoon tea—he is a Toucan and no mistake. I had a nice letter from him written from Marseilles. It is strange how an obscure individual like me finds myself associating and playing a part with all these Toucans who are really doing something worth doing.

Toucan seems to refer to the new advertisement for Guinness with the play on words: ‘just see what two/tou-can do’ Christopherson enjoyed this joke and drew a Toucan with two glasses of Guinness on the back of the envelope he sent to Joyce. He used the Toucan reference, this image of the bright coloured and engaging bird, to refer to these young and idealistic doctors heading out to Ethiopia. This is not the place for a history of the BASE but these brief anecdotes show just how difficult and challenging it is to equip ambulance units for a far-off war in almost unknown terrain, with funding on a shoestring. The full story has been admirably written in two publications: 50 There were both Swedish and Dutch ambulance teams working in the battle areas and all helped one another on varying occasions.

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the official Report of the BASE committee, and An Ethiopian Diary by J.W.S. Macfie who was second in command under Dr. Melly on the first unit. In the end Macfie had to be invalided out, and he was not the only one, worse was to follow: Dr. Melly was mortally wounded, shot by a looter, on 3 May, 1936 at the fall of Addis Ababa. He died two days later. Curiously the reaction of the people the units were sent to help, both soldiers and civilians, is described entirely differently in the two publications. Dr. W.S. Empey who served on the first unit with medical officers John Melly, J.W.S. Macfie, A. Barkhus, C.E. Bevan and J. Perverseff et al. wrote “. . . the appreciation of the services of the B.A.S.E. was shown by people who came as much as a day’s journey by mule for treatment.51 He and his fellow physicians had treated, in that past two months, 200 in-patients and 4,000 outpatients, many bombing casualties. Yet Dr. Macfie, wrote quite differently on this subject making it the thesis of his Introduction. Since returning to Europe I have been asked again and again if I thought our efforts to assist the Ethiopian wounded and sick were appreciated. I must say I doubt it. The soldiers and the country folk were willing enough to take advantage of our services, but often we felt that they thought we were working somehow to our own advantage. We were to them foreigners and perhaps they only dimly distinguished between us who were trying to help them, and those other who were fighting against them.52

I can only assume that Dr. Empey decided on a conciliatory line out of deference to all those who had worked so hard and given so generously; Dr. Macfie, for his own reasons, elected to speak plainly. The story of the two units’ struggles to extricate themselves from a country overrun by the Italians is one of danger, hardship and monumental frustration but it makes for exciting reading. Once Addis Ababa had fallen and the emperor had fled, the BASE units withdrew. Back home the committees had to decide what to do with the leftover funds. Christopherson was much taken up with this matter. Having attended the public memorial service to Dr. Melly, in London, on 15 May, he turned his attention to using the funds to honour Melly’s memory specifically, and was particularly concerned that

51

Empey & Kelly, Op. cit., p. 27. J.W.S. Macfie, An Ethiopian Diary: A Record of the British Ambulance Service in Ethiopia. (London: University Press of Liverpool. 1936), p. ix. 52

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they should not just go back into the Red Cross general pot.53 “I would like to see a memorial to Melly—He was a good fellow and I think the type of Englishman not too frequently born now a days . . .” he wrote to Joyce in the summer of 1936. He wanted to see money for scholarships for Abyssinian students to attend Khartoum Medical School, there being no opportunity at that time in Addis Ababa. Although it took a long time, funds were gradually distributed to the Abyssinian Refugees Relief Fund, towards training for Ethiopian students at the American University in Beirut and other worthy causes.

The Move from London to a Life in Their Country Home At the end of 1935 he wrote to Joyce: I think that I will have to have a pied a terre in London for a bit as I cannot break off suddenly without breathing a word to the UMCA or the Freemasons Hospital I would like too to finish my bronchitis work and the Sudan Illustrated book of Diseases for wh. I should be near to the Royal Society of Medicine.54 I shall be awfully sorry to leave this house but we cannot afford two Heavensgates.

In 1933 the Christophersons purchased their dream retirement house. To cut his London expenses Christopherson leased rooms at No. 5 Devonshire Place, a tenancy that lasted only a year. In future when he had to be in town, he stayed either at the Athenaeum Club or with old friends like the Segundos. As he wrote in January of 1936, to Joyce: “I am like the Cheshire cat in Alice thro’ the Looking Glass, fading out of London.” Heaven’s Gate—‘A Charming Small Residential Estate,’ was bought by auction on Wednesday 25th October 1933.55 The brochure, another treasure owned by Peter Ormerod, shows a pretty house with a slate roof and veranda along the south, the front elevation. It stands in twentynine acres of grounds: “. . . [and a] lawn with rose beds and shrubbery with conifers.” Another “. . . delightful lawn with herbaceous borders,

53 According to archivist Helen Pugh, “the accounts of the BASE published in the annual report of the British Red Cross for 1939 there is a footnote that “There is a contingent liability of £300 towards a Memorial to Dr. Melly in the Liverpool Cathedral.” Personal communication 25 August, 2006. 54 Universities’ Missions to Central Africa. 55 Jack and Joyce changed the name slightly to read ‘Heavensgate.’

13.3. Heavensgate, with roses climbing the porch, and the farm workers.

13.4. Heavensgate, a woodcut by Joyce for their Christmas card.

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and rose pergola beyond which is a tennis lawn . . . a large productive kitchen garden with fruit trees . . .” sounded enticing. There was pasture land and woodland and a larch plantation and the usual country outbuildings suitable for animals or cars. All still sit above the Severn estuary, as lovely as ever, one mile from the village of Aylburton. The house had two generously sized reception rooms and four good-sized bedrooms and a maid’s bedroom. It was at once both ‘a gem’ and a ‘handyman’s special.’ The brochure also mentioned electricity. This was not the turn-on-the switch variety such as we expect today. Both water and electricity had to be induced to flow by means of a pump for one and a generator for the other. For the first few years Christopherson was not permanently in residence, except for weekends. The pump was left to the hired help and Joyce to master. At one point when the equipment was being particularly recalcitrant, Christopherson wrote to suggest that the maids might rise by candlelight until he can get home. This was certainly a new venture, farming as he called it, although Heavensgate was really more of a small-holding which generated flowers for friends and family, and holly as gifts for the local hospitals at Christmas. Honey was another product; Joyce took care of the bees. When Diana joined them a few years later, she was a big help. The fragrance of new-mown hay, the English mist and rain, and the apple blossoms in spring must have been the answer to Joyce’s dreams after her years in parched and suffocatingly hot Khartoum. The Christophersons eventually ran a car, although try as he might, and numerous letters contain gentle suggestions, Christopherson could not persuade either Joyce or Diana to learn to drive. Dyke, their longtime workman, eventually kitted out in chauffeur’s uniform, took on the job of meeting the train on weekends and driving Joyce to Lydney or Gloucester for shopping when necessary. These years were a time to look back on his work in Sudan, to enjoy memories of his achievements. Regrettably and for reasons not explained, he never did finish the planned Sudan Illustrated Book of Diseases. Perhaps he just ran out of time and enthusiasm as the BASE work compromised his otherwise free time and his life in Gloucestershire involved him more.

CHAPTER FOURTEEN

HEAVENSGATE, GLOUCESTERSHIRE

I have always believed that the clinical work I was doing at that time on Leishmaniasis was what chiefly gave me the idea which finally led to the discovery of the Antimony cure for Bilharzia. —J.B. Christopherson

It is conceivable that by the mid-1930s Christopherson welcomed his retirement from the medical fray. He lived the last twenty years, as his obituary rather quaintly put it, “to busy himself with horticultural and country pursuits.”1 His nephews remember visiting Heavensgate in Lydney in Gloucestershire. Peter Harris recalled the ‘watch goose’ that ‘absolutely terrified’ him. Another nephew, Peter Ormerod, wrote: “I remember Lohengrin very clearly, a very fierce gander who defended his two geese and would charge across the field neck outstretched and calling loudly when my sister and I went to feed the hens.”2 Peter Ormerod and his sister Dorothy were evacuated from the city, and spent the summer of 1944 living in the country with Jack and Joyce and Diana. The house was pretty, stuccoed white with a slate roof; the interior was light and cheerful. During the summer the petrol generator for electricity was little used; instead the house, in the late the evenings, was lit with oil lamps. It was a happy summer. When my sister and I stayed there in July and August 1944 we were in quite small rooms over the kitchen and always have very pleasant memories of it, of the surrounding countryside and of course of Jack, Joyce and aunt Diana, . . . who lived there too . . . There were two cockerels called Mr. Farmer (A Rhode Island Red) and Mr. Pecksniff with the hens, and also guinea fowl who used to lay eggs in odd places . . .3 As an 11 year old I was struck by the country peace after the constant bombs around our home at that time . . . I also recall sounds; cocks crowing

1 2 3

Medicine and the Law. (30 Jul, 1955), p. 255. Personal communication, T. Peter Ormerod. 9 February, 2002. Personal correspondence from Dr. T. Peter Ormerod. c. 2004.

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chapter fourteen in the morning and the nightjars making their churring noise at night, as I lay in bed before getting to sleep. The Forest of Dean is still a stronghold of nightjars, but they are much rarer nowadays. Both these sounds still bring back memories of those days.4

Peter had brought with him homework that his father expected him to attend to but his uncle dismissed this: “Oh you don’t want to bother with that, you can learn all you need to know from the countryside . . .” he’d say, handing the youngsters binoculars and suggesting birds they might look for. Peter remembers hayrides over the fields that his uncle had leased to local farmers, and in retrospect years later, he thought that his uncle and aunts rather enjoyed having the young people there. Other family members recall that it was a great sadness to Jack and Joyce that they had no children. I asked about the cat, who sat so serenely in Jack’s lap in a photo. Timmy, or Timotheus, was actually Joyce’s, as was the other important member of the household mentioned in many letters, Sebastian, a grey parrot brought back from Sudan. He could talk quite well and “Joyce used to let it fly round the room once in the evening.”5 Joyce also brought a Sudanese servant called Osman back with her. She loved the Sudanese, saying once to young Peter that: “the Sudanese were lovely.” Family members told me that both Joyce and Jack spoke some Arabic, and of course, as well-educated people, they both spoke French, also a useful language in Sudan. There was a caveat about Christopherson’s French. Joyce and Diana considered his accent so atrocious that they forbade him to speak to the children in French for fear of polluting their accents. He enjoyed the teasing and responded with: “Allez-vous ong/to the continong/where oui is yes and no is nong.” Another nephew, Peter Carveth Harris, was nineteen in 1933. His father, Lt. Colonel Dr. Temple Harris IMS,6 brother-in-law to Christopherson, had died tragically young in Burma in 1927. Temple’s widow, Eva, Christopherson’s youngest sister, struggling to get by on a small pension, brought Peter up to London to discuss his future with her distinguished brother in his consulting rooms. Young Peter had been outfitted for this auspicious occasion with his first formal suit, bowler hat and rolled umbrella. He felt uneasy, at eighteen, dressed as a gentle4

Ibid. 19 February, 2007. Ibid. 6 Curiously, although the two brothers-in-law were both in medicine and both worked in the tropics, I cannot find any instance of one man mentioning the other. 5

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man for the city. As it turned out, Peter’s opinion, thoughts or dreams were not required. He was left downstairs and Eva was ushered up to the great man’s office. All was silence downstairs save for the ticking of the clock. Finally Eva reappeared from the interview, followed by Christopherson, and the three walked out to the pavement. There, turning to his sister, the doctor raised his arm, “Eva, he’s no good. Send him to the colonies with ten pounds.” Eva left in tears with her son in tow. Peter did not go to the colonies; he entered Sandhurst and later distinguished himself in the Second World War on the Anzio beach, earning the Military Cross. This peremptory behavior was not out of character for an exasperated Edwardian uncle asked to advise on a difficult teenager who, he felt, should begin learning about the seriousness of life. Even in his late eighties, Peter Harris told that story more than once. It may well have contributed to his determination to make it on his own, and he never bore a grudge. This Peter also recalled time spent at Heavensgate while his parents remained in India. He was nine years old and his uncle Jack had been designated his guardian. He remembers aunt Joyce as ‘incredibly correct’, sitting at one end of the large dinner table and his uncle at the other, while he sat in the middle fidgeting and feeling not entirely happy. Yet he also recalled how later his uncle took him to buy a new bowler hat in London, and that once he came back from the war seriously wounded, his uncle seemed to have more time for him. Christopherson’s automobile driving eccentricities were legendary. He was erratic and ‘careened’ around the countryside in a bull-nosed Morris he named ‘Mr. Moses.’ Peter Ormerod told me that the passenger door of his uncle’s car was held closed with string, and that he kept peppermint drops in the glove compartment for visiting youngsters. He was not the only person to remember Jack’s hazardous driving. The Ormerod family still speak of it. The Christopherson household was hospitable, whether in the grander establishment at 29 Devonshire Place or at Heavensgate in Gloucestershire. The country house had no electricity laid on from the mains; even as late as 1944, the radio ran off batteries. In September of 1934 living arrangements were rather Spartan. Christopherson bought “good barrels for the Cider and another tank (65 gals) with top for rain water . . . The kettle which I bought holds 2 galls 8 pints and if you had 2 kettles full of rain water boiled and carried up and deposited in the bath, you could splash about and the result would be a very good apology for a bath

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etc . . . There is no reason why you and Diana should not have a bath apiece occasionally,” he wrote encouragingly to Joyce. Heavensgate was a rural idyll with more than the usual inconveniences. Peter Harris recalls his uncle Jack’s taking him on his rounds to visit veteran patients, whom he often treated at no charge. Peter once ventured to remark that he didn’t think nurses were very well paid. “Don’t you understand, there’s no money in medicine?” Jack shouted, thumping the table. “He was intolerant with people who didn’t come up to scratch, but he was a helluva man,” said his nephew. During the World War Two, Joyce trained with St. John Ambulance Association. Every week she trotted out, feeling embarrassed about the uniform and not wanting people to know where she went. Both nephews recalled that conversation at the dinner table centred round music and composers. Joyce was also an amateur painter of some standing, having taken lessons from Dora Mason;7 she (Joyce) was thrilled to have had a painting hung in the Royal Academy one year. In Sudan she had continued to paint, to play her violin and to enjoy a game of tennis. All told she comes across as an intelligent and talented woman, a warm-hearted and generous friend, and a devoted wife. Both Jack and Joyce were sociable: they loved people, they loved animals and they considered family ties important. A few years ago, the daughter-in-law of Christopherson’s older brother, Arthur, the Christopherson who emigrated to Australia, sent me a copy of An Ethiopian Diary. The author, J.W.S. Macfie, described the kindness offered him by Dr. Christopherson for the young doctor’s efforts to join the British Ambulance Service in Ethiopia (BASE). “After examining me he decided I was quite fit enough to serve. I know he also took a good deal of trouble to give the Committee a report on my work.”8 Arthur had carefully treasured this book along with a number of other family items that were eventually passed on to me. In mid-May 1935, John Robert Newlove, Christopherson’s assistant and faithful ally from his early days in Sudan, died. He was the man who had carried on with the identification of bilharzia eggs in urine in 1917, remaining in Khartoum and enduring those stifl ing summers while Christopherson worked with the Commission on Medical 7

Dora Mason. Exhibited at the Royal Academy 1910–12 and at the Walker Art Gallery, Liverpool. Dictionary of British Artists. 1880–1940. 8 Macfie, J.W.S. An Ethiopian Diary. (Liverpool: University Press Liverpool, 1936), p. 2.

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Establishments in France. Newlove, even in retirement in Kent, came up to London from time to time to help organize his old boss’s papers. Eventually, in the damp British winter of 1934 and ’35, Christopherson noticed Newlove gradually failing, becoming, as Christopherson’s letter to Joyce put it, “a weak reed,” and finally dying in May. The funeral and burial in a cemetery in Streatham required travel by tube, bus and tram but “The whole thing [journey] was an adventure . . . It was the least I could do for Mr. Newlove who I think was very much attached to my cause and had done, on many an occasion, much for me.”9 Christopherson’s horticultural pursuits translated into more plebeian language as the growing of vegetables. During the Second World War, our household in Surrey benefited considerably. The postal system in England, the war notwithstanding, was excellent, and potatoes and cabbages turned up by parcel post regularly at our home. Jack and Joyce kept hens and bees, and there was also a cow whose calf looked suspiciously like the neighbouring farmer’s bull. Christopherson immersed himself thoroughly in village life and ‘quietly gave his support to many small clubs and organizations.’10 For example, 25 June 1937, as reported in The Lydney Observer, offered a brilliant day for a local carnival procession, with the Christophersons as judges. In fact Jack and Joyce were known to offer their fields for local picnics and gatherings; earlier in April he had successfully raised enough money for a slide for the children’s playground. Then he ceremonially declared it open by sliding down first, much to everyone’s amusement. This jollity had been preceded by a speech on the changes in education: “One hundred years ago, the methods used to teach children were strangely different from those of the present day. Schoolboys looked upon their schoolmaster as their natural enemy: the schoolmaster in return looked upon the schoolboy as his natural enemy. Nobody cared much about the education of girls.”11 Then he offered exhortations for ‘playing the game’, ‘a generosity of spirit’, ‘consideration for the feelings of others’—along with the ‘necessity to spell correctly’. All were illustrated by quotations from Dickens. This same newspaper notified the public of the Lydney Nursing Association meeting to ‘let bygones be bygones.’ Some scandal, not

9 10 11

Ltr. to Joyce, 16 May, 1935. The Lydney Observer, (Obituary) Friday 29 July, 1955. The Lydney Observer, 30 April, 1937.

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precisely identified but to do with the dismissal of a nurse, had broken in to the public arena and new nurses were required. Naturally Christopherson was not slow to insert himself into the fray. Such phrases about the Nursing Association problems as ‘two camps’, ‘divergent views’, ‘bitter words’, ‘unfounded comment’ peppered the articles. One camp favoured Nurse Palin over whose dismissal the controversy had been raging. On the other side was Christopherson, who with his usual lack of temperance, may have forgotten that a reporter would be present at these meetings and that any remarks would lose nothing in the telling. He had a long list of complaints. For example she was ‘too old at fifty-five’, had ‘been there too long’ (fifteen and a half years), and ‘talked too much.’ Even more rashly he said: “. . . [she] wore brown stockings and shoes and a brown mackintosh, and was like a brown paper parcel on a bike . . .”12 What Christopherson really wanted to see, was new nurses, Barts nurses. And so his country life continued as he cajoled his two or three farm hands towards planting and harvesting, and wrestling with the generator. There was still Joyce’s large family to be helped with their inevitable illnesses, and a younger generation to advise and occasionally bail out for over-spending allowances. His own Christopherson family had its share of troubles too, a widowed sister-in-law to support, and others to help and advise. In 1946 Christopherson was seventy-eight. He knew time was getting short and decided to entrust one of his most treasured possessions to his niece, Dr. Susan Chappel. Earlier he had warned Susan about the perils of sherry parties and other frivolities that could disrupt her studies at Cambridge. Now Susan, a qualified doctor herself, was about to marry a doctor and the family treasure, described below, became his and Joyce’s wedding present to the couple.13 In his first letter to Susan he wrote: I have in my possession a very good old Medicine Chest of rosewood or walnut, which was handed to me when the Colton House14 furniture and fittings were sold some 30 years ago.

12

Ibid. 30 April, 1937. Susan was daughter of JBC’s sister, Caroline. Drs. John and Susan Sloper née Chappel had three daughters, all physicians. Susan died in 2008. 14 Colton House, Colton, Lancs. Owned by Rev. Arthur Christopherson, later in possession of the Rev. Brian. 13

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Probably now over 100 years old and beautifully fashioned. Just the most magnificent old medicine chest possible and I am sure you will value it. I have left it stocked as I received it with the good old-fashioned household remedies with the labels on the bottles. It will want cleaning up a little with brass polishing and I hope when you come to anchor and have a house of your own you will be able to put it in a place of honor . . . I will hand it to you personally for safe keeping. Open the package and examine it later. With love and all good wishes for a happy and successful marriage, Your affectionate Uncle J.B. Christopherson M.D.

In October of that year he delivered the chest with the following note: Dear Susan, I am sending you an old Rosewood medicine chest, which came into my family via uncle Arthur Christopherson (M.A.) who was vicar of Caton near Lancaster. He married a Miss Dockray a well known Lancashire family and you will find the Dockray initials engraved on the plate on the lid. It is a valuable relic of the past and I leave it to you just as it was left to me. I hope it will bring you good luck in your profession same as it has brought me. It is I dare say 120 years old or more.

The chest is stunningly beautiful and filled with delicately made objects. A drawer at the bottom is released by withdrawal of a secret locking rod. This opens to reveal little brass scales and other small instruments. The charm of the bottles with their gold and black labels takes one’s breath away. Now living permanently in Gloucestershire, he had little chance of bumping into his old Sudan friends at the Athenaeum or at medical meetings. There is evidence that Gwynne, ‘The Bish,’ kept in touch with Jack and Joyce.15 Gwynne lived to the great age of ninety-four. He died in 1957. Earlier, in March of 1947, Jack reacquainted himself with his old friend, having heard news of the bishop’s retirement (at eightyfour!). It is a touching letter beginning “My very dear old Bishop” and mentions Elderton16 “with whom I am in constant correspondence” and Udal, the former principal of the Gordon Memorial College:17

15

Gwynne, Llewellyn Henry, b. 1863, Missionary to Khartoum 1899, Bishop of Khartoum, 1908–1920, Bishop of Egypt and Sudan 1920–1945. Who’s Who, 1954. 16 Elderton, Major R.P.S. b. 1867. 17 Udal, N.R. (1883–1964) Principal of Gordon Memorial College.

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chapter fourteen I think your retirement is the most momentous news since I first went out to the Sudan in 1902. The friend of everybody your presence meant so much to all and I think this is true not only of the British community but also to a great extent of the native official government. I had a varied career myself but on the whole not altogether unsuccessful. I remember with the greatest satisfaction your coming up after service in the Cathedral, I think nearly always when you were in Khartoum, to the civil hospital to see the British officials patients in the hospital and to talk about a variety of other subjects interesting to me. And I named you Surgeon bishop to the Civil Hospital in order that you could come to the hospital any time you wished, a privilege not even [given to] Udal or anyone else who came regularly to see their protégé . . . I am 78 myself and I and my wife would be awfully pleased to see you again . . . With love my dear old Bishop from both, Yours affectionately, J.B. Christopherson.

On 28 Oct. 1954, a year before Christopherson died and three years before his own death, Gwynne sent the following postcard written in a clear hand: Duggie [N.R.] Udal sent me news of you and J[oyce] which brought back happy memories.18 I am now nearly 92—a bit lame and a bit deaf, but still able to get about and preach about Missions. You have the great advantage over me in having a first class wife, whom I remember patiently waiting for you to come back to lunch when you were chasing the hookworm bug to death. [illegible] you ‘keep Thou my feet’ is my prayer for I too had a bad crash last year. I wish I were nearer to drop in and talk to you both about the old days. God bless, keep you both. Yours ever, Llewellyn Gwynne.

He addressed the front of the card thus: C.B.E. F.R.C.P. F.R.C.S. ‘etc’! In fact by that time Christopherson had become ill. Joyce wrote to Udal, the man who had been at the helm of the Gordon College in Khartoum and who had always sent his students to be cared for by Christopherson. Udal replied at the end of June 1955. My dear Mrs Christo, It was so sweet of you to write & tell me all about our beloved Christo & thank you more than I can say. It is so sad to hear that he is not now able to get about or enjoy life as he used to do, & particularly that he cannot read or write but it is wonderful to hear of his courage & cheerfulness, in spite of everything & he is an inspiration to us all. 18 Udal’s nick-name of ‘Duggie’ stemmed from his schooldays. Personal communication from his son, John Udal. 14 January, 2007.

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Please give him my very best love & a big kiss & tell him that I can never forget all his wonderful kindness to me & my boys at the Gordon College in the good old days. I will send your letter to the dear old Bish, [Gywnne] who will I know, be very sad to hear that the news is not better, but please God his & our prayers will be answered you will both be given strength & courage, & your wonderfully happy life together must be a constant joy & comfort to you both. The news from the Sudan is more cheering, I am thankful to say, & S.A.R.’s19 charge that the dirty Gippies [Egyptians] (“I buy keeps”, as you so rightly say! had bought the Sudanese at the last Elections has been proved up to the hilt by the recent testimony given in the Courts in Khartoum by the Treasurer of the pro-Egyptian party, who produced receipts for nearly £200,000 given by the Gippies in bribery, & that is only a small fraction of what they really spent on bribery! However, now practically all the Sudanese want Independence & if it were not for S.A.M.’s undying hatred & jealously of S.A.R., the whole country would be united against the Gyppies. The Admiral & Hugh Fraser & Lady Bonham Carter [sic] & the Pawsons & Jessie Munro are sitting at our table at the Sudan Dinner next week & I will write & tell you all about it but, we are going to Spain for a fortnight on July 7th (D.V.), so I may not have time to write at once. No more now but with our best love to you both and God bless you. Yours always N. Robin Udal

Jack Christopherson died at Heavensgate on 21 July, 1955. He was eighty-seven. His ashes are buried in the nearby church where there is a memorial bearing the names of his close family: Joyce who died twenty-seven years later, and Diana who died thirty-three years later aged ninety-nine. In 1989 I received a letter from my mother’s cousin, Dr. Bill Tandy, (the other side of my family). We had been corresponding for some time and for some reason the subject of Jack Christopherson came up. Bill wrote: “I never met Dr. Christopherson. I was intrigued that he

19 S.A.R., S.A.M. refers to the leaders at that time of the two great religious sects, the Khatmia and the Ansar. Leader of the Kharmia was Sayed Sir Ali l Mirghani, close supporter of the Government and had commercial and cultural links with Egypt. The leader of the other sect, the Ansar, was Sayed Sir Abdel Rahman el Mahdi, posthumous son of Mohammed Ahmed, the Mahdi. The government decided to reward S.A.R. for his loyalty, an act that provoked the S.A.M. into flirting with Egypt. All this and more complicated the upcoming election to determine whether Sudan would join Egypt at Independence. Personal correspondence from Philip Bowcock, former Assistant District Commissioner in Western Nuer. 31 January, 2007.

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optimistically named his retirement home ‘Heaven’s Gate.’ [sic] I was tempted, for a very short time, to name my retirement home ‘Hell’s Gate’ but desisted. Unlike your great uncle, I am no prophet.”20 Bill also told me that he had been the second physician to sign the cremation certificate (two were required to do so) for Christopherson, and that Jack had died of “natural causes.” There was a flood of condolence letters when the obituary was published in The Times. There were many from local people, many were pro forma, and of course as expected, all were laudatory. A few letters had items of particular interest. I found Major R.P.S. Elderton’s letter the most intriguing: As you know, he was the only Englishman in the Sudan who was “wailed” for by a large crowd of women around his house when a rumour of his death reached Khartoum during the first war and no doctor anywhere can ever have sacrificed everything to his patients more completely than he did.

The above confirms a great deal: both his importance to the local Sudanese and the affection with which he was held. It also may indicate why his reciprocal affection for his local (so-called then, ‘native’) physicians and other medical workers tended to put him at odds with his fellow Europeans who frequented the Sudan Club. Gentlemen did not form close friendships with non-whites. “Officials who . . . often sided with Sudanese or had a general sympathy for them were apt to earn the dubious distinction of being “too pro-nâs (people). Aloofness was clearly required to maintain prestige . . .” wrote Janice Boddy in her recent book on Colonial Sudan.21 An old Barts hospital friend, Air Vice Marshall D’Arcy Power, wrote: [I] feel that he is almost the last of our old family friends and of the Chandos Street days. I shall never forget his great kindness in 1950, & the characteristic energy he displayed, in putting me up for the Athenaeum & for the lovely boxes of holly he sent every Christmas to the Masonic Hospital which did so much to brighten up the ward.

And Rudolph Farmer wrote; “His memory will remain ever dear to us for he was the finest & most kindly man it has ever been our privilege 20

Dr. William Tandy. Personal communication, 4 November, 1989. Boddy, J. Civilizing Women: British Crusades in Colonial Sudan. (Princeton, Princeton U. Press. 2007), p. 97. 21

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to know. I shall always treasure the book he sent to me when I was on active service.”22 The family felt bereft. Christopherson’s youngest sister, Eva, a widow herself for many years, felt lost without him: “The loss to all of us is dreadful to think of. The head of the family has gone, he was always so helpful to us all, both in our troubles & our joys & always so interested in the families’ doings.” Walter Ormerod, who himself became a specialist in tropical medicine and was much influenced by his uncle, wrote: Dear Aunt Joyce, I was hoping to have seen you on Monday, but I am very sorry I shall not be able to come. I have been reading the obituary notice of Uncle Jack in the “Times” The mention of his discovery of the treatment of Bilharzia appears as though it was an event merely of historical interest, it does not say that this is still the method of treatment in general securing many thousands every year and, although he was too modest and would have laughed the idea, surely puts him into the ranks of Paul Ehrlich and Sir Alexander Fleming. I am sure in the future this will be recognized, it is recognized now by those working in this field that in spite of very much expense and research there is still no treatment for Bilharzia definitely better than Antimony Tartrate. This probably seems a soulless and unaffectionate letter from a nephew, but I felt that you would like better to hear from one who is in touch with the work in Uncle Jack’s field that his work is still very much alive and will live for many years. Please give my love to Aunt Diana and to yourself. Your affectionate nephew Walter Ormerod.

Joyce and Jack’s closest friends outside the family were the de Segundos, also a medical family, although Dr. Charles de Segundo died long before his wife. Of their three sons only one, Bertram, lived to have children of his own. My dear Mrs Christopherson, I was indeed grieved to see the telegram which you sent to mother and which she sent on to me and so to learn that Christo had passed to his rest. You will know that I had known him all my conscious life & he had known me since I was a few hours old. Both mother & I had suspected that he had not been well of recent months as she had not heard from

22

I have been unable to identify R. Farmer.

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chapter fourteen him for some time and I know how very very sorry Mother was to hear this sad news. At the same time I think it is as important to remember that Christo’s life was one of great achievement in the fight against disease especially in the Sudan and notably in the case of bilharzia. I have not the least no doubt that, of all my Father’s friends, Christo was the one that I knew best and many were the kindnesses which I have received from him. I know that at one time he offered to take me with him to Khartoum to see whether the climate there would cure my asthma; I remember a visit to Falmouth where I developed mumps & passed it on, I regret to say, to others: I remember with what pride I wore a grey silk tie which he bought for me many many years ago in London when I was just of an age especially to appreciate such a gift. I have sought Christo’s advice on various matters at different times and always was it good and encouraging. I feel then that I have some small right to share your burden of sorrow at this time and I shall ever remember with gratitude that I knew Christo & that he was my Father’s best man. I do not see that I can offer any comfort unless it be some help to know that others are thinking of you and are only too anxious to lighten your burden if that were possible. I would have liked to have been with you last Monday but I just could not manage it especially as I did not get Mother’s letter until Saturday when I also saw the Times announcement. Please do not think of answering this letter but I do want you to know how much you are in my thoughts and how deeply grieved I am to feel that so old, so honoured & so loved a friend has left us. Runa & I send you our love. Yours very sincerely, Bertram

Bertram’s mother Gertrude, a widow for many years, wrote several times, once passing on something that must have been a great comfort to Joyce, “You have been a wonderful wife & I don’t know what Jack would have done without you. He has often said so & thanked God he had married you.” And again, to acknowledge a surprise gift left to her in his will: “Last week I had a letter from the National Pro. Bank at Cheltenham telling me Jack had left me a legacy of £50. I can’t tell you how much I appreciate his kind thought for me. I feel I ought not to have it.” Indeed she made an effort to return it. Gertrude de Segundo was not the only friend to have been remembered. Charles Armbruster, his staunch ally in those difficult Sudan days, received fifty pounds that he planned to put towards publishing his latest book and remembering Jack in the Preface.23 23

Regrettably, it would appear that Armbruster died before his could be accomplished.

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Perhaps one of the most important letters came from Dr. H.C. Squires who had gone out to Sudan in 1908 as a physician and had known Christopherson well. and who wrote one of the best known histories of the Sudan Medical Service.24 Dear Mrs Christopherson, The sad announcement in this morning’s Times took me back 47 years to one November afternoon when I first met Dr. Christopherson on the platform of Khartoum North station. I hope you won’t mind my writing but I had to send you my very sincere sympathy. And there is just one thing I should like to add. I believe that during the four years 1904–1908 he did the most important medical work of his life—because it was during these four years that the pattern of the new medical service in the Sudan was created that was to influence the lives & the health of millions. And the high standard that Dr. Christopherson arrived at & in his view none but the best was good enough, was never really lost sight of in the years that were to follow. Yours very sincerely, H.C. Squires

It is curious that Squires, who was certainly in a position to assess Christopherson’s work in Sudan, chose to highlight his early administrative and organizational effort, the setting up of the department, 1904–1909. Perhaps Squires felt that these pioneering years had been the most fraught and difficult years, and deserved better recognition. Udal, whose piece in The Times had been an addendum to the official notice, wrote “Actually, owing to pressure of space the “Times” were not able to print all that I wrote, & they missed out the last sentence, in which I said: ‘The abiding friendship between the Sudanese & the British is largely due to the example set by men like Dr. Christopherson, his name will always be remembered with gratitude & affection in the Sudan.’ ” Christopherson certainly had his admirers. Sir Philip MansonBahr left no doubt about his admiration for his friend in his Lancet obituary: Christo was a charming personality; he was of an inquisitive disposition with an active mind. Dark, with beetling eyebrows, he spoke with a rather hesitant manner and, on that account, was not a very good lecturer, but he could dissimulate his little stammer with a pleasant and infectious

24 H.C. Squires, The Sudan Medical Service: An Experiment in Social Medicine. (London: William Heineman Medical Books Ltd. 1958).

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chapter fourteen laugh. He was a kind soul and a pleasant companion who never spoke ill of any man. He was also deeply religious and a good Christian. He was a good friend to the Church and for many years medical adviser to the University Mission to Central Africa. When roused and when he knew he was in the right he could be firm and tough. Usually he won through. Christo’s name will live long in the annals of tropical medicine and in the hearts of his many friends.25

In the classic work, Manson’s Tropical Diseases, re-edited through dozens of editions by his son-in-law, Philip Manson-Bahr, Christopherson’s primacy on the treatment of bilharzia with antimony is strongly endorsed. “The successful treatment of schistosomiasis, by the intravenous injection of sodium antimony tartrate, is due to Christopherson. His results have been abundantly confirmed.”26 In sum, Christopherson’s work was his passion, his patients his concern, and such niceties as attending the right club held no charm for him. Perhaps most appropriately for the man who worked so diligently for so many years and with a bulldog-like determination, his memory is honoured in Khartoum at the hospital he practically lived at, by a plaque with the inscription:27 J.B. CHRISTOPHERSON R.A.M.C. Director Medical Department, Khartoum. First to employ Potassium Antimonyl Tartrate for Treatment of Bilharziasis 1917.

25

British Medical Journal. (taken from The Lancet, 30 July, 1955), p. 255. Manson-Bahr, Philip H. Ed. Manson’s Tropical Diseases: A Manual of the Diseases of Warm Climates. (London: Cassell and Co. Ltd. Eighth Ed.), p. 491. 27 This plaque was installed with more enthusiasm than accuracy. Just to set the record straight, JBC was not RAMC nor was he, strictly speaking, the first to employ Potassium Antimony tartrate for bilharziasis but none of these quibbles should detract from his accomplishments. 26

heavensgate, gloucestershire

14.1. JBC with Joyce’s cat, Timotheus.

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CHAPTER FIFTEEN

LOOKING BACK FROM THE TWENTY-FIRST CENTURY

As you know, he was the only Englishman in the Sudan who was “wailed” for by a large crowd of women around his house when a rumour of his death reached Khartoum during the first war, and no doctor anywhere can ever have sacrificed everything to his patients more completely than he did. —Major R.P.S. Elderton

Certain diseases that affect those living on the continent of Africa, particularly the poor, are still neglected. It is ninety years since Christopherson published his discovery; and at the time of writing, 2008, here we are with the same problem of schistosomiasis, and many new illnesses as well. Schistosomiasis is actually listed by the WHO as a ‘Neglected Disease.’ and for good reason; There can be no denying this. 2007 saw the launch of a new journal, Journal of Neglected Diseases from the Public Library of Science (PloS).1 The website says it will generally ignore the big three, HIV/AIDS, Malaria and Tuberculosis,and instead concentrate on Protozoan, Helminthic, Bacterial and Fungal infections—the old enemies Christopherson spent his professional life battling in Sudan all those years ago. In Africa alone, even in the twenty-first century, schistosomiasis is second most common, after malaria, of the tropical diseases. The impact of this illness, associated with incredible lassitude, anemia, pain and diarrhea, leading eventually to total disability and sometimes death, is enormous. The problem continues unabated. The explanation comes down to lack of funds and lack of political will to educate the masses, to control the molluscs that harbour the trematodes, and to provide for adequate treatment. All approaches were endorsed by Christopherson. He had been optimistic; he considered his treatment, if used correctly, to be a

1

Public Library of Science. ISSN 19352727.

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specific—something to cure the affected, to make an important reduction of incidence and perhaps eradicate the illness altogether. In the Journal of Biosocial Science, a paper published in 2004 discussed the perceived symptoms and causes of S. haematobium and S. mansoni which the researchers found endemic along the shore of Lake Victoria in Tanzania. Eighty-five years after Christopherson’s discoveries and demonstrations, diagnostic and curative services at the government health-care facilities were still lacking. Reasons given were that adults and primary school children still considered schistosomiasis a shameful disease.2 Before the antimony treatment there was no remedy. The Encyclopedia Britannica, 1910 edition, states that the only drug used “with much success” was the liquid extract of male fern. In fact this treatment was totally without effect. Similarly, in 1912 Dr. Crispin’s book The Prevention and Treatment of Disease in the Tropics had the following advice “[when] . . . later [as bilharzia] causes considerable anaemia and debility, . . . treatment must be limited to improving this with tonics such as Easton’s syrup.”3 Time and again Christopherson published his concerns regarding the health of the Egyptian fellaheen, using strings of powerful adjectives to illustrate and emphasise their sad condition. He argued that were these men free of the helminths that plagued their lives, they could be drawn into the ways of the west and thus made useful—the word ‘empire’ was tacitly implicit here. His July 1919 paper in the Journal of Tropical Medicine and Hygiene offers an example of how he attributes the fellaheen’s problems directly to disease: . . . one would naturally venture to think that the docile, dirty, slovenly, patient though not unindustrious, but unenterprising, unambitious, short-sighted, miserable fatalist one associates with the type [of] Egyptian, would be a very different person were he minus the parasites, particularly of bilharzia (and ankylostoma and T.[aenia] nana) which are at once an overwhelming physical, mental, moral and economic handicap, which more than anything else have kept him shackled by invisible chains, and have retarded his civilization. Ninety per cent. of the population of

2 J.R. Mwanga, P. Magnuseen et al. Schistosomiasis-related Perceptions, Attitudes and Treatment-seeking Practices in Magu District, Tanzania: Public Health Implications. J. of Biosocial Science (2003), pp. 1–19. (Cambridge U. Press), p. 54. 3 E.S. Crispin, The Prevention and Treatment of Disease in the Tropics. (London: Charles Griffith & Co. 1912). Easton’s was a thick syrup containing phosphates of iron, quinine and strychnine.

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Egypt have not advanced in civilization since the days of the Israelites of the Old Testament.4

Christopherson was a missionary for the use of antimony injections to save Africa from schistosomiasis. The Egyptians, in particular, he said were ‘saturated’ with it. Many of his earlier patients, students at the Gordon College, Khartoum, were very young, as was noted in an earlier chapter, and the doses had to be carefully considered for these children. In 1920, at the Royal Free Hospital, London, he gave a detailed talk and demonstration of his treatment along with slides showing dead ova and helminth found in the urine of infected patients. Here he demonstrated his technique using . . . An English boy aged 8 born in Nyasaland and who became first aware of his infection by Biharzia at Fort Johnson, 4 1/2 years ago was shewn. The little boy was undergoing a course of treatment by intravenous injections, a total of 4 grains having already been given. The urine already showed a great improvement and the boy was free from subjective symptoms.5

There is no word on how this child felt being presented to such an august company as the Medical Society while bravely enduring a difficult injection.

Christopherson in Sudan—A Square Peg in a Round Hole? In the first two decades of the twentieth century, in both civil and military circles, there was a strong emphasis on social conformity. Gabriel Warburg pointed out how some circumstances led to resentment: “By and large, the military mistrusted the civilians as a class, an attitude which prevailed throughout Wingate’s governor-generalship and was shared by many of the senior military officials.”6 Indeed, Christopherson, as a civilian doctor, bitterly resented the fact that he had not achieved 4 J.B. Christopherson & J.R. Newlove. “Laboratory and other notes on Seventy Cases of Bilharzia treated at the Khartoum Civil Hospital by Intravenous Injections of Antimony Tartrate.” J. of Trop. Med. & Hygiene. No. 14. Vol. XXII. (15 July, 1919), p. 141. 5 J.B. Christopherson, Egyptian Bilharzia Disease: A Demonstration of the technique of intravenous injection of antimony tartrate in bilharzia disease. Proceedings of the Royal Society of Medicine—Section Tropical Disease and parasitology. (1920), xiv. pp. 17–21. 6 Gabriel Warburg. The Sudan Under Wingate: Administration in the Anglo-Egyptian Sudan 1899–1916. (London: Frank Cass & Co. Ltd. 1971), p. 83.

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the rank of Pasha and he never fully adapted to the predominantly military hierarchy of the administration.7 The farther from England the British set up home, whether in Africa or in India or some other colony, the more straitlaced the protocol became. This nostalgic attempt to set up a ‘little England’ in the colonies bred a lot of time-wasting superficiality, usually encouraged by wives with many servants and very little to occupy their own lives. As formality began to shape the administration in Khartoum in 1904, and a decade later as women began to accompany their men to Sudan, the social mores changed and the gap between Europeans and locals widened. Lady Wingate did much to promote elaborate codes of etiquette and protocol. For instance, anyone hoping for an invitation to the palace had to learn how to behave, and more importantly, how not to behave. Christopherson does not appear to have been invited often to the palace and he was not a frequenter of the Sudan Club; the latter is documented and could have contributed to his being seen as an outsider. More likely he preferred doing something, rather than indulging in social drinking and chit-chat. Both he and his great friend, Major William May, the man dubbed by Wingate as ‘reclusive’ and ‘bohemian’ despite his army rank, were seen as outsiders, difficult to read, and therefore eyed with suspicion.8 Major P.R. Phipps disliked May as much as he disliked Christopherson and their other friend Charles Armbruster, at one point referring to the group as the ‘Armbruster league’. Wingate and his close associate Phipps both showed enthusiasm for maintaining the status quo. This meant, on occasion, promoting military ahead of civil. Those so favoured acquired status, power and money, so it was natural there would be resentment in those left at lower rank. Christopherson did not change to fit in and seemed not to be concerned. Everything points to his putting his hospital, his patients, his 7

Civilian doctors were given assimilated Egyptian ranks. In 1917, about the time that Christopherson was working in France, his friend Major May found work in Mesopotamia as financial adviser to the amazing Gertrude Bell, the woman credited with shaping the country of Iraq. May had an office across the courtyard from Miss Bell where a tame peacock enjoyed sitting in his office and occasionally visiting Miss Bell. Source: Gertrude Bell: Queen of the Desert, Shaper of Nations. By Georgina Howell. Farrar, Straus and Giroux. New York. p. 284. Miss Bell’s letters survive, and given that she had plenty to say about almost everyone, pleasant and unpleasant and, that there is nothing else written about Major May except that Miss Bell was pleased with the office workers around her, we can assume she had no complaints about him. 8

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laboratory work with his microscope first, Bishop Gwynne wrote in an obituary: ‘Christo,’ a name by which he was known by his many friends in Khartoum, was most popular with the Sudanese who worked with him in his researches, but had little time for social life in the British community, by whom he was much admired: . . . he was well known for his many selfless kindnesses to his patients and would often ask me to visit some special patient in whom he was interested.9

Wingate’s November 1908 comment that “. . . he has altogether failed to obtain the friendship or the confidence of any of his Profession . . .” has dogged Christopherson’s reputation. It may have been true that he was judged a failure as an administrator; perhaps he never learned to delegate efficiently.10 It should be noted that this opinion, second-hand at best given that Wingate was not often on-site around the hospital and was known to spend very little time actually in Khartoum, is totally unsupported by the doctor’s local staff and many friends. That he and other physicians and administrators were frequently overloaded in those first few years, and that conditions of both climate and infrastructure were abrasive in the extreme, did not necessarily encourage conviviality. Christopherson had to recruit local staff—turmorgis (male nurses), orderlies, messengers etc. among the local Sudanese men, and some women. In 1903 he complained in his hospital diary: “A native officer never does an ounce of work that he is not made to do . . .”11 As late as 1909 he lodged his opinion in the Annual Report: “The native women are so indolent and ignorant that it is hopeless at present to try and train them as nurses.”12 They were not up to his expectations and Christopherson was hiring and firing as fast as he could turn around. It was not until towards the end of his tenure as Department Director that he was able to hire two experienced British nurses. He had been campaigning for them for several years in a period of tight budget constraints, and these two pioneers more than proved their worth. By the time the department underwent a reorganization in 1909 there was a better understanding of how, given the difficult circumstances, 9

Bishop Ll. Gwynne. The Sudan Diocesan Review. (Autumn 1956), p. 26. Wingate to Acland 29 November, 1908. SAD 284/3/68–70. 11 JBC’s diary. 15 March, 1903. SAD 406/5/64. 12 Reports on the finance, administration and condition of the Sudan, 1909 (Cairo, 1910) Sudan Medical Department Report, 1909. p. 414. SAD SudA PK1561 GRE. 10

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hospitals could be run in Sudan. In Khartoum, some of the conditions Christopherson had had to put up with were gone, in particular the thirty-bed mud-brick hospital and an operating theatre without a door. Under his new appointment he was responsible for just two civil hospitals, one in each of the two major cities of Sudan, across the river one from the other. Surely, in retrospect he must have looked back and privately acknowledged considerable success. In eight years he had built a fine department with a major hospital in Khartoum, another in Omdurman, and a series of outlying hospitals and clinics in smaller towns. Now he could concentrate on what, in truth, he did best; run these two hospitals staffed with his hand-picked nurses who thought as he did, and where major surgical cases were under his authority.

Why Was Christopherson’s Work Ignored by His Contemporaries in Sudan? Why did no one in the Sudan government pick up Christopherson’s important work in 1917–18 and promote it as a ‘feather in the cap’ of the Medical Department and or the administration? His bilharzia success merited a whole chief ’s headdress of feathers. Phipps had left in 1914, and Wingate, who would not likely have been one to miss such an opportunity, had gone by 1917. Crispin, never Christopherson’s friend after the 1904 appointment débâcle, was at first acting Director and eventually Department Director (SMD). It is hard to believe that Crispin was foolish enough to ignore something that would bring recognition for his own department. Did Christopherson bring this to the attention of his colleagues? Surely they must all have known about the schistosomiasis patients, given that he was out of the country when some of the trials were going on and the work was being conducted on his behalf by others? Yet although this was pioneer work and exciting, he makes no reference to it in letters to Joyce. Bilharz, Leiper and Rogers are well known names in the history of medicine. In Farley’s book, Bilharzia: A History of Imperial Tropical Medicine (1999), Christopherson is cited once only and that citation was overlooked in the index. Teodoro Pennacchia, writing in Storia delle Malattie Tropicali in 1960, mentions both McDonagh and Christopherson. In translation this reads: “Another name that must not be

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forgotten in the history of this illness is that of Christopherson, who together with McDonagh was the first to propose and disseminate the use of ‘tartaro stibiato’ in this disease, in which was revealed the true specific . . .”13 Christopherson, had he read this, would not have appreciated the words ‘together with.’ Australian helminthologist David Grove mentioned the McDonagh/ Christopherson dispute and dismissed it in Christopherson’s favour: “Not surprisingly, when an effective drug was promulgated, others [he meant McDonagh] tried to cash in on the credit.”14 H.C. Squires, author of The Sudan Medical Service, endorsed Christopherson when he wrote to Sir Richard Hill, the founder of the Sudan archive in Durham, “The most important contribution to tropical medicine made by any member of the Service was Christopherson’s discovery of the use of Tartar Emetic in the treatment of Bilharzial infection.”15 Similarly George C. Low in an address at the BMA meeting in Melbourne stated: “In 1917 Christopherson tried antimony injections in the treatment of vesical and rectal bilharziasis at the Khartum Civil Hospital with a success that passed all expectations . . . and the disease was thus for the first time brought within the effective range of therapeutics. . . . Patients on treatment by the new method were quickly and definitely cured. Results such as these speak for themselves.”16 But these were all medical men, writing for other medical men. His name is missing in those books of memoirs depicting hunting game or Edwardian tours down the Nile, or tea parties on the governor’s lawn at the Palace. There is no mention from any of the missionaries or political agents who spent weeks away in some distant outpost, yet would, from time to time, have come in to Khartoum and looked for medical advice or medicines. Something happened in the heart of Sudan, a discovery to benefit thousands of seriously infected people, sometimes sick to the point of death, and no one in Sudan administration mentions it at the time. Surely Dr. Crispin had nothing to lose by promoting this discovery? Any credit to Christopherson comes years later: books by Squires, Bayoumi,

13 Teodoro, Pennacchia, Storia Delle Malattie Tropicali. (Pisa: Umberto Giardini 1960), p. 300. 14 David Grove, etc. and H.C. Squires in The Sudan Medical Service p. 99. 15 11 January 1958. E-mail from archivist J. Hogan 4 September, 2002. 16 BMJ (Oct. 19, 1935), p. 715.

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D’Arcy et al.17 The little item on page eight of the London Times in 1919, (as mentioned in chapter eleven), barely credits Christopherson, and his name sank from sight.

Friends and Adversaries In any public dispute, frequently on the basis of prior opinions or prior knowledge or prior misinformation, sides are taken. After eight years of research on the subject of Dr. Christopherson and his two decades in Sudan, based on the documented evidence I have been able to find, what follows is a list of friends and of adversaries. In Khartoum his friends were: E.E. Bernard (Financial Secretary 1905–23), Charles Armbruster (linguist and scholar), Dr. Noel Waterfield, Major William May, James Currie (Director of Education), Major R.P.S. Elderton, Bishop Gwynne, Wasey Sterry (first legal advisor appointed 1901), N.R. Udal (Education Department), Said Shuqair (Dir.-Gen. of Accounts for the Sudan Government 1907–21), Rudolph Slatin and the Egyptian and Syrian physicians like Dr. Zaki. It is also worth noting that some of the above held military ranks. Sterry, Currie and Bernard were administration heavyweights, as was Gwynne. Christopherson appointed Gwynne as “Bishop to the hospital,” so that he could visit any time. It is hard to believe that none of these men left anything written about the doctor they all knew and must have conferred with and seen in town, often on a weekly, if not daily basis. Was it that he was just too controversial to write about? William May, the finance officer, who disagreed with E.E. Bernard’s way of doing things in the finance department, remains an enigma. When he died in 1937 Christopherson rushed to the north of England to attend his friend’s funeral. He wrote to Joyce: “The police have formally seized all May’s private papers. I suppose pending the question of an enquiry being determined . . . May will be greatly missed here in Alnmouth. Everyone knew him and loved him, there is no other word for the feeling he inspired.”18 Just why the police were involved has to remain a mystery. There was no inquest, no autopsy, no hint of suicide, in fact nothing out of the ordinary. Major May died of ‘heart disease.’

17 18

See Bibliography. Letter to Joyce 25 March, 1937.

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His wife had predeceased him and they had no children. William May must remain a bit of a ‘Bohemian’ whom ‘everyone loved,’ except perhaps E.E. Bernard and P.R. Phipps. There were many overlapping circles of friendship. No one could afford to upset Wingate. A number of Christopherson’s friends and supporters were also, like Bishop Gwynne, friends of Wingate. It is known that Dr. Theodore Acland, Wingate’s personal physician, although not his official personal physician, was also a good friend of Christopherson; there are instances of their meeting socially in London.19 Those unsympathetic to Christopherson or even adversarial, include: Major P.R. Phipps, Legal Secretary Bonham-Carter, Col. H.B. Mathias P.M.O, E.A.M.C.,20 Dr. Leonard Bousfield, Dr. Andrew Balfour and Dr. E.S. Crispin and possibly the mysterious Dr. Michu although his opinion would be unlikely to count. Phipps, Balfour and BonhamCarter were major figures in the administration. Crispin, who finally got his chance to run the department in 1916, unsurprisingly gave no quarter, easing Christopherson out of any decision making.21 As one would well understand, he ran the organization ‘his way.’ He must have felt some satisfaction after all these years of waiting in the wings and being answerable to Christopherson. In such a politically determined, yet isolated, posting, one had to choose and maintain friends carefully. It is likely that Christopherson had not paid enough attention to this aspect of life in Khartoum, as evidenced by the problems he had over the Court of Enquiry.

Priority Issues It will be recalled in my earlier discussion of zeitgeist, that the expansion of Empire brought about simultaneous needs for medical advancement in widely separated tropical locales. As a consequence, people worked in isolation from one another on similar problems. This sometimes led to discoveries of a similar nature, which tended to be published concurrently. Some were generated by members of the IMS, who can be

19 JBC was appointed Physician to H.E. the Governor General in 1905, but this was considered a sop. Acland had, decades earlier, saved Wingate’s life and was in reality Wingate’s personal physician. (see Daly’s “Empire on the Nile” p. 260). 20 Principal Medical Officer of the Egyptian Army Medical Corps. 21 He became Acting Director in 1915 and Director in 1916.

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said to have lived where a plethora of diseases waited to be conquered. We know that those like Christopherson, working in ‘colonial’ Africa, read the Indian Medical Gazette and found many parallels to their own work. Christopherson’s brief posting at the Seamen’s Hospital, Greenwich, had taught him that many tropical illnesses filtered into the mother country. This likely prompted his interest in ‘Diseases of Warm Climates’, as the field was sometimes referred to. The interest of his government, had he the time to consider the issue, was in trade and potentially rich natural resources. In sum, tropical medicine was pushed by expanding empires, and empires were able to expand by making it at least acceptably healthy for Europeans to live and work there. Sir Isaac Newton speaking to Robert Hook famously said, “If I have seen further, it is by standing on the shoulders of giants.”22 Without a doubt this was Christopherson’s lot. The shoulders he stood on in this instance were those of Sir Leonard Rogers and the others before him, pioneers in the use of antimony for kala-azar and sleeping sickness, as the chain was described back in chapter eleven. The pyramid is really an upside down pyramid: the more that is discovered the more researchers will use the earlier findings and expand this knowledge outward. Christopherson took his discovery and pursued it doggedly. As it turned out, a few others had also successfully used the same treatment, but they did not follow up or publish in the traditional journals. Hiding such a particular light under a bushel (in McDonagh’s case, the ‘bushel’ was a book on venereal disease), without any details of dosage regimen or other useful data, meant that his news was well buried. Thirteen years younger than Christopherson, McDonagh had led a distinguished career. He gave the Hunterian Oration (his was at the College of Surgeons) in 1926, ten years ahead of Christopherson’s Hunterian Oration which was delivered at the Society of Apothecaries. McDonagh was cited as ‘significant’ in a long article—Dermatology at St. Bartholomew’s Hospital—by R.M.B. MacKenna, but after noting his accomplishments MacKenna added: Eventually he became a controversial figure, but never a negligible one. The rest of his professional life is best summarized in his own words, taken from Who’s Who, 1964, “Founder and Director, Nature of Disease Institute since 1929; research work has led to reaching of conclusions on

22

Howard Markel, NEJ Med. 351; 27 (30 December, 2004), p. 2794.

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cause of syphilis, the common cold, influenza, the corresponding infections of animals . . . which are at variance with those generally held.”23

My searches for the private papers of this controversial doctor almost came to naught, but a few hints surfaced. I visited The Royal College of Surgeons in order to see the famous Hunterian museum and found adjacent to that entrance, the College’s library. There, I was amazed to see a separate shelf of McDonagh’s books—he was a prolific writer on venereal disease—and learned that this was a special bequest. On the wall above the books hangs a photograph and a short, framed biography part of which reads: “Ehrlich entrusted to him the first consignment to this country of Salvarsan 606 which revolutionised the treatment of syphilis.” The biographical sketch ends by saying: “He was a cultured man with a great love for flowers and flowering shrubs which he cultivated in the garden at his home in Storrington, and later after his move to Stowmarket, where he died on 14 February, 1965.” Assuming that this bequest would yield a paper trail leading back to McDonagh’s family and associates, I made enquiries. The archivists informed me that any paper trail was lost in the 1960s and that the College librarians from that period had all died. I took a second look at McDonagh’s will. He requested that the Board of Management of the ‘N.O.D. Institute Ltd.,’ hand over everything to do with the Institute in order to extend its work. N.O.D. was the Nature of Disease Institute, an organization founded by McDonagh in 1929. Its first and only Annual Report was published by Heinemann in 1948, nineteen years later! The work of this institute was to investigate, publish and disseminate McDonagh’s passionate belief in a “. . . unitary theory of disease . . . there is only one disease of which there are not numerous varieties . . .” (he wrote in his introduction). He also challenged the well-established viral origin of Influenza.24 McDonagh wrote of his problems in getting published “. . . other journals [with the exception of The Medical Officer] closed their columns to me because the unitary theory of disease is not acceptable to the medical hierarchy . . .”25 Curiously, I found only one entry for antimony in the Index. It was a comment en passant and referred neither to schistosomiasis nor to 23 R.M.B. MacKenna, Dermatology at St. Bartholomew’s Hospital, London (1123– 1946) British J. of Dermatology. 78 (8–9), p. 440. 24 McDonagh, J.E.R. The Nature of Disease Institute. First Annual Report. (London: William Heinemann. Medical Books Ltd. 1948), p. 118. 25 Ibid. p. 117.

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bilharzia, nor was either in the Index. McDonagh seems to have given up his earlier work in order to concentrate on his N.O.D. Institute. Unsurprisingly this Report was reviewed somewhat tartly in the Quarterly Review of Biology: . . . [This] first annual report . . . is in the form of an exceedingly obscure book covering chemotherapy, endocrinology, vitamins, immunotherapy, homeopathy, microbiology, influenza in 1945–46, . . . [and] claims to be an attempt to present ‘a unitary theory of disease.’ . . . The result is a vague farrago of opaque terminology . . . Some purveyors of eccentric literature are able to make their claims superficially plausible, even if they reason very loosely from very dubious assumptions. Thus it is sometimes interesting to read works which attempt to prove that the earth is flat, or that all civilizations originated form the continent Mu which later sank into the Pacific Ocean. Other eccentrics are merely tiresome and dull. It is the opinion of the reviewer that this book falls in the latter class.26

This review was amusing but it speaks of work quite at odds with McDonagh’s reputation as, for example, the physician entrusted by Ehrlich with the first samples of salvarsan for syphilis, or even his reputation as serious horticulturalist. Surprisingly, after almost eight years of searching for descendants of this controversial doctor, his grandson saw one of my many queries on the web and e-mailed me. From him I learned that most of McDonagh’s papers had been destroyed. Two letters pertaining to the placement of his books in the library of the Royal College of Surgeons, and his original notebook for his curious work on the Unitary Theory of Disease are all that have survived. Not a word about his adversary, Christopherson, although the family recalls there was ‘bad blood’ over this. Nevertheless, for all their differences, McDonagh and Christopherson had a great deal in common: they were both Barts’ men, they had a great love for the countryside, and, of course, each continued resenting the other’s priority claim. McDonagh’s obituary in The Times sums him up, “He seemed to live for two things—flowers and the advancement of medical knowledge. His Irish origins gave him a combative frame of mind which was loved by some and feared by others.27 Christopherson’s brother-in-law, Dr. Tom Ormerod, also a Bartstrained physician, was heard to say: “Jack always cherished his ene-

26 Tobie, Walter C. The Quarterly Review of Biology. Vol. 24. No. 3. (September, 1949), p. 261. 27 A. Dickson Wright, The Times, (22 February, 1965), p. 12e.

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mies.”28 In view of what I have been able to unearth this seems to be a perceptive statement made kindly but shrewdly; it hints at a bulldog tenacity. This trait sometimes served him well—in planning for the new hospitals and operating in desperately difficult and swelteringly hot conditions—but perhaps not so well when dealing with a rigid administration. The story, told by Elderton of Christopherson’s being the only Englishman ‘wailed for’ in Sudan is a point of family pride now. I question why, when many Europeans still in Sudan during the war must have heard of this incident, none thought to mention it, even as a point of derision in any narratives of ‘life in the tropics.’ What would Lady Wingate have thought? Perhaps she would have been amused. Manson-Bahr firmly endorsed Christopherson: “The crowning success of antimony therapy in biharziasis (schistosomiasis) must be accorded to J.B. Christopherson in 1918: a discovery which has since been abundantly confirmed.”29 Manson-Bahr’s generous words in the preface quoted above were a personal kindness, a gesture to his friend who he knew had been overlooked. There are two schools of thought about Jack Christopherson, even in his family. On the one hand, he was kind and considerate, ready to help the most disadvantaged. On the other hand, he was short of patience and expected his advice to be followed unquestioningly. Fifty years ago this was not at all out of character for any male.

What Happened to the Cast of Characters That Peopled Christopherson’s World in Khartoum One Hundred Years Ago? Sir Reginald Wingate was offered the post of High Commissioner to Egypt in 1916. He accepted but he was not a popular choice. On his part, he was disappointed that his appointment did not include authority as Commander-in-Chief of the British forces in Egypt. His year started tragically with the death of his son Malcolm at the Front, in March, 1917. With regard to Sudan, Wingate managed to cling to the remnants

28

Personal communication from Dr. T.P. Ormerod. 27 July, 2005. P. Manson-Bahr, Preface in Advances in the Therapeutics of Antimony, (Leipzig: Georg Thieme 1938), p. viii. 29

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of his old job there by seeing to it that the Sirdar replacing him was given the titles Acting Sirdar and Acting Governor-General of Sudan. In Egypt, problems of all kinds erupted. The history of Wingate in Egypt, along with stories of a number of his personal enemies have been told in detail by Daly.30 The Sudan administration had endured a number of intrigues but nothing in comparison to those in Egypt during and shortly after the war. Here the situation was much more serious, as seen from any perspective. As Daly explained, Wingate’s failure in Egypt was personal not political. He was eventually called to London, and finally, dismissed. It was a humiliating experience from which he tried to salvage his name and his honour. “Vindication obsessed him.”31 He wrote myriads of letters and threatened a public enquiry. At only fifty-eight, unable to keep up the regal standards he and Kitty had earlier enjoyed, he was desperate for work—commensurate with his standing of course. His remaining son Ronald wrote a “filial biography” (Daly’s term) and he is remembered in Daly’s two books and in the vast Wingate archive at Durham University.32 Phipps, the man closest to Wingate in the early years of Christopherson’s tenure in Khartoum, was, by the end of 1913, fifty years old and ready to retire. Wingate wrote a persuasive letter to Lord Kitchener on behalf of his friend, urging him to push for some kind of civil recognition, preferably not Egyptian. Wingate wrote that Phipps’ health was “broken down” and he was being sent home for medical reasons. Phipps appears not to have married. He died in August 1932. His final British rank was as Lieutenant-Colonel but his decorations: (Osmanieh 3rd class, Mejidie 2nd and 4th class, Nile 2nd Class)33 were not quite what he had hoped. Phipps appears to have been a popular uncle, with abundant nieces and nephews, and at least one dozen godchildren, all of whom were remembered by name in his lengthy and generous will. The memorabilia from his Sudan days were sent to his Dorset regimental headquarters, and some silver trophies were shipped back

30 Martin Daly, The Sirdar: Sir Reginald Wingate and the British Empire in the Middle East. (Philadelphia: American Philosophical Soc. 1999). 31 Ibid. p. 301. 32 Ibid. Daly, and Empire on the Nile: The Anglo-Egyptian Sudan, 1898–1934 (Cambridge: Cambridge U. Press. 1986). 33 Henry Keown-Boyd. Soldiers of the Nile: A Biographical History of the British Officers of the Egyptian Army 1882–1925. (Thornbury: Thornbury Publications. 1996), p. 154.

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to Sudan where they sit in dusty glass cases in the old cathedral, now a state museum. Dr. E.S. Crispin, ‘Uncle Ted’ to a nephew and niece who remember him, was much decorated and much married, although sadness was attached to all three marriages. His first wife and their infant died in Port Sudan in about 1922. He retired soon after and according to his obituary,34 never again took up active professional work. His second wife ran off with someone else, and his third wife predeceased him. Those who remember him recall a tall good-looking man, “. . . socially inclined, an amusing companion, and an excellent host. He died at sea on the journey home from a visit to South Africa.”35 As already explained, all efforts to find his unpublished memoir have not succeeded. Sir Andrew Balfour, protégé of Sir Henry Wellcome and a man who had overseen the building of the Wellcome Lab on the Nile (housed in the Gordon College), and almost single-handedly rid Khartoum of malaria, fought depression for much of his life. In the end he lost the battle and at the age of fifty-seven, while in hospital in Kent, committed suicide. As a young man, and a former football player of note, he wrote a number of swashbuckling novels, served in the Boer War, accrued many friends and later, at least one adversary (Christopherson). He was a dedicated worker who drove himself to ill health on more than one occasion. I have not been able to explain with total confidence why Christopherson and Balfour, around 1906, came to serious disagreement. Balfour’s private papers from this period have not survived36 so the situation must be pieced together from letters (see chapter six): Christopherson’s furious letter to Said Shuquair on one hand, and Balfour’s enigmatic comments on the other hand. Sentences that might have remained unnoticed, were it not for how neatly they linked with the points of Christopherson’s attack, finally add up to a reasonable hypothesis. Christopherson, in contrast, never learned to be subtle. Balfour was the considerably more skilled than Christopherson in aiming a barb. He seemed to be able to engineer slights that few but he

34

Obituary: BMJ 29 March, 1958. BMJ 29 March, 1958. 36 I have examined his early diaries. WA/BSR/BA/Sci/B in the Wellcome Library and a number of letters he wrote from Granada and places other than Sudan. He was neat and dedicated. He wrote detailed accounts of his expenses for cigars, laundry and the like in his very small compact diaries. In one letter to Henry Wellcome in 1906 he mentions the ‘vile climate’ of Sudan. There is not one word pertaining to his relationship with Dr. Christopherson. 35

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for whom it was intended would recognize. For instance, in a lengthy paper, Medical Science as a Factor in Imperial Development 1870–1921, Balfour discussed many of the tropical illnesses that had plagued India and Africa. As he began talking about bilharzia he spoke of Bilharz, the German working in Egypt who had first described the fluke that lived in the blood vessels. He mentioned Sambon in 1907, “. . . who contended that there must be two species of human schistosome and proposed for them the names S. mansoni (with lateral spined eggs) and S. haematobium (with terminal spined eggs).” He then mentioned S. japonicum and further work by Leiper, and he named others. It comes as no surprise to see that Christopherson’s name was not mentioned. Balfour concludes this section by saying “While there has been other helminthological work of scientific importance and not devoid of practical interest, it cannot be said to be germane to our subject and so may be discarded.”37 Christopherson would have been furious had he read this. Balfour’s explanation could be that he was speaking of helminths, not treatments. And in that sense he would be right. Christopherson’s temperament was such that he was not likely to look back on his and Balfour’s mutual disaffection and wonder if he could have handled things differently. Presumably, this sort of on-again off-again battle, a nebulous one-upmanship, was just a part of life. It is noteworthy that Christopherson had good relations with the next two Wellcome directors. The Wellcome Lab on the Nile was an extraordinary and generous gift to tropical medicine, to science, and to the people of Sudan. It began with much fanfare as a centre for gathering samples of everything—animal, vegetable and mineral. Balfour saw to it that, over the thirteen years he was director, there were a number of handsome Reports showcasing impressive accomplishment, and papers by medical men then serving in Sudan. In spite of a near-disastrous fire in May 1908 when the library and parts of the laboratories had to be rebuilt and refurbished, the work had continued. Scientifically, the Wellcome Tropical Laboratory on the Nile put Sudan on the map. Regrettably the Lab’s glory days were interrupted both by the war and by Balfour’s departure in 1913. After he left, there was a squabble over who should pay for continuing the rather sumptuous Reports, and

37 Andrew Balfour. Medical Science as a factor in Imperial Development 1870–1921. Paper written circa 1929–30. LSHTM archive Ref. GB 0809 Balfour/01/26.

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no more were published. This is not to say nothing was accomplished. The second director, Dr. Albert Chalmers, ran the laboratory from 1913–1920 and, as Patrick D’Arcy pointed out “the systematic study of tropical diseases was undertaken.”38 On this same page D’Arcy wrote . . . in 1919, Christopherson successfully treated seventy cases of the disease in Khartum Civil Hospital using intravenous tartar emetic or potassium antimony tartrate. A plaque recording this hung in one of the wards of the hospital; one hopes that it still remains, for it recorded one of the most significant contributions to tropical medicine made by any member of the Sudan Medical service.39

Christopherson seems to have got along well with Chalmers. Th ey published two papers together, one in 1914 and a second in 1916. Robert Archibald was the third Director of the Wellcome Tropical Research Laboratories as it had been renamed in 1911. After Balfour’s term ended he also published a paper with Christopherson. This signalled a lessening of tension between the Wellcome Labs and the director of the two civil hospitals. It is not surprising that Gordon College grew and eventually needed the wing originally dedicated to the Wellcome Labs. “Therefore, in 1927, the laboratories were transferred to a new building, the Stack Laboratories, adjacent to Khartoum Civil Hospital [named in honour of Sir Lee Stack, former governor-general of Sudan, assassinated in 1924] and the Kitchener School of Medicine.”40 In the 1930s further difficulties arose due to this need for expansion and to the introduction of other research labs in Khartoum. Henry Wellcome made a generous offer to fund a new Wellcome Lab in a place of his choosing, a preferred piece of land facing the Nile. Under Sir Stewart Symes, Sirdar at the time, the offer was turned down. As D’Arcy puts it, “It was an unfortunate clash of personalities between Wellcome and a British official of the Sudan Government . . .”41 This greatly offended Wellcome and was seen by a number of people as a bitter blow, and as a disservice to Sudan. I read Sir Stewart Symes’ biography, Tour of Duty, with care, looking

38 Patrick F. D’Arcy. Laboratory on the Nile: A history of the Wellcome Tropical Research Laboratories. (London. Pharmaceutical Products Press, 1999), p. 253. 39 Ibid. It is not known if this original plaque is still there, there is a new plaque outside the ward, dedicated in 2003. 40 Ibid. p. 250. 41 Ibid. p. 252.

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for mention of Sir Henry Wellcome’s offer.42 There is not one word of Wellcome or of his offer.

The Condominium: Looking Back Historian Martin Daly wrote: “Personality, not policy, determined the course of the Condominium . . .”43 This seems particularly apt when the history of the first two decades is revealed through the life of Christopherson, his colleagues, and the SMD. The Department and the hospitals, while not the hub of the administration, were necessary components. Everyone out there got malaria, scorpion stings or some sort of injury, so clean efficient hospitals, good nursing, and competent physicians were important. In addition, western medicine was a tool to instill confidence and by extension gain power and authority. There were military hospitals if you were military, civil hospitals if you were not. There were pharmacies and clinics, and everyone knew Dr. Christopherson was the best surgeon. By the 1920s, those who had gone out two decades earlier had begun to retire. The climate had a deleterious effect on health of some, and the Boer War and the First World War had sapped the strength of others. Some had married and were considering raising children back in England, rather than sending them home at the magic age of seven, as was the custom in the Indian Civil Service and Indian Medical Service. Many young Sudanese and Egyptians, often those who had been educated at Gordon College and trained in the ways of the west, unsurprisingly became dissatisfied with their lives. They began to think in terms of advancement from their low-level, low-paid, desk work. The British who had trained these men to fill such positions soon found that the best of them were anxious to gain a step on the ladder of success and find positions of authority in their own country. Most of such problems that surfaced more vocally, including the assassination of Governor Lee Stack in 1924, occurred after Christopherson left. Retrospective views of the Condominium from the late twentieth century are characterized by generous phrases describing the people

42

Stewart Symes, Tour of Duty. (London: Collins. 1946). Martin Daly. Empire of the Nile: The Anglo-Egyptian Sudan, 1898–1934. (Cambridge: Cambridge U. Press. 1986), p. 452. 43

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of England and Sudan as “The best of enemies”44 or having been held by Bonds of Silk.45 Now when Sudanese and British get together for a conference, there is the atmosphere of a family reunion. Those older men, and some women, both Sudanese and British, who were serving later, shortly before Independence, exhibit a great regard one for another, and an atmosphere of camaraderie exists. They were no longer ruler and ruled. Recent Sudan Studies Conferences that I have attended show the same spontaneous informality between participants from the two countries. The Sudanese are known for their courtesy and friendliness and wonderful hospitality.

Post-Script: Christopherson’s Family Joyce and Diana moved to Chichester. Why in particular did they pick that town? I asked her nephew Peter Ormerod. “Well, it was a pretty cathedral town,” Joyce lived on to the great age of ninety-five and a half, “her mind clear as a bell until the last two weeks.” He also told me that Jack and Joyce had known Howard Carter, the great archeologist and discoverer of the tomb of Tutankhamun. Peter remembers hearing of Jack’s comment at the time of the discovery in 1922: “I’d love to have a bit of his liver!” Decades later, in 1972, when Joyce and Diana were waiting in line at the British museum to see the newly opened Tutankhamun exhibition they were recognized, fished out of the queue, and, as friends of Carter, given the royal treatment. Walter Ormerod and I had many discussions about Christopherson.46 Walter, not un-naturally, feels that his uncle got a bad rap and that his is a case where ‘the good is oft interred with their bones.’ His comment on the London School of Hygiene and Tropical Medicine was that it was a den of infighting and academic shenanigans. He should know; he spent thirty years on the faculty.

44 The Sudanese-British Relations. Papers From an International Conference Khartoum, (Khartoum: Khartoum U. Press. Feb. 2001). 45 F.M. Deng M.W. Daly. Bonds of Silk: The Human Factor in the British Administration of the Sudan. (Michigan: Michigan State U. Press. 1989). 46 Parasitologist specializing in sleeping sickness. He is nephew by marriage to JBC.

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It is now more than a hundred years since the founding of the London and Liverpool schools of tropical medicine in 1899 and over ninety years since Christopherson discovered the use of tartar emetic for treating schistosomiasis. His contributions, both in setting up a formal medical department and in his pioneer bilharzia work, were substantial. Looking back at the diseases of the tropics from the distance of a century helps to view these pioneer events as a chain of medical successes. His antimony cure stood for almost sixty years. One can still meet people who received those injections. Nevertheless, his treatment will not wipe out the disease as total success is dependent on behaviour of people, mainly the poor, living and working near fresh water in the tropics. Although I have been researching and writing this book for eight years, I had not seen much really new or encouraging on the subject of schistosomiasis until recently. First, word of a new drug for schistosomiasis filtered out in the scientific literature, beginning with an article online on 16 March, 2008 in the influential journal Nature–Medicine, and in a few days this was taken up by NIH News and others.47 In short the “chemical compounds known as oxadiazoles can inhibit an enzyme vital to survival of Schistosoma, . . .” and holds promise against the three major schistosome species infecting humans. Second, in August, both CNN and the BBC World News offered the curious story of the ‘Cockroach of the Nile.’ Just exactly how an American crayfish came to be found in the Nile, on the one hand wreaking havoc on fishermen’s nets but on the other conveniently gobbling up the snail (bulinus, the intermediate host for the bilharzia worm), has become entangled in an example of urban myth. It certainly made a good story, embellished by showing Egyptians cashing in on the possibility of serving the crayfish as culinary delicacies. In fact this crayfish (Procambarus Clarkii) had been written about by a group of Kenyan, Mexican and American scientists back in 1999.48 Their interest was in considering the crayfish as a possible predator, to clear the snail-infested waters in Kenya. The investigators found that “. . . snails which were initially abundant, essentially disappeared following crayfish

47 A.A. Sayed, et al. Nature Medicine 14, 407–412 (2008) and followed shortly by Nature on 20 March, NIH News etc. 48 Mkoji et al. Am. J. Trop. Med. Hyg. 61(5). 1999, pp. 751–759.

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introduction. Children at the experimental school were more than 3 times less likely to acquire infections . . .”49 Questions remain regarding the impact of the snail on the local freshwater ecosystems. The question that seems not to have been asked is “If the crayfish eat the infected snails and humans eat the crayfish, are humans infected with bilharzias?” I wrote to Dr. Martin Taylor, recently retired from the London School of Hygiene and Tropical Medicine and an authority on schistosomiasis. He suggested, “It is possible to get schisto by the oral route either by taking in cercariae when swimming (they can penetrate the oral mucosa but of course would be killed by stomach acid if . . . swallowed) or by eating snails if these had mature cercariae inside them . . . So if you ate a raw crayfish which had not yet killed the cercariae within its snail snack you could I suppose get schisto but the odds of all this happening would be vanishingly small . . .”50 This all brought to mind the old Yorkshire song “On Ilkla Moor Baht Hat,” where someone who forgets to wear a hat, takes cold, dies and is buried. Then worms eat the body, ducks eat the worms and we eat the ducks—completing the circle!

European Responsibility in Africa? Having taken over (conquered) a people, is there not an obligation to offer a health service? The British brought western medicine and ‘bestowed’ it on the Sudanese. They certainly did much good, but also brought, in the name of progress in the 1920s, more disease, as with the spread of schistosomiasis. a result of the Gezira cotton-growing industry. Sudan needed to generate income to run the country, but the spread of the infected snail through irrigation canals was a perfect example of good intentions and unforeseen consequences. The British were well aware that this was a likely problem, they had discussed the subject years earlier but, lacking a better plan to inhibit the spread of snails, went ahead anyway.51 (The Three Gorges Dam in China has caused a similar effect in the Yangtze River.)

49

Ibid. p. 757. Prof. Martin Taylor, e-mail to author 21 October, 2008. 51 The British did make considerable effort to control the movement of people from infected areas, subjecting them to medical inspections and treatment at border crossings. 50

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Sir Stewart Symes, in 1946 writing of his African experience with mission schools (this included Tanzania, then Tanganyika, as well as Sudan), noted “. . . a marked decline in native morale . . . it was becoming evident that the trouble was deep rooted, and a direct consequence of subversion of natives’ traditional beliefs accompanied by rapid change in their social and economic conditions.”52,53 There is glimmer here that Sir Stewart saw that ‘civilizing the natives’ from a Eurocentric point of view might not work, or at least not work peacefully or profitably for anyone. Many serving in Sudan had a great interest in anthropology, and Christopherson was no exception. It was not the kind of anthropology studied today, where conditions of health, daily life and so on are examined from the patients’ interpretation of their condition. The ‘natives,’ as the Sudanese were then referred to, were looked on as curiosities; and their behaviour and culture were contrasted with the white man’s image and culture. Their medical and cultural practices were noted by Christopherson and others as something to be remarked upon, rather than understood as part of a larger, valid belief structure. He did have one succinct message drawn from his experience of working with other than Europeans: “Medicine and Religion are incompatible when mixed in the same bottle”54 Of course, by this he meant ‘western medicine’ and non-western religion. Christian missions were forbidden in the northern half of the country for fear of stirring up any fanatical Moslems, and this rule was strictly adhered to despite the energetic efforts of the affable Bishop Gwynne. Christopherson held the post of medical advisor to the Universities’ Mission to Central Africa (UMCA) for many years. In this case, he was not overtly proselytizing but interviewing physicians for missions in the south. This was an honorary post, and it is doubtful that he ever received any financial reward for his work. As he wrote to Joyce many years later: “Missionary Societies are built up on sentiment, Providence is their financial Secretary and he lets them down very often.”55

52 1909–1912 Assistant-Director of Intelligence at Khartoum; 1934–40 GovernorGeneral of the Sudan. 53 Stewart Symes, Tour of Duty. (London: Collins, 1946), p. 238. 54 JBC to Joyce. SAD 407/6/19. 55 JBC to Joyce 8 January, 1936, about the time he resigned from the organization.

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Christopherson’s involvement with the UMCA spanned years. In 1921 he wrote an eight-page impassioned article for Central Africa, the journal of the UMCA, calling for better financing for medical missionary doctors. This included a glowing endorsement of the London School of Tropical Medicine whose “. . . regular school curriculum . . . is a three months strenuous course . . . in medical zoology, . . . pathology, diagnosis and treatment of disease of the tropics and full instruction in hygiene and public health appropriate to tropical countries. It is no ordinary holiday task.”56 He may have been a bit over-ambitious when he wrote: “The cure of such tropical disease [as ankylostomia, bilharzia, yaws, malaria, dysentery] is almost a matter of mathematical calculation. Every year a hitherto incurable tropical malady becomes a simple and quite curable disease.”57 In this article he made a effort to persuade the British Government to see that Africa should not be seen as a black man’s country, nor for that matter a white man’s country, but rather to see the problem as doctors see the country, as a country fit ‘for a man to live in by making it healthy.’ Labour is needed for trade opportunities, and better health would solve the labour question. He wisely suggested that the ‘natives’ must be educated to understand where and how they contracted their illnesses. He saw the medical man in Africa as the modern ‘pioneer of civilization’ and cautioned, as he had years ago in Sudan, that ‘As the native only judges by results the doctors should be adequately equipped to make the result successful.”58 In a footnote to his article for the UMCA on Medical Work at Magila, German East Africa, Christopherson advocated “Quinine and petroleum59 should be supplied gratis to any one in a tropical country who will use them properly against malaria.”60 At Wad Medani in about 1908 at dinner in the home of Dickinson Bey61 one guest ventured: “Don’t you see . . . that it is all hypocrisy to say that we are here only for the good of the people. If they gain by our

56 Christopherson, J.B. The Medical Work of the U.M.C.A. Central Africa. (No. 461. May 1921), p. 86. 57 Ibid. p. 86. 58 Ibid. p. 91. 59 A layer of petroleum was poured on water containers or puddles to suffocate the mosquito larvae. 60 Christopherson, J.B. The Medical Work of the U.M.C.A. Central Africa. No. 461. May 1921. 61 Dickinson Bey, Col. Ernest Arthur Dickinson (1864–?) Governor Blue Nile Province 1905–1914).

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administration of the country, so much the better for them, but we are here—so far as I know—in the interests of the Empire!” a remark that “fell quite flat with the rest of the company: none of them took [it] up or even smiled.”62 I considered whether Christopherson would have taken up this line of argument. My impressions after reading hundreds of letters, his and others, that he believed he was there to care for the sick. This he did.

Christopherson’s Legacy What is Christopherson’s place in the history of Sudan? His name is found almost exclusively by those trawling the early twentieth-century issues of the Lancet and BMJ, the J. of Tropical Medicine and Hygiene and one or two books on parasitology. The Wellcome Lab, although dismantled as such in Sudan, already had a distinguished place in the pharmaceutical world, and in continued work as the Wellcome Bureau of Scientific Research in London, under the direction of Sir Andrew Balfour. In time Henry Wellcome’s empire grew to fund research worldwide and the newly renovated building on the Euston road is acknowledged as the most significant centre for the history of medicine in the world.63 Christopherson’s legacy was the founding of the Sudan Medical Service, the building of the Khartoum Civil Hospital, the bringing in the first British nurses (Barts Sisters in fact) and, more importantly, his establishing and gaining the trust of the Sudanese and his discovering and teaching the cure for bilharzia. But above all, what stand out are his refusal to go along with the hierarchical rigidity and his ignoring of the exclusionary tactics of the Administration. His stance was not admired, it was maintained at considerable personal cost, but he hung on, living and working there for almost two decades, adhering to his beliefs. He was one of the very early medical pioneers, he loved his work, his friends and his patients. He also adored his wife and supported both his and her large family in personal medical care and, where necessary, financial help. He retired to Gloucestershire knowing he had made a 62

Yacoub Pasha Artin. Trans. George Robb. England in the Sudan. (London: MacMillan & Co. Ltd. 1911), 123. 63 The Wellcome Institute, after the Gates Foundation, is the most heavily funded science and medicine foundation in the world.

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difference, and that his discovery of tartar emetic for the treatment of schistosomiasis had improved, and sometimes saved the lives, of many. Tartar emetic was still in use at the time of his death in 1955. His colleague and admirer, the South African doctor, F. Gordon Cawston of Durban, who took Christopherson’s early work and carried it further by contributing dozens of articles on the use of tartar emetic for bilharziasis, added a final flourish to his 1934 paper: “To the sacrifice of the death of General Gordon in Khartoum on January 26, 1885, we owe the salvation of the Sudan and the establishment of the Sudan medical service with the discovery of the routine treatment of bilharzia disease in 1917.”64 For some reason he did not name Christopherson for this work of ‘salvation.’

Khartoum Civil Hospital in 2003—Vindication It was serendipity when the indispensable Google led me to an article in the Bulletin of the Postgraduate Medical Studies Board (published in Khartoum), discussing the history of the Sudan Medical Department. Prof. Abdel A’ Al Abdella Osman, had written about Dr. Christopherson and other early medical pioneers, and his editor, Prof. Mohamed ElMakki Ahmed, when contacted, invited me to visit Sudan and to give a short talk at their upcoming schistosomiasis symposium. I accepted, and was delighted to discover that the event was to be held in February of 2003, in the old Khartoum Civil Hospital (Christopherson’s old hospital), now the Sudan Medical Specialization Board, and that the papers were to be presented in the original men’s ward where Christopherson had done his experimental work in 1917.65 The programme consisted of two sessions: the first, an Introduction followed by the Christopherson Memorial Lecture by Prof. Mamoun Humeida: The Evolution of AntiBilharzial Chemotherapy. My talk Dr. J.B. Christopherson Rediscovered, was followed by the unveiling of a memorial plaque by H.E. the British Ambassador in Khartoum. The second session included five papers on

64 F.G. Cawston, The Treatment of Bilharzia Diseases by Antimonium Potassium tartrate with the Consideration of Claims advanced for Other Remedies. J. of Trop. Med. and Hygiene, (15 December, 1934, Vol. 37. No. 24), p. 386. 65 The conference was organized by Prof. A/Rahman M. Musa, President of the SMSB.

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various aspects of present-day schistosomiasis.66 Following all was a sumptuous lunch for all present. In Khartoum that day, I met Dr. Halim, the most senior and most revered physician in Sudan.67 Dr. Halim remembered Dr. Hasan Zaki and told me that when Zaki was very old he became incompetent and started writing cheques to everyone. In consequence, he was brought before a ‘board’ to certify that someone must be given a Power of Attorney to act for him. Before we left one physician came up to me saying: “Your great uncle is a hero to us in Sudan!” Old ‘Christo’ would have been proud. Back in 1921 Rudolph Slatin Pasha had dubbed his friend appropriately, “The Sheikh of Bilharzia.”68

15.1. Plaque honoring JBC, at the original Khartoum Civil Hospital, unveiled in 2001. (Now home to the Sudan Medical Specialization Board.)

66 Hepatic Schistosomiasis by Prof. Ahmed Mohd Elhassan; Immunological Impacts of Schistosomiasis by Dr. Nasr Eldin Elwali; Non-Surgical Management of Portal Hypertension by Prof. Suleiman Saleh Fedail; Surgical Management of Portal Hypertension by Prof. Shawgi Elmasri and Urological Aspects of Schistosomiasis by Prof. A/Raouf Sharfi. 67 Recently honoured in his previous capacity as first president of the African Soccer Union. Dr. Halim has many interests besides being the most senior physician. He is a poet and was member of the presidential council of the Republic in early 1964–69. Personal communication. Rasheid, (Dr. Mohamed El Makki Ahmed) 16 February, 2007. 68 Sir Rudolph Slatin to Joyce Christopherson. 20 December, 1921.

APPENDIX A

AN ANALYSIS OF J.B. CHRISTOPHERSON’S DOSING METHOD1

Christopherson was moving into a relatively unknown and risky course of medication. He went directly to the treatment of his patients. He was rightly cautious in adapting the dosage to the response of the patient. Earlier users of tartar emetic, like Rogers,2 had not, to the best of his knowledge, reported any relationship between patient characteristics—weight or age—and the dosage regimen. Like them, Christopherson reports almost no information about patient characteristics. However, in the medical data that were kept of his treatments with tartar emetic, the ages of thirty-three patients, and the weight of one of them were noted. Each ‘treatment’ was an experimental trial aimed at finding a patient’s maximum dose acceptance by a progressive increase while monitoring the response. He then continued the maximum tolerable dose until the parasite was sterile or dead: i.e. there were no further excretions of the ova of the parasite. His published papers taught his readers how to repeat his experiment, and admonished them to take great care. For example, in his first publication he advises, . . . 2. A proper sense of responsibility when injecting remedies directly into the general circulation via the vein. 3. The due appreciation of the fact that the drug injected is a poison, and that its reckless use will kill the patient. 4. The exercise of judgment as to dosage and length of time of administration, stopping altogether, suspending, increasing dosage, according to circumstances.3

He did not show them how to estimate the amount of tartar emetic required to kill the parasite without harming the patient.

1

Prepared with the assistance of John W. Senders. Prof. Emeritus U. of Toronto. Vianna, Rogers, Coronia, et al. 3 J.B. Christopherson. The use of Antimony in bilharziosis. The Lancet. (7 September, 1918), p. 327. 2

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appendix a Christopherson’s Data Re-Examined

When we examine his available records with a more modern eye we find that, even if a patients’ weight is unknown, age, as a surrogate measure, would have permitted a reasonably accurate calculation of the necessary dose. It would have been important information, helpful to the practitioners of that time. Although most of his patients were young men, some merely children, given their circumstances, probably none would have been over-weight and some might have been under-weight. We have analyzed his data on ‘the thirty-three’ with the hypothesis that age would serve as a useable surrogate for weight. Their ages, and the doses (in grains) given to each of them every second day, and the durations of treatment (in days) were our data. We have calculated the correlations between age and days of treatment, age and total number of grains administered, and age and the daily dose, i.e., the total number of grains divided by the number of days of treatment.4 The results of the calculations follow. Our first observation is that the correlation between age and duration of treatment is effectively zero. This is clearly shown in Figure 1 below. Our second observation is that the total dose increases with age; and the correlation between age and total dose is 0.46 (0.95 CI: 0.14–0.69).5 See Figure 2 below. Finally, our third observation is that the per diem dose (total dose divided by duration of treatment) is even more closely related to age with a correlation between age and per diem dose of 0.63. (0.95 CI: 0.36–0.80). See Figure 3 below. These latter two correlations are significant, and their 95% confidence intervals encompass nicely the range of probable age-weight correlations. We do not have information about the correlation between male body weight and age in Sudan in 1917/1918 and it is unlikely that such

4 The Pearson ‘product moment correlation’ shows how much of the variability of the obtained data, ‘daily dose’ for example, can be attributed to the common variable, ‘age.’ If the correlation is high, then age of a patient allows a good estimate of the number of grains that need to be administered per day (or alternate days) to achieve a cure. If the correlation is low, it is of little value in estimating what dose to use. The correlations we obtained c.0.46 and 0.60, are large enough to be of assistance to the clinician. The abbreviation for correlation is ‘r’. 5 “0.95 C.I.” is the 95% confidence interval. It means, in this case, that we can be 95% sure that the real value is between the limits stated.

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DAYS IN TREATMENT

60 50 40 30 20 10 0

0

5

10 15 20 PATIENT AGE IN YEARS

25

30

TOTAL DOSE-GRAINS

Fig. 1. Days in treatment as a function of patient age (r < 0.01) 40 35 30 25 20 15 10 5 0

0

5

10 15 20 PATIENT AGE IN YEARS

25

30

Fig. 2. Total dose as a function of patient age (r = 0.46); dose = (1.18 × years) gr. 1.6

DAILY DOSE-GRAINS

1.4 1.2 1 0.8 0.6 0.4 0.2 0

0

5

10 15 20 PATIENT AGE IN YEARS

25

Fig. 3. Mean daily dose as a function of patient age (r = 0.63); dose = (0.04 × years) gr.

30

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information could be found. It is reasonable, however, to assume both that the correlation between age and weight was between 0.40 and 0.60 (in the age bracket from 8 to 25 years), and that his method ended up essentially equivalent to a weight-based dosing. One is tempted to imagine that the departures from the regression line of Figure 3 are actually reflections of variation (from the regression line) of the body weights of the thirty-three young male patients who were his subjects. If Christopherson had recorded the ages of all his patients and made the same calculations that are presented here, his claim to have made a significant medical breakthrough would have been even stronger and his followers would have been better instructed in how to replicate his success. After assessing the general health of the patient, and their possibility of being infested with other parasites, the physician would have only to weigh the patient and arrive at a safe and (probably) effective dose, followed of course, by careful observation for inappropriate response. The one patient whose weight we know, patient number ten, was 12 years old and weighed 70.5 pounds and received a total dose over 48 days of 30.75 grains. His per diem dose was therefore 0.64 grains. His per diem dose per pound was therefore c. 0.01 grains/pound/day until cured; or, with Christopherson’s alternative day dosing, 0.02 grains/pound every other day. The dose calculated on the basis of his age would have been 0.48 grains per day, somewhat less than the dose arrived at by Christopherson on the basis of the patient’s reaction. An instruction to weigh the patient and administer an easily calculated amount (weight in pounds times 0.01 equals the daily dose in grains) is more likely to be followed in a reliable way. The physician must still be careful, but the success of the treatment and the avoidance of patient injury would not depend so heavily on vague imponderables. Of course all this is easy to say from the distance of a hundred years and in very different physical circumstances. Like his contemporaries, Christopherson did not plot his data in graphical form, nor appear to see the utility of plotting dosage as a function of age, height or weight. However one must also ask whether such visual presentations of data in graphic form, as opposed to tables, may have arisen in the medical world after the years of his education and even after his early work on tartar emetic and bilharzia. With this in mind we undertook a rather cursory but informative examination of the pages of The Lancet. We found in the 10 December, 1910 issue, a plot of a dependent variable as a function of patient age. By 1915 we

an analysis of j.b. christopherson’s dosing method

395

found several graphs, one for example showing the duration of breast feeding and its distribution, i.e. the number of instances of breast feeding for various periods of time. The dependent variable was the number of patients who had breast fed for each particular interval of time (in months). But data in these early years of the twentieth century were still being largely presented as straight text as well as in tables. By 1920 plots of variables as a function of time had become more common. Generally, data in the early years of the twentieth century were still being presented as straight text as well as in tables. By 1920 plots of variables as a function of time had become more common. We conclude that Christopherson was not alone in his failure to see the utility of data plots of dependent variables as a function of relevant independent variables, such as age, height and weight.

The Role of the World Health Organization (WHO) in Recent Decades WHO, faced with the non-availability or untrustworthiness of scales in isolated and primitive circumstances, have introduced the use of ‘dose-poles’ that facilitate the use of patient height as a surrogate for weight. These are described in the Carter Center Report: “Schistosomiasis: New York Times Feature Examines Vicious Cycle of Disease” 22 December, 2004.6 The article explains how a pediatric parasitologist demonstrates this method in hard-to-reach villages where the parasite is rife. A “. . . stick with yellow, green, blue and red bars . . . [uses coarsely scaled children’s heights to quantify doses] Those who reached yellow, 35 inches tall, were handed one pill [praziquantel]. The tallest children were handed four, which they swallowed with a cup of water dipped from a cooking pot.”7 This method has been found to be inexpensive, simple, and reliable enough to be used in remote settings by nonmedical staff. A plot of dose against patient height would have yielded pretty much what can be extracted from JBC’s data on patient age. I learned recently that although the general idea had actually been used for some years, the calibration of the intervals of the pole for use in dispensing

6 Originally published in the Nov. 2, 2004 issue of The New York Times. By Donald G. McNeil, Jr. 7 Op. cit. Carter Report.

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Praziquantel had been worked out by Dr. Antonio Montresor of the WHO in Geneva.8 His colleagues kindly sent me, at no charge, their own photo of the pole in use, obviating the need for my paying $250.00 to the N.Y. Times for a similar photo.9

A.1. Dose-Pole in use in Africa

8 9

Dr. Montresor kindly verified our calculations for the graphs. With thanks also to Drs. Lorenzo Savioli and Albis Gabrielli.

APPENDIX B

PUBLISHED PAPERS AND LETTERS BY J.B. CHRISTOPHERSON

1. Single non-tuberculous ulcer of the bladder: Suprapubic cystotomy: Cure. BMJ. (29 March, 1902): i. 771. 2. Imperfect descent of testicle, both testicles in the same inguinal canal, one rudimentary. BMJ. (7 February, 1903): i. 302. 3. Case of peripheral neuritis, probably rice produced, simulating beri-beri, from Omdurman, Soudan. J. of Tropical Medicine. (15 May, 1903): vi. 6–154. 4. Haemorrhage into the bursa patellae. BMJ. Memoranda. (22 August, 1903): ii. 414. 5. JBC. & A. Webb Jones Two cases of hypertrophied breasts in the male (Gynaecomastia) The Lancet. (26 March, 1904): i. 865. 6. Trypanosomiasis in the Egyptian Sudan. J. Royal Army Medical Corps. (1905): v. 139. 7. A curious case of lipoma, not uncommon in the Egyptian Sudan, taking the form of an apronlike fold extending as far as the middle of the thighs. J. Army Medical Corps. (1906): 355–6. 8. Health in the Sudan: Extract from a report. St. Bartholomew’s Hospital Journal. (July 1906): 152–3. 9. The Sudan Medical Service—letter to editor St. Bartholomew’s Hospital Journal (October 1906): 14. 10. A case of hydatid cyst of the left ventricle, together with some remarks on hydatid disease in the Anglo-Egyptian Sudan. J. of Trop. Med. & H. No. 21, Vol. 12. (1 November, 1909): 317–18. 11. Khartoum. Spirillum in Relapsing Fever. Telegram to J. of Trop. Med. & H. (15 November, 1909): ii. 347. 12. Spirillum found in cases of Relapsing Fever in the Sudan. (Telegram) Note in J. Trop. Med. & H. (1 December, 1909): xiii. 353. 13. Earth eating in the Egyptian Sudan. J. of Trop. Med. & H. (1 January, 1910): viii. 3–7. 14. St. Bartholomew. Patron saint of St. Bartholomew’s Hospital, London. St. Bartholomew’s Hospital Journal. (March 1910): xviii. 83–84.

398

appendix b

15. Necator Americanus in the Bahr-El-Ghazal province of the Anglo–Egyptian Sudan Letter. J. of Trop. Med. & H. (16 May, 1910): 146. 16. A reminder of the battle of Omdurman. Shrapnel in leg for 11 years. The Lancet. (1 October, 1910): ii. 1010. 17. Lead bullet removed from metatarsal bone after 23 years. The Lancet. (2 December, 1911): ii. 1154. 18. The mutilation of wounded on the battlefield: A case described. Annals of Tropical Medicine (Parasitology) (1914–15): viii. 129– 135. 19. JBC. & Albert J. Chalmers, Murmekiasmosis Amphilaphes. J. of Trop. Med. & H. No. 9. (1 May, 1914): xvii. 129–135. 20. On a case of naso-oral Leishmaniasis (corresponding to the description of Espundia): and on a case of oriental sore, both originating in the Anglo-Egyptian Sudan. Annals of Trop. Med. (1914–15): viii. 485–494. 21. A simple ulcer of the oesophagus: perforating the descending portion of the aortic arch and causing fatal haematemesis. The Lancet. (10 March, 1917): i. 367–371. 22. Large salivary calculus from Khartoum. Proceedings of the Royal Society of Medicine—Section Pathology. Pt. 3. (1916–17): x. 1–4. 23. Fractured base of the skull: The subsequent history of the case and its termination 24 years after the accident. The Lancet. (22 September, 1917): ii. 458–459. 24. JBC. & Albert J. Chalmers, A Sudanese Actinomycosis. Annals of Trop. Med.—Section Parasitology). (1916–17): x. 223–282. 25. Notes on a case of espundia (naso-oral, Leishmaniasis) and three cases of Kala-Azar in the Sudan treated by the intravenous injection of antimonium Tartaratum. J. of Trop. Med. & H. No. 20. (15 October, 1917): xx. 229–236. 26. JBC. & J.R. Newlove, Clinical Notes: Medical, surgical, obstetrical, and therapeutical. A note on Oriental sore. The Lancet. (8 June, 1918): i. 802. 27. JBC. & M. Izzedin. Acute intestinal obstruction by Taenia saginata blocking of the ileocaecal valve needing laparotomy. BMJ (22 June, 1918): i. 697. 28. Osteomalacia sclerotica: boomerang bone, corkscrew bones etc. Proceeding of the Royal Soc, of Med.–Section Pathology. (1917–18): xi. 35–46.

published papers and letters by j.b. christopherson

399

29. JBC. & J.R. Newlove, The passing of Bilharzia worms in the urine. J. of Trop. Med. & H. (2 September, 1918): xxi. 180. 30. The successful use of Antimony in Bilharziosis. Administered as intravenous injections of antimonium tartaratum (tartar emetic). The Lancet. (7 September, 1918): ii. 325–27. 31. Intravenous antimony tartrate in bilharziasis. BMJ (14 December, 1918): ii. 652–3. 32. JBC. & R.G. Archibald, Primary nocardiasis of the lacrymal gland. The Lancet. (21 December, 1918): ii. 847. 33. Letter to Editor of The Lancet: Antimony in bilharziosis. (11 January, 1919): i. 79. 34. Antimony tartrate in bilharziosis and tachycardia. BMJ. (April 19, 1919): ii. 480. 35. The cure of Bilharzia Disease by the Intravenous Injections of Antimony Tartrate. J. of Trop. Med. & H. (16 June, 1919): xxii. 113–114. 36. Antimony tartrate for bilharziasis: a specific cure. The Lancet. (14 June, 1919): i. 1021–23. 37. JBC. & J.R. Newlove, Original Communication. Laboratory and other notes on seventy cases of bilharzia treated at the Khartoum Civil hospital by intravenous injections of antimony tartrate. J. of Trop. Med. & H. No. 14. (15 July, 1919): xxii. 129–144. 38. Intravenous Injections of Antimony Tartrate in Bilharziasis. Letter to the Editor. The Lancet. (16 August, 1919): ii. 299. 39. The cure of bilharzia disease by intravenous injections of antimony tartrate: The prophylactic action of the drug. BMJ (18 October, 1919): ii. 494. 40. Original Communications. The cure of Bilharzia disease by the intravenous injection of antimony. The prophylactic action far more important than the direct action on the adult worms. (Schistoma H and M.) J. Trop. Med. & H. No. 21. (1 November, 1919): xxii. 57. 41. JBC & R.G. Archibald, Case of primary nocardiasis of the lachrymal gland caused by a species of Nocardia hitherto undecided. Proceedings of the Royal Society of Medicine.—Section Ophthalmology. (6 November 1918): xii. 4–14. 42. JBC. & R.G. Archibald, Nocardiasis of the lachrymal gland (Actinomycosis). American J. Ophthalmology. Series 3. (1919): ii. 57.

400

appendix b

43. Egyptian bilharzial disease: a demonstration given on Friday November 21, 1920 before the Medical Society, Royal Free Hospital. Magazine of the R.F.H.L.S.M.W. 7–21. 44. Bilharzia disease: the sterilization of the ova during the course of cure by antimony (tartrate). J. Trop. Med. & H. (1 July, 1920): xxiii. 165–67. 45. A demonstration of the technique of intravenous injection of antimony tartrate in bilharzia disease. Proceedings of the Royal Society of Medicine—Section Tropical Diseases and parasitology. (1920): xiv. 18–21. 46. Letter to Editor of the BMJ. Antimony in Bilharzia. (14 August, 1920): ii. 256. 47. Letter to the editor of The Lancet. The time of day to give Antimony tartrate for bilharzia. (1 September, 1920): ii. 525. 48. On the action of tartrate of antimony in intravenous injections: The “permeability” of bilharzia ova and some protozoal organisms. BMJ. (4 December, 1920): ii. 854. 49. Discussion at Royal Society of Medicine Proceedings on the Ankylostomiasis campaign in Egypt. pt. 3. (1920–21). xiv. 74. 50. The Lancet, Report of the meeting of the Royal Society of Medicine. Christopherson demonstrated method of treatment of biharziasis by means of intravenous injections of sodium antimony tartrate in two patients, aged 48 and 40 who had become infected in South Africa during the war in 1900 etc. (11 December, 1920): ii. 1198–1200. 51. Further notes on intravenous antimony: Leucoderma and skin complaints: administration of large doses. The Lancet. (12 March, 1921): i. 522–525. 52. Bilharzial disease in Egypt BMJ. (2 April, 1921): i. 491. 53. The intravenous injection of antimony tartrate in Japanese bilharzial disease, BMJ. (8 October, 1921): ii. 551. 54. The “Blue Bodies” in Leishmaniasis. Proceedings of the Royal Soc. of Med.—Section of Tropical diseases and Parasitology. (1922–23): xv. 21–24. 55. Remarks upon a Photograph of an Endemic Focus of Bilharziasis Disease in Portugal: Specimens of the Intermediary Host, Planorbis dufourii (Graells). Proceedings of the Royal Soc. of Med.—Section Tropical Diseases and Parasitology. Part 3. (1922–23): 47. 56. The Lancet: Report of the meeting of the Royal Society of Medicine: neurology. Certain blue bodies seen in leishmaniasis. ( From meeting of Royal Society of Medicine.) JBC also read Dr. F.J. Harpur’s

published papers and letters by j.b. christopherson

401

letter: Canal Infection in Egypt. The Lancet. (18 February, 1922): i. 324–325. 57. Leishmaniasis of the Skin resembling Lupus Vulgaris. Proceedings Royal Society of Medicine—Section Dermatology. (1922–23): xvi. 48–50. 58. Case of leishmaniasis of the skin Proceedings of the Royal Society of Medicine—section Dermatology. (1922-23): xvi. 8–11. 59. Intermediary Hosts of Schistoma Haematobium and Mansoni in Nyasaland. Letter to Editor. BMJ. (8 September, 1923): 437. 60. The Curative Dose of Antimony Tartrate in Schistosomiasis (Bilharzia Disease). BMJ. (29 December, 1923): 1254. 61. Specimens of (1) Schistoma bovis and of its snail carrier: (2) the intermediate hosts of Schistosoma mansoni from Brazil. Proceedings of the Royal Society of Medicine—Section Tropical Disease & Parasitology. (1922–23): xvi. 56. 62. Lupus leishmaniasis: a leishmania of the skin resembling lupus vulgaris hitherto unclassified. Brit. J. of Dermatology and Syphilis, London. (April 1923): xxxv. 123–131. 63. The treatment of bilharziasis with antimony: J. Trop. Med. & H. Original Communications. JBC reply to J.E.R. McDonagh. No. 12. (15 June, 1923): xxvi. 211. 64. The Intermediary Hosts of the Human Trematodes, Schistosoma haematobium and Schistosoma mansoni in Nyasaland Protectorate. Letter to Editor Nature. No. 2812, (22 September, 1923): cxii. 436. 65. Longevity of parasitic worms: term of living existence of Schistosoma haematobium in the human body. The Lancet. (12 April, 1924): i. 742–3. 66. Treatment of bilharzia disease The Lancet. [A Series of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions.] LXXII. Modern Technique in Treatment. (24 May, 1924): i. 1071–2. 67. Prophylactic treatment of bilharzia disease (schistosomiasis) J. State Medicine London. Vol. 32. (1924): 367–381 [Originally presented to British Congress of Hygiene held at Bordeaux 5 June, 1924.] 68. Abstract of above paper in South African Medical Record. (26 July, 1924): 335–37. 69. Tartar Emetic in Bilharziasis. The Lancet. Letter to the Editor. (7 June, 1924): i. 1184.

402

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70. Foreword in Schistosomiasis Vel Bilharziasis by C.G. Kay Sharp. New York. William Wood & Co. (1925). 71. Cure of schistosomiasis by intravenous injection of antimony tartrate. Indian Medical Gazette. Calcutta. Vol. 60. (March, 1925): 108–111. 72. Rectal injection of tartar emetic for bilharziasis. (Correspondence ) BMJ. (7 November, 1925): 866. 73. Notes by a nurse on the treatment of yaws (Framboesia) with Novarsan. By Freda Wilson. Nursing sister attached to the Universities Mission in Central Africa) Introductory remarks by JBC. (Medical Examiner to the UMCA) J. Tropical Medicine & Hygiene. (1 December, 1925): 424–426. 74. JBC. & S.R. Gloyne, The biochemical action of intravenous antimony tartrate injections. The Lancet. (30 January, 1926): i. 227–229. 75. Bilharzia ova and the test tube. BMJ. (5 March, 1927): i. 418–19. 76. Discussion of the special uses of Antimony. Proceedings of the Royal Society of Medicine. Joint discussion No. 1 Section of Therapeutics and pharmacology with the section of tropical diseases and Parasitology. (13 November, 1928): 560–568. 77. Treatment of actinomycosis type of mycetoma. Proceeding of the Royal Society of Medicine—Section Trop. Disease & Parasitology. Vol. 21. (1927–28): 25–28. 78. Elimination of bilharzia disease. J. Tropical Medicine & Hygiene. Original Communications. Vol. 31. (16 April, 1928): 89–90. 79. National outlook on tropical medicine: President’s address. Proceeding of Royal Society of Medicine—Section Trop. Dis. & Parasitology. Vol. 22. pt. 1. (1 November, 1928): 1–6. 80. Report in The Lancet of discussion at the annual meeting of the BMA in Cardiff. Section Tropical Medicine, Human Helminthiasis. (1928): ii. 628. 81. Radioscopical diagnosis of filariasis. BMJ. (4 May, 1929): i. 808. 82. New pattern lipiodol trogar and cannula. Letter under “In New Inventions” The Lancet. (2 August, 1930): ii. 242. 83. Motive in women’s dress in the tropics. “Original communications.” J. Tropical Medicine & Hygiene. Vol. XXXIII. (15 July, 1930): 201–7. 84. Bilharzia disease in children Proceedings of the Royal Society of Medicine—Section. Tropical Disease & Parasitology. Vol. 23. (October, 1930): 43–54.

published papers and letters by j.b. christopherson

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85. Radio-stereoscopy of the chest. Tubercle. Vol. 12. (September, 1931): 532–539. 86. Chronic Bronchitis and its relation to the involuntary nervous system. The Medical Press. Hunterian Oration, read at the Hall of the Apothecaries Soc. 25 February, 1932. Part I. (11 May, 1932): 381–384. Part II. (18 May, 1932): 401–404. 87. The anatomy of asthma as disclosed by lipiodol investigation. The Lancet. (7 January, 1933): ii. 11–12. 88. Slatin Pasha: a friend of the British Red Cross Units in Serbia. Brief account of his career. British Serbian Units. (British Legion) Bulletin. Vol. 23. (February 1933). 89 Iodized Poppy-Seed Oil Investigation in Asthma. Reprinted from The Lancet of 7 January, 1933 in Journal of American Medical Association. Vol. 100. No. 16. (22 April, 1933): 1295. 90. Encysted pedunculated haematoma in the pleural cavity in artificial pneumothorax. Brit. J. Surgery Vol. 20. (1933): 532–536. 91. The Anatomy of chronic bronchitis & bronchial asthma as disclosed by lipiodal examination American J. of the Medical Sciences Vol. 186. (1933): 504–9. 92. JBC. & M. Broadbent, Ephedrine and pseudo-ephedrine in asthma, bronchial asthma enuresis BMJ. (2 June, 1934): 978–79. 93. JBC. & Broadbent, M. A new method of approach in certain respiratory disorders in elderly persons. British J. Physical Medicine. Vol. 9. (2 June, 1934): 77–80. 94. JBC. & R.O. Ward, Bilharzia disease in England: cystoscopic appearance of bilharzia before and after intravenous injections of sodium antimonyl tartrate. British J. Surgery. Vol. XXI. No. 84. (April 1934): 632–36. 95. Chronic Respiratory Disorders and the Autonomic System. Correspondence BMJ (30 March, 1935): 679–80.

APPENDIX C

CHRONOLOGY

World Events

J.B. Christopherson

1832 British Medical Assoc. founded. 1835 J. Malcolmson describes beriberi. 1851 Bilharz (1825–62) discovers the vesical blood fluke, Schistosoma haematobium. 1853 Queen Victoria accepts chloroform during the birth of her seventh child. 1865 Lister, first real test of antiseptics. 1867 Lister, operates using antiseptics. 1868 JBC b. Batley, Yorkshire. 1874 London Sch. of Med. for Women opens. 1877 Manson shows that mosquitoes transmit infective diseases. 1878 JBC educated Newcastle Royal Grammar School. 1879 Robert Koch, established the germ theory of disease. 1880 Alphonse Laveran observes the malaria plasmodium. 1882 Christopherson family moves 1883 Louis Pasteur vaccinates against to Falmouth, Cornwall. anthrax. 1885 Dr. A. Hughes Bennett & Sir 1883–1886 JBC educated Clifton Rickman Godlee credited with College, Bristol. first successful removal of a brain tumour. 1887 JBC enters Gonville & Caius College, Cambridge. 1897 Ross discovers parasite responsible for malaria. (20th August, ‘mosquito day’).

chronology

405

Table (cont.) World Events

J.B. Christopherson

1889 Infectious disease notification act. Manson becomes physician to the Seaman’s Hospital which served as the clinical facility to the School of Trop Med. that he established in 1899. 1890 JBC—BA 1893 JBC—MB, B.Chir. (Cantab) 1893–1902 Barts Hosp. variously House Surgeon, House Physician, Demonstrator of Anatomy. Also surgeon at Albert Dock Hosp. 1895 Wilhelm Röntgen takes first 1895–JBC—MRCS and LRCP. X-ray, of his wife’s hand. 1897–JBC—FRCS. 1897–JBC—Sr. Resident Med. Officer, at Evalina Children’s Hosp. London. 1898 Pierre & Marie Curie discover radium. 1899 19 January, Kitchener appointed first Governor-General of the new Sudan. 1899–1902 Boer War. 1900 JBC sails for South Africa & Boer War. Spends 8 months in S.A. 1901 Death of Queen Victoria. 1902 Jan. JBC arrives in Sudan. 1904 JBC Appt. Dir. Sudan Medical Dept. 1905–JBC—MRCP. 1907 Lord Cromer, British Agent, Egypt, retires. 1908 Serious and mysterious trouble in JBC’s dept. Council of Secretaries Investigate. 1909 Ehrlich introduces Salvarsan, 1909 JBC removed from Dir. of seen as the birth of S.M.D. Accepts job of Dir. chemotherapy. Omdurman and Khartoum Civil Hosps. 1910 May, King Edward VII dies. 1911 JBC before a Court of Enquiry.

406

appendix c

Table (cont.) World Events

J.B. Christopherson 1912 Sept. JBC marries Joyce Ormerod. 1913 FRCP.

1914 P.R. Phipps & A. Balfour leave Sudan. 1914–1918 First World War. 1915 JBC uses Rogers’ treatment 1915 Rogers and others use antimony for kala-azar (leishmaniasis). injections to treat leishmaniasis successfully. 1915 Sept. JBC joins Berry Red 1915 Leiper solves the problem of the Cross Unit in Serbia. Becomes intermediate host (the snail) for prisoner of war. 1916 Red Cross Unit rescued with bilharzia. help from Slatin Pasha. 1917 May, in Khartoum, JBC uses injections of antimony to treat bilharzia. 1917 Sept. JBC Secretary to Commission on Medical Establishments in France. The group inspects battlefields hospitals. 1918 November, First World War 1918–1920 & later, JBC publishes ends. on antimony for bilharzia 1919 visit by Sir P. Manson-Bahr & friends to Khartoum Civil Hosp. 1919 JBC & Joyce leave Sudan for England. JBC awarded CBE. 1920 Nominated for Nobel Prize for Med. Prize awarded to August Krogh of Denmark. JBC buys 29 Devonshire Place for home and ‘consulting rooms.’ 1921 Insulin treatment for diabetes 1920–24 In charge of Bilharzia developed in Toronto, Canada. Clinic, Min. of Pensions, London. 1924 Sir. Ronald Ross suggests nominating JBC for an FRS. This comes to naught.

chronology

407

Table (cont.) World Events

J.B. Christopherson 1926 Opening of the Ross Inst. London. 1926 JBC gives Hunterian Oration.

1828 Fleming discovers penicillin (not used clinically until 1940s). 1931 Jan. Death of Sir Andrew Balfour. 1932 Death of Rudolph Slatin.

1939–1945 Second World War.

1933 JBC & Joyce buy Heavensgate, Aylburton, Nr. Lydney, Glos. 1933 JBC Publishes Bulletin in appreciation of Slatin Pasha. 1935 JBC on BASE committee. (Ethiopia) 1936 JBC leaves London and retires to countryside, permanently.

1953 29 January, Wingate dies. 1955 JBC dies, in July, at home. 1956 1 January, Sudan declared a fully independent sovereign state. 1982 Joyce dies, in Chichester. Her funeral was in Cheltenham and her ashes taken to Aylburton church to join JBC’s.

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INDEX

Abbaye de Royaumont, 216 Abbeville, 251 Abbott, Peter, 312 Abdallah, Asha bint, 208 Abdin Mess, 99, 217 Abyssinian Refugees Relief Fund, 346 Acland, Theodore, 181 and appointment blunder, 122 and Court of Enquiry, 200, 210, 318 as Wingate’s doctor, 125, 193–194, 198, 373 Addis Ababa, 341, 345–346 Adeel, Ahmed, 152, 157–158, 168, 169, 321 Afrikaner/Boer nationalism, 70 Ahmed, Mohamed El-Makki, 389 Albania, 219 Albert Dock Hospital, 5, 11 see also Seamen’s Hospital Alexandria, 217 Allah Laughed, (Beveridge), 312 Allen & Hanburys, 16, 17 Alnmouth, 372 Alsebrook, David, 288n41 American Association of Nurse Anesthetists (AANA), 263 amputation, 311–312 An Ethiopian Diary, (Macfie), 352 Ancona, 231 Anderson, Capt. R.G., 153, 155–156 Anderson, George W., 99n9, 217 Anderson, John, 291 Anglo-Egyptian Condominium, 1 explained, 12, 22, 27 Anglo-Egyptian Sudan, The, (Gleichen), 28 ankylostomiasis (hookworm), 9, 366 Annals of Tropical Medicine and Parasitology, 11 anopheles mosquito, 8, 20, 45, 165, 269 antiluetin, 290 antimony, 130, 274, 374 antimony potassium tartrate, 274 syn. (tartar emetic), 288–290, 295, 299, 332, 371, 388 or Antimonium Tartaratum, 274 treatment for bilharziasis, 35, 36, 248, 258–261, 275–276, 279–280

Apothecaries, Society of, 327 Archibald, Robert G., 27, 157, 381 Armbruster League, 133, 309, 368 Armbruster, Charles, 336 at Erkowit, 243 discusses Nobel nomination, 328–329 friend of JBC, 133, 192, 201, 308, 368, 372 in JBC’s will, 360 Armbruster, Stefania, 243 Army Nursing Reserve, 72 Arnold, David, 333 Arras, 254 artemether, 18 Ashdowne, Wallace C.G., 72 Asquith, Arthur Melland, 253 Atbara, 138, 191, 261 Athenaeum Club, 327, 333, 346, 358 Atiya, Salim, 321 Atkey, A.O.F., 150–151, 342 Australian Dermatological Hospital, Egypt, 286 Austrian prisoners, 222–223 Aylburton, Glos., 348 Bahr-El-Ghazal, 165–166 Bahr-El-Jebel, 165 Balfour, Sir Andrew, 6, 27 adversarial to JBC, 320, 373 after Sudan, 379–380, 388 and floating school of trop. med., 283, 286 and Sheffield Neave, 165–168 and the ‘Christo affair’, 21, 146, 150, 159, 175, 186–191, 195–196 as Director of the Wellcome Lab., 137–138, 147–148, 151, 153, 155, 248, 260 at opening of Ross Inst., 327 background, 143, 145–146 death of, 146, 339–340 endorses emetine, 293–294 health of, 13, 339 MOH for Khartoum, 152, 198 visits JBC’s hospital, 100 Wellcome Lab Reports, 143, 146, 189, 154, 148–149, 153, 156, 163, 196, 282 Wellcome Reports cease, 381

416

index

Ballance, Ailsa, 204 Ballance, Hamilton A. at IYH camp, 89, 92 in France, 253–254 is decorated, 260 leaves for S.A., 72 Barbers, sanitary, 308 see also, Halak or Muzaeen, 309 Barclay, A., 302 Barkhus, A., 345 Barlow, Claude, 295 Barnado, Syrie see Wellcome, Syrie Barrow, Major-General H.P.W., 341 bassir, 309 Bastianelli, G., 269 Batley, Yorkshire, 53 Battar, Charles, 242, 253, 265 Bayoumi, Ahmed, 118, 164, 371 Beddoes, Dr., 243 Bedri, Ali, MOH, Khartoum, 124 Bell, Gertrude, 264n65, 368n8 Bell, Heather, 104, 137, 156–157, 166, 201 Belloc, Hillaire, 26 Bentinck, Major Arthur, 341 beri-beri, 134–135 Bernard, E.E., 225, 247, 249–250, 326 and Kennedy affair, 318–319, 372 and the ‘Christo affair,’ 186–188, 192, 201 as Financial Sec., 209–210 Berry Red Cross Unit, 25, 216–217, 220–221 Berry, F. May Dickinson, 215 Berry, Sir James, 221–223 attitude of enemies, 225 Red Cross Unit, 215–216–230, 338 Bevan, C.E., 345 Beveridge, C.E.G., 179, 312 Bignami, A., 269 Bilharz, Theodor, 46, 283, 370, 380 Bilharzia (schistosomiasis), 1, 8, 19, 44, 130, 147, 307, 339 rectal and bladder, 34, 279, 371 snail (intermediate host), 9, 20, 45, 47, 283 Bilharzia Clinic, Min. of Pensions, 323, 326 Blackbourne, Rev. J., 74 Bland, Richard, 61n19 Bloemfontein, 74 Bloss, John F.E., 119, 123 Boddy, Janice, 358 Boer War, 65, 67, 253, 326

bonesetters, 241, 309 see also bassir Bonham-Carter, E.G. adversary, 201, 373 and ‘Christo affair’, 187, 190–191 and Fothergill, 212 Booth, Judge, 317 Boots (Chemist), 16 Borrelia recurrentis, 161 bossars, 313 Boulogne, 251 Bousfield, Leonard as adversary, 201, 320, 373 early days, 27–28, 298–299 relapsing fever priority, 153, 155, 163–164, 196 Bowcock, Philip, 357n19 Bramwell, Prof., 339 Bray, Major, 147, 182n32 Brazil, 46 Brazzaville, Congo, 14, 291 Bright, Mr., 166 Bristol-Myers Squibb, Co., 302 British Ambulance Service in Ethiopia (BASE), 340, 343, 346, 348, 352 and Red Cross, 341 British Government attitude to female physicians, 216 Broadbent, Marjorie, 334 Broden, A., 291, 331 Browne, E. Wayles, 218n10 Bulawayo, 79 Bulgaria, 219 Bulgarians, 222, 225–226 Bulinus contortus, 47, 384 Bulletin of the Postgraduate Medical Studies Board, 389 Burges, Frank, Pasha, 197–198 Burkina Faso, 18 Burma, 17, 350 Burroughs Wellcome Co., 16, 17, 142 Burroughs, Silas, 16, 142 Burtchaell, Gen. C.H., 242 Byam, William, 159, 312 Cairo, 16, 24, 185 Cairo Medical School, Egypt, 47 Calais, 252 Cambridge, U.K., 328–329 Canadian Voyageurs and Mohawk Indians, 25n55 see also Mohawk Indians and Voyageurs, Canadian Canning, 73 Cantlie, Sir James, 11, 11n24, 135, 163, 190

index Cape Colony, 70, 93 Cape Town, 67, 74, 77, 95 Caronia, G., 278, 303–304 Carter, Howard, 383 Casino Palace Hotel, Port Said, 243 Cassel Hospital, Penshurst, Kent, 340 Castellani, Sir Aldo, 292, 331–332 Cataracts (medical), 311 Caton, Lancashire, 49, 51, 325 Cawston, F. Gordon, 389 Cecil, Lord Edward, 250 Central African Republic, The, 22 cerebrospinal meningitis, 136, 188–189 Chad, 22 Chagas’ disease, 9 Chalmers, A.J., 291–292, 381 Chappel, Caroline, née Christopherson, 239, 257, 326 Chappel, Herbert, 326 Chappel, Susan, see Sloper, Susan Chappel, William, 239 chemotherapy, 35, 274, 389 Chesham, Lady, 71, 77, 81, 87 Chesterman, F.E., 321 Cheyne, Sir William Watson, 241–242, 249, 258, 260, 262, 265, 318 Chichester, 383 Chiene, John, 79, 81, 86, 86n28, 93, 190 China, 14, 46, 386 cholera, 9, 27, 63 cholera belts, 73 Christian, Princess, 74 Christopherson, Aimée, 204 Christopherson, Arthur C. in Australia, 205, 236, 323, 325, 352 youth, 53–55 Christopherson, Brian–the tanner, 50–51, 53, 66 Christopherson, Caroline, née Ord Denton, 3–4, 52–53, 326 Christopherson, Claude, 4, 55 Christopherson, Denton Dockray, 4, 55 Christopherson, Edward (Ted) Oscar Ord, 60, 204–205 Christopherson, Elsa, 204 Christopherson, Emmie, 325 Christopherson, Eva see Harris Christopherson, Evelyn, 55, 61, 325 Christopherson, J.B., 27, 167–168 accomplishments, 206, 370, 388 and 1904 appointment problem, 119–125, 138

417 and Balfour, 146, 148–157, 164, 201, 282, 288 and BASE, 341, 344 and bilharzia patients, 35, 245, 250, 272, 296 and Council of Secretaries, 186–190, 268 and France 1917, 242–243, 251, 256, 261 and kala-azar patients, 33, 43, 272, 304 and languages, 308 and London 1917, 257, 264–265, 267 and medical curiosities, 135 and non-European physicians, 22, 120–130, 132, 308 and original Khartoum hospital, 100–101, 119, 121, 370 and Ronald Ross, 330 and Slatin, 236–237, 336, 338 and smallpox in Sudan, 63, 97, 104–115 and vaccination programme, 137 and Wingate re Kennedy affair, 318–319 and women in medicine, 332, 334 at Barts, 63 at Gonville & Caius College, Cambridge, 61–62 Balfour disagreement, 379 birth of, 53 changes specialty, 324 complains about Crispin, 266, 318 Court of Enquiry issue, 185, 196–198, 317, 373 death of, 357–358 death of Wm. May, 372 decision to stay in Sudan, 206 earth-eating, 156, 308, 312 friends and adversaries, 20, 372 Heavensgate and retirement, 353–355 his discovery myth, 32, 36–37, 271, 280 illness in 1909, 195 in South Africa, 68, 74, 87, 89, 93, 95 leaves Sudan, 321 marriage, 204, 210 native medicine, 308–313 on ‘Mohammedan’ religion, 179, 313 on Crispin as Dir. of SMD, 282, 317, 370–371 on Kennedy affair, 316–318 patients unsuitable for treatment, 297–298

418

index

pharmacy problem, 21, 172, 174–177 practice of medicine in Africa, 387 priority dispute, 39–42, 271–273, 286–292 President of Royal Soc. Section of Trop. Disease & Parasitology, 331, 334 publishes in medical journals, 44, 130, 274, 275–276, 287–288, 296, 304, 306, 326, 366 religion, 386 report to Wingate on Serbian mission, 231–233 running of his hospital, 151–152, 173, 175–177, 185, 298 school in Newcastle-upon-Tyne, 54 Sudanese men as midwives, 310 tartar emetic, dosage, 305–306 tensions and controversies, 14–15, 21, 36, 39, 134, 126, 133–134, 171, 183, 266, 367–368, 372–373, 377, 381 with Berry Red Cross Unit, Serbia, 211, 217, 222–230 worries about money, 258, 268, 319, 325 Christopherson, Joyce, née Ormerod after Sudan, 325–327, 346 death of, 357 during First World War, 211, 225–226, 234, 239, 242, 245–247, 258 leaves Sudan, 321 life at ‘Heavensgate’, 348, 350–353 marriage, 203–206, 210 refuses to discuss Balfour issue, 159 trip down the White Nile, 318 Christopherson, Marie, 51n8 Christopherson, Mary née Dockray, 51 Christopherson, Muriel, see Grylls Christopherson, Rev. Arthur, 49, 51, 355 Christopherson, Rev. (Canon) Brian, 3, 50, 51–55, 60, 66, 204, 325 death of, 239 Christopherson, Thomas, 50 Church, Sir W.S., 84 cinchona tree, 9, 302 circumcision of female children, 156, 308–309 City of London Hospital for Chest Diseases, 323, 326 Clayton, G.F., 198–200 Clifton College, Bristol, 61 Clinical Parasitology, (Craig & Faust), 289 Cockroach of the Nile (Procambarus Clarkii), 384–385

Coleman, R.B., 294 Colenso, 70 Colgate, 17 Collins, Robert O., 316–317 colloidal antimony, 290 Colonial Health Service (French), 14 Colton House, Colton, 49, 325 Colton, Cumbria, 49, 51 Commission on Medical Establishments in France, 38, 239, 258, 262–263, 265–266, 318–319 Cook, Gordon, 158n44 Cornwall, 3, 180 family life in, 60 Côte D’Ivoire, 18 Council of Secretaries, 182, 186 Court of Enquiry 1911, See Christopherson, Phipps and Wingate cowpox, 301 Crawford, Col. Archibald, 196–199 Crispin, E.S. after Sudan, 379 as adversary, 201, 261, 266, 318, 370, 373 as Assistant Director, 194 as Director, 215, 266, 282, 317, 366 In 1902, 27 search for, 4–5 the appointment blunder, 122–125 trouble in the SMD, 138, 191 Cromer, Lord. (Evelyn Baring) and JBC’s Report, 114 and the Condominium, 22 and the Mahdi, 24 and Wellcome, 142 gets advice, 244 Crowfoot, J.W., 318 Crozier, Anna, 7 Cummins, Capt. A.G., 163 cupping, 309 Currie, James, 145 and early Med. Sch. idea, 151–153 and Neave, 166 as friend of JBC, 134, 190, 192, 196, 201, 372 Curzon, Lady Georgiana, 71, 74, 93, 95 see also Howe, Countess Curzon, The Hon. F.G., 73 Cushing, Harvey, 141, 255–256 opinion of Commission, 263–264 D’Arcy, Patrick, 372, 381 daier, 309

index Daly, Martin, 21 re Bernard, 210 re JBC’s character, 201 re the Condominium, 382 re Wingate and Acland, 125 re Wingate in Egypt, 378 Daniels, C.W., 159 and JBC’s telegram, 196, 199 of the LSHTM, 163 Darfur, 25, 27 Davenport-Hines, R., 18 Davidson, Judge Nigel G., 198 Day, H.B., 293, 299 De Aar, 67, 74, 79, 92, 95 de Segundo, Bertram, 359–360 de Segundo, Charles, 158, 359 de Segundo, Dr. and Mrs., 126n19, 346 de Segundo, Gertrude, 360 de Segundo, William, 247 Deelfontein hospital camp, 79, 81, 92, 95 Kipling visits, 86, 343 plate, 89 railway at, 67, 74, 77 Denton & Gray, 52–53 Denton, Caroline Ord, 52–53 Denton, John Punshon, 52 Denton, Leila, 325 Denton, Richard (Dickie), 60, 215, 325 Derby, Lord (Edward G. Villiers Stanley), 254–255 dervish, 23, 26, 153 Desowitz, Robert, 10 Devonshire Place, No. 5, 346 Devonshire Place, No. 29, 323, 329 Dewey, Clive, 2 Di Cristina, G., 278, 303–304 Dickinson, Col. Ernest Arthur, Bey, 387 digitalis, 16 Doctor Without a Country, (Lambie), 342 Doctors in the Great War, (Whitehead), 266 Doctor’s Tale, The, (Abbott), 312 doctors, Egyptian and Syrian, 11n24, 125, 164, 298, 372 Dongting Lake, 46 donkeys, 119, 136 Donovan, Charles, 168 dosing regimen, 306–307 Dowling, Amy, 204 Doyle, Mr., 294 Drzhavna, the, 223–225

419

Durham University, Sudan archive, 3–4, 123, 125, 186–187, 195, 210, 236, 308–309, 339, 371, 378 Dutton & Todd, 161 East Africa, 8–9 East London, 74 Easton’s Syrup, 366 Echenberg, Myron, 14 Edward VII, King, 141, 328 Edwards, Ena née Christopherson, 61n18, 204 Egypt doctors in, 8, 293 History of, 8, 12, 19–20, 22–24, 30, 46 JBC’s opinion on, 297 Joyce in, 265, 283 Kennedy affair, 316–317 Egyptians and crayfish, 384 and poor work opportunity, 15, 382 and the grab for Africa, 30 and the Mahdi, 24 infected with bilharzia, 40, 297, 367 Udal’s letter, 357 Egypt Report 1904, 117 Egyptian Army Medical Corps (EAMC), 119 Egyptian Army Military Hospital, Khtm, 40 Egyptian Fellaheen infected, 9, 11, 37, 45, 296–297, 299, 334, 366 Ehrlich, Paul, 35, 293, 302 and McDonagh, 375 re Nobel prize, 329, 359 see also Salvarsan Eiselsberg, Prof. V., 231 El Aigel, Ahmed, 208 Elderton, Major R.P.S. appreciation of JBC, 365, 377 assists JBC, 191–192, 201 in retirement, 355, 358, 372 sends farewell telegram, 321 elephantiasis, 6 Elliot, Andrew, 72 El-Obeid, 311, 319 emetine, 293 Empey, W.S., 345 Encyclopedia Britannica, 366 Endemic haematuria (bilharzia), 147 Eritrea, 22 Erkowit, 197–198, 206, 243 espundia, 275–276 Esser, S.J.D., 293

420

index

Etaples, 252, 254 Ethiopia, 340–342 Ethiopian Diary, An, (Macfie), 345 Evelina Hospital for Children, 63 Fakirs, 309 Falmouth, 3, 32, 60–61, 180, 360 famine fever see relapsing fever Fanon, Franz, 15 Fantham, F.B., 333 Farley, John, 45, 130, 288, 370 Farmer, Rudolph, 358 Farwell, Byron, 24 Feilden, R.M., 318 Fens of England, 9 Ferguson, Major AAMC, 291 Fiennes, Celia, 50 Fire and Sword, (Slatin), 142 Firtitawi tribe, 136 Five Years in Sudan, (Fothergill), 98, 127 Flanders, 206, 239, 242 Fleming, Sir Alexander, 35 Foley, Pat, 92 Forest of Dean, 350 Forster, A.J., 210 Fothergill, Edward, 98, 127–129, 210–212 Fouadin (stibophen), 295 Fowke, Major General G.H., 256 Fowleri (sodium arsenate), 332 Fraser, Hugh, 357 Freemason’s Hospital, 326, 346 Freemasonry, 180–181 French Algerian colonial project, 12 French colonial medicine, in Africa, 12 French Army Medical Corps, 14 Freud, Sigmund, 329 Fripp, Alfred, 83n23, 89 Frothingham, Helen Losanitch, 218–219 Fry, Charles, 92–93 Fuad, King, 295 Gabrielli, Albis, 396n9 Gallagher, N.E., 13 Gallipoli, 47 Gallois, William, 13 Garstin, Sir William, 179–180 Gask, George E., 241, 252n32, 253 Georgina Howe, Lady Gezira cotton-growing industry, 316, 385 Ghose, (or Ghosa), 310 Gillette, 17 Girard, G., 14

Glaxo, 16–18 Godlee, Sir Rickman J., 242 JBC appeals to Godlee, 268, 318 JBC’s opinion of, 260 problems with report, 265 re Commission, 242, 249–250, 254, 257–258 Gonville & Caius College, Cambridge, 61–62 Gordon College, Khartoum, 98, 190 boys infected with bilharzia, 280, 307, 355–357, 367 Currie, Dir. of Ed, 166 education at, 145–152, 382 needs more space, 381 students, 382 Udal, Dir. of Ed., 356 Wellcome lab in, 143, 147, 379 Gordon, General Charles and Zaki, 154 anniversary of death, 203 Cawston remembers, 389 hero to the British, 7, 20, 24–26 refused to convert, 237 Grabham, G.W., 318 Graphic, The, 79, 81 Grassi, Giovanni Battista, 12, 269 Greenwood, Brian, 18 Grove, David, 295, 371 Gruenbaum, Ellen, 138 Grylls, Muriel née Christopherson, 55, 257, 260 Grylls, Tom, 260 Guinea, 18 Guthrie, Murray, M.P., 72 Guy’s hospital, 72 Guy’s Hospital Gazette, 83 Gwynne, Bishop Llewellyn, 22 as friend, 201, 206–207, 372–37 at JBC’s wedding, 204 in France, 251, 253 in old age, 255, 355–357 remembers JBC, 26, 129, 234, 369 gynaecomastia (hypertrophied breasts), 136 Haddad, Nassib, 321 Halak, 309 Halfa, 197, 311 Halfaya, 106–107 Hallageen, 313 Hall-Edwards, John R., 92 Hamer, W.H., 63 Happy Toil, (Rogers), 278 Harkness, A.H., 280n27, 290–292, 294

index Harnett, Col. W.L., 341 Harris, Ben., 325 Harris, Eva R. née Christopherson, 55 at Colton, 325 gets advice, 350–351 in India, 257 on death of JBC, 359 Harris, Lt.-Col. E. Temple, 350 Harris, Peter Carveth, 325, 340, 349–351 At ‘Heavensgate’, 351–352 Harrison, Mark, 8, 12 Harrogate, 249, 325 Hartlepool, 52, 54 Hartwig, Gerald, 115–117 Harvard Unit, (Base Hospital No. 5), 256 Harvey, William, 62 Hasan, Prof. Yusuf Fadl, 22n51 Hasseeb, Mansour, 315 Hata, Sahachiro, 35 ‘Heavensgate,’ 346 Henry, Sir G.C., 121 Hepburn, Katherine, 31 Hesdin, 263 Hicks, General William, Pasha, 24 High, Mary, 50 Hill, Richard, 123, 371 History of the School of Tropical Medicine in London, (Manson-Bahr), 37 HIV/AIDS, 365 Hobsbaum, Eric, 181 Hodgins, Agatha, 263 Hodson, V.S. arrives in Khtm., 27 character, 38 works with JBC, 130, 182, 258, 261, 280 Hogan, Jane R., 171n1 Hook, Robert, 374 Horder, T.J. (later Lord Horder), 333–334 Howard, Sir Francis, 242, 249–250 Howe, Countess, 71, 95, 412 Hume, Capt. N.H. 304 Humeida, Mamoun, 389 Hunter, George Douglas, 182, 260 Hunter, John, 327–328 Hunter, William, 328 Hunterian Orator, 327, 374 Hunterian Society, 327 Hunyadi, Count, 233 Hutchinson, Alice, 232 Huxley, Julian, 333–334 Ibrahim, Aly Pasha, 295 Illustrated Police Budget, The, 60n15

421

Imperial Yeomanry, 67, 70–71, 73, 76 Imperial Yeomanry Hospital, (IYH), 72, 81, 93, 243, 252–253, 343 Commission, 243 Hospital diet, 81 India, 8, 10, 68, 291, 351 Smallpox in, 115–116 Indian Civil Service (ICS), 1, 7, 382 Indian Medical Gazette, 11, 19, 281, 303, 374 Indian Medical Service (IMS), 1, 7, 9, 373, 382 Innes, Major Arthur, 40, 190, 288, 290 Inoculation arm to arm, 111 description, 97, 102 in India, 115 International Commission of Zoological Nomenclature, 46 International Herald Tribune, 46 Iran, 14 irrigation projects, British, 8, 45, 316, 385 Izzedin, Mustafa, colleague of JBC on antimony trials, 38, 246, 248, 261, 275, 281, 321 Jackson, Col. H.W., 182 jaguar, regimental, 136 Jenner, Edward, 97, 103 Johannesburg, 67, 95 Johnson, Raymond, 92 Jones, A. Webb, 136 Jones, Nurse M.G., 172n1 Jones, Rev. Denton, 60n16, 204 Journal of Neglected Diseases, 365 Journal of Parasitology, 12 Journal of Pathology and Bacteriology, 12 Journal of Tropical Medicine and Hygiene, 261 Journal of the Royal Army Medical Corps, 12, 136 Journal of the Royal Society of Medicine, 12 Kaiser-I-Hind, 246 kala-azar (visceral leishmaniasis), 9, 37, 261, 274, 297–298 Karoo, the, 95 Kasr-el-Ainy Hospital, Cairo, 179, 293 Kelly, P.J., 344 Kempthorne, John Key, 60 Kennedy, Lt.-Col. M. Ralston, Pasha, 316–319

422

index

Kenya, 13, 22, 343, 384 Kenyon, Susan, 3, 20n45, 130 Keogh, Sir Alfred, 239, 250, 252 Keown-Boyd, H., 177n20, 189 Khalifa, the, 25, 137, 153–155, 237 his house, 99, 121 Khalil, Mohammed, 295 Khartoum in 2003, 389–390 Khartoum, Cathedral, 26, 27n58, 203, 356 Khartoum Civil Hospital (built 1909), 3, 19, 39, 246, 313 and nurse Moore, 192 antimony successes, 371, 388 antimony trials, 261–287 Fothergill’s experience, 127–128 plaque, 381, 389 rules, 111 visit of colleagues, 291, 312, 356 Khartoum Civil Hospital, (old), 99, 112, 119–120, 125, 134, 138, 156 and pharmacy, 174 Khartoum Club, 130 Khartoum Medical School, 346 Khartoum North, 361 Kimberley, 70, 74 Kinsky, Count K.A., 233 Kipling, Rudyard, 86–87 Kitchener, Lord, 20, 26 and JBC, 231 appeals for money to build, 142 refuses to ride a donkey, 121 Kitchener School of Medicine, 381 Knutsford, Lord (Sidney Holland), 254–256 Koch, Robert, 329 Krogh, August, 329 Ladysmith, 70, 84, 249 Lake Victoria, Tanzania, 366 Lambie, T.A., 321, 342 Lancashire cotton mills, 8 Lasbury, F.O., 294 Laurie, Sergeant, 112 Laverin, Alphonse, 269 Lebib (or Labib), Hassan Eff. and smallpox, 105, 107, 112, 114 news of death of, 338 Leiper, R.T., 46–47, 283, 370 Leishmania brasiliensis, 278 Leishmania cruzi, 303 Leishmania donovani, 167–168 leishmaniasis. see kala-azar leprosy, 9

lice (Pediculus humanus humanus), 221 Liverpool School of Tropical Medicine, 32, 384 Living with Colonialism (Sharkey), 28, 145 Lobkowitz, Col. Perry F., 225–226, 229, 233 London School of Hygiene & Tropical JBC and Balfour, 159 Medicine (LSHTM), 6, 383, 385 problems, 323 London School of Tropical Medicine (LSTM), 5, 196 Loos, Arthur, 47 Low, George C. endorses antimony treatment, 289, 331, 371 founds Soc. Trop. Med. and H, 11 Lugard, Lord F.J.D., 341 Lyautey, Hubert, 10 Lydney, (Nr. Aylburton), Glos., 349 Lydney Observer, The, 353 Nursing Association, 353 Macdonald, Dr. George, 31n1 MacDonald, Sir Murdock, 316–317, 319 Macfie, J.W.S., 345, 352 MacKenna, R.M.B., 374 Macpherson, General Sir W.G., 240 Macready, Sir Nevil, 250, 255 Madagascar, 14 Mafeking, 70, 74, 79, 81, 84 Magersfontein, 70 Maghreb, the, 15 Mahdi, The (Mohammed Ahmed), history and influence, 20, 23, 24–26, 153–154 prisoners of, 25, 337 Majestic, 76 Makim, Sir G.H., 250 Malaria and Balfour, 339, 379 and JBC, 335, 387 and kala-azar diagnosis, 168 in Canada, 9 in Serbia, 222 in Wellcome Reports, 147 none in Omdurman, 314 priority issue, 12, 33, 269 quinine for, 16, 18, 302 Ross, Sir Ronald, 269 vector for, 20, 45 Wellcome sees sufferers of, 143

index Malaysia, 10 Mali, 18 Malouf, Nikola, 29n66, 130, 258 Malouf, René, (and Sonia) 29, 119, 130, 177, 183n35 Manual of Tropical Diseases, 292 Manson, Sir Patrick, 5, 143, 190 Manson-Bahr, Mark, 6n13 Manson-Bahr, Sir Philip, 6n13, 278, 291, 331, 361–362 and history of the LSHTM, 162, 184 and Walter Ormerod, 161 on Balfour, 162, 291, 340 recalls visit to Khtm, 291 view of JBC’s accomplishments, 2, 33, 37–38, 44, 157–160, 271–272, 331, 377 Manson’s Tropical Diseases, (Manson-Bahr), 362 Markel, Howard, 272 Martin, G., 14 Maschoieff, Joseph interviewed by JBC, 179 puzzle over his name, 184–186 works with JBC, 261, 275, 291 Maschoieff, Viviane Pescov, 185 Mason, Dora, 352 Masonic Hospital, 326, 358 Masoud, Ferid, 261n56 Mathias, Col. H.B., 124, 182, 194–197, 373 Matthews, Godfrey Estcourt, 196–198 Maugham, Somerset, 143 Mauritania, 18 Maxim guns, 26 May, Major W.R.S., 132 and work in Mesopotamia, 264, 368 death of, 372 description, 207–211, 250 friend of JBC, 201, 372 JBC’s ‘best man’, 204 Mazumdar, Pauline, 180n27 McDonagh, J.E.R., 39–42, 289–292, 330, 370–371, 375 character, 374–375 challenges JBC, 269, 288 death of, 375 search for, 375 McLeod, Sir Charles, 327 Meadows, A.J., 296n65 measles, 301 Mecca, 8 Medical Officer, The, 375

423

Medical School, Khartoum BASE funds for scholarship, 346 JBC’s problem with, 152–153, 157 memorandum, 151 Medical Work at Magila, (JBC), 387 Medicine and Power in Tunisia (Gallagher), 13 Melly, A.J.M., 341, 343–346 Memmi, Albert, 2 Memorandum on the Kitchener Memorial Medical School, Khartoum, (Sudan Govt.), 150 Mendinghem, 263 mercury, 16 Mesopotamia, 255, 264 Michu/Michou accuser of JBC, 176 enigma of his name, 184–191, 194–195, 198, 373 midwife, 309–310 see also, daia Midwinter, E.C., 197, 318 Ministry of Pensions, see Bilharzia Clinic Modderspruit, 70 Mohamed, Abdel Halim, 390 Mohawk Indians, 25n55 Mongolia, 246 Montagu, Lady Mary Wortley, 102 Montenegro, 219 Montresor, Antonio, 396, 396n8 Mooltan, 246 Moore, Maria Pye, see also Nurse Moore, 129, 171, 192 Moore, Wendy, 328 Moretan, 246 Morhig, Alfred (and Madeleine), 17, 177, 177n19 Morhig, George N., 16, 17, 174–177 Morhig’s Pharmacy, 16, 17, 177 Morning Post, The, 247 Motive in Women’s Dress in the Tropics, The, (JBC), 334–335 Moyan, Col., 242 Muir, E., 303, 307 Munro, Jessie, 357 Musa, A./Rahman M., 244n13, 389n65 Muslim doctors, Algerian born, 13, 15 Muslims, Condominium policy toward, 26 Muzaeen, 309 Nason, Gov. Gen. Pasha, 107n32 Natal, 70 native remedies, notes on, 156, 308 Native Women as Nurses, 193n55

424

index

Nature, 37, 283 Nature-Medicine, 384 Nature of Disease Institute (NOD Institute), 374–375 Near East, The, 212 Neave, Airey, 165n64 Neave, Sheffield H.M. Acting Sec. London Zoo, 333 finds Leishmania donovani, 167–168 Report and dismissal, 165–168 Wellcome’s attitude to, 16 New York Times Magazine, the, 45 Newcastle-upon-Tyne, 3, 60 Newham, H.B.G., 289 Newlove, J.R. assistant to JBC, 34, 35n10, 38 death of, 352–353 in Khtm. while JBC in France, 245–246, 248–249, 258, 260–261, 281, 291, 304 Newton, Sir Isaac, 374 Niagara Peninsula, 9 Nicolle, Charles, 221 NIH News, 384 Niklawi, (Nicklawy) Mitalai Bey, 314–315, 321, 338 Nissh, 217 Nobel Prize for Medicine, 35, 221, 269, 302, 328–329 Norana, 246 Norman, 75 Norton, Durham, U.K., 52 Notes on Medicine in the Sudan, (JBC), 309 Nurse anesthetists, 263 Nurse Moore, 126, 173 Nurse Practitioners, 263 Nurses, British, 369 Barts, 388 O’Shaughnessy, Laurence, 131 Obermeier, Otto, 159 Ogier Ward, R., 292 Omdurman Civil Hospital, 3 children in, 314 Fothergill prefers, 128 Neave does splenic puncture in, 168 Orange Free State, 70 Orange River, 70 oriental sore (cutaneous leishmaniasis), 275 Ormerod, Barbara, 204, 247 Ormerod, Christine, 326 Ormerod, Diana and JBC, 204–206 and Ormerod family, 326

death of, 357 letter from W. Ormerod, 359 lives with J and J in Glos., 348, 350–352 move to Chichester, 383 Ormerod, Dorothy, 349 Ormerod, Elizabeth (Betty), 203 Ormerod, Edward Wareing (Wang), 251 Ormerod, Joseph Aderne, 63, 66, 194, 203, 325 Ormerod, T. Peter, 4n10, 63, 128, 150, 168n78, 204n1, 206, 215n2, 236, 241n7, 259n49, 327, 330n14, 349, 377n28, 383 childhood memory of JBC and ‘Heavensgate’, 248, 346, 349–351 Ormerod, Thomas, 215, 376 Ormerod, Walter, 51n7, 159 and Balfour story, 163 memories of his uncle, 383 re Joyce and Major May, 211 re Manson-Bahr, 161 Ornithodorus moubata, 161 Osler, William, 115 Osman, Abdel A’ Al Abdella, 389 Osman, (servant to JBC), 350 Oxen Park, 51 Page, Mr. & Mrs. Charles, 318 Paget, Lady Arthur, 220 Palin, Nurse, 354 Parke Davis, 17 Parker, Mr. A.P., 92 Pasteur Institute, Paris, 14 Pasteur, Louis, 14 Pauson, A.G. & Helen, 357 Pearson’s product-moment correlation (PMC), 306 Penfield, F.C., 226, 231 Pennacchia, Teodoro, 370 Penton, Major R.H., 119 peripheral neuritis, 134, 195, 321 Perreton, Miss, 155 Perverseff, J., 345 petroleum, 387 pharmaceutical industry, 16 Philippines, the, 10, 288 Phillips, L.P., 243 Phipps, Major P.R. after Sudan, 378 Council of Secretaries issue, 181–191, 194 Court of Enquiry issue, 195–200 health issue, 13 relationship with JBC, 20–21, 30,

index 132–133, 182–183, 175–177, 191–192, 207–209, 211–212, 215, 234, 244–245, 368, 370, 373 phthisis, 301 plague, 8 Port Elizabeth, 74 Port Sudan, 123–125, 138, 194, 310, 321 Porter, Annie, 333 Portland, Duchess of, 327 Power, D’Arcy, Air Vice Marshall, 358 praziquantel, 45 Prevention and Treatment of Disease in the Tropics, The, (Crispin), 366 Prime, Peter, 79n19, 83n23 Prince of Wales, HRH the, 72, 77, 327 Principles and Practices of Medicine (Osler), 115 Proceedings of the Royal Society of Medicine, 38 Proud, Linda, 126 Pugh, Helen, 346n53 Quarterly Review of Biology, 376 quinine, 16, 18, 302, 387 Rea, Marion, 63 Red Cross Society, Ethiopia, 341 Red Cross Unit, Serbia, 25, 206 relapsing fever, 2, 153, 159, 161–164, 195–196, 199, 220, 339 see also tick fever Richards, Owen, 293 Richardson, Ruth, 296 Richmond, Sir David, 84 rinderpest, 8 Roberts, Lord, 74 Robic, J., 14 Rockefeller Foundation, Egypt, 295 Rodhain, J., 291, 331 Rogers, Sir Leonard, 286, 333, 370, 374 and tartar emetic for kala-azar, 19, 32n3, 43, 271, 275–278, 281, 286, 291 and dosage, 303–305, 307 and ‘the Barts gang,’ 279 Ross Institute & Hospital for Tropical Diseases, 327 Ross, Sir Ronald and FRS idea for JBC, 330 and Nobel Prize for Medicine, 269, 328 and Ross Institute, 327 priority dispute, 12, 32 re Leishmania donovani, 167–168 re malaria, 33

425

Royal Army Medical Corps (RAMC), 68 Royal College of Surgeons, 375 Royal Commission, The, (South African Campaign), 83–84, 241 Royal Free Hospital, London, 216, 280n26, 367 Royal Grammar School, Newcastle, 53–54 Royal Society, The, 257, 265, 330 Royal Society of Medicine, The, 292, 299 Royal Victoria Hospital, Netley, 5 Rugg, John, 246n16 Saagh, Selim, 310 Salgetta, 246 Salonika, 217, 219 salvarsan (606), 35, 293, 307, 375–376 Sambon, L.W., 283, 286, 380 Sanders, Lisa, 45n30, 46n31 Saunders, H.W., 72 S.A.M. (Sayyid ‘Ali Mirghani), 357 S.A.R. (Sayyid ‘Abd al-Rahman), 357 SARS in Canada, 117 Savile, Mr., Editor of Near East, 212–213 Savioli, Lorenzo, 396n9 scarlet fever, 4, 55, 301 Schistosoma haematobium, 365 Schistosoma japonicum, 288 Schistosoma mansoni, 147, 366 Scourge, (Tucker), 97 scorpion root (Irk-el-Akrab), 315 scorpions, 313–315, 382 Scot, 87, 95 Scott, H. Harold, 135 Seamen’s Hospital, London (at Albert Dock), 31, 62, 97, 374 Selassie, Emperor Hailie, 341, 343–344 Senders, John W., 305n8, 391n1 Senegal, 18 Serbia, 215–219 Serbian Macedonia, 219 Serbian Relief Fund, 220 Seventeen Letters to Tatham (Crichton-Harris), 9n20 Shabini, Mohammed Atyieh, 34, 37 Sharkey, Heather, 28, 145 Shepheard’s Hotel, Cairo, 217 shiftas, 343 Shine, Lt.-Col. James M.F., 253 Shuqair, Said, Pasha, 175, 183, 189, 192, 201, 207, 209–210, 372 Sidahmed, Alsir, 107n35, 154n31

426

index

Simond, P.L., 14 Sirdar, the See Wingate, Sir Reginald Skopje, 220 Slatin, Sir Rudolph von, Pasha and ‘Rowdy House’ Omdurman, 211 conversion to Islam, 237 death of his wife, Alice, 237, 336 death of, 238 friend of JBC, 201 presents a goat, 148 prisoner of the Mahdi, 25 re May and JBC, 207–208 reassures Joyce, 25, 226, 234 reputation attacked by Fothergill, 212 with Austrian Red Cross, 211, 230, 336, 338 sleeping sickness, 27, 374 Slinn, J., 18 Sloggett, Brian, 252n32 Sloggett, Lt-Col. Sir A.T., 74, 77, 83–84, 87, 92–93, 95 in France, 239, 242–243, 249, 252, 255–256 Sloper, Susan, née Chappel, 354–355 Smallpox, 8, 27, 63, 301 in Serbia, 221 major & minor definitions, 101–104 Smallpox Report, (JBC), 3, 111–112, 114, 117 Smith, Col. G.M.C., 342 snail fever, 46 snail, bulinus contortus, 47, 385 Snow, John, 63 Society of Tropical Medicine & Hygiene, 11 sodium antimony tartrate, 274, 286 Somerset, Noel, 247 Sooadi, (or Suaadi) Habib, 311 spirillum recurrentis see relapsing fever spironema recurrentis—African tick fever, 159, 161 Squires, H.C. condolence letter to Joyce, 361 re JBC, 47, 122–123 re personalities in the SMD, 130, 137, 164, 158 St. Bartholomew’s (Barts), 297 and Barts journal, 125, 149 and Boer War, 72 and Ormerod family tradition, 63, 65 Barts nurses, 129, 172, 354, 388 JBC trained at, 12, 32, 62–63 others trained at Barts, 149, 203, 358, 376, 259n49, 376

Rogers and the ‘Barts gang’, 279 St. John Ambulance Association, 352 St. John’s College, Cambridge, U.K., 52 St. Omer, 252 St. Thomas’s hospital, 65 Stack, Gov.-Gen. Sir Lee, 15, 267, 319, 381 Stack Medical Laboratories, Khartoum, 315 Sterry, Wasey, 133–134 and Kennedy trial, 318 friend of JBC, 192, 196, 201, 372 Stevens, G.W., 142 Stiles, Lt.-Col. A.J. is knighted, 260 on the Commission, 242–243, 250, 265 re family connection, 262n59 Storia delle Malattie Tropicali (Pennacchia), 370 Stormberg, 70 Storrington, 375 Stowmarket, 375 Stroud, Tom, 60 Sudan, 12, 14, 22–23 Sudan Club, 22, 130, 207 JBC and the club, 43, 362, 368 policy, 358, 368 Sudan Gazette, 123, 184, 210 Sudan Illustrated Book of Diseases, The, (JBC), 156, 308, 346, 348 Sudan Medical Department (SMD), 3, 20 (Later, in 1924, S. M. Service), 2, 15 Sudan Medical Service, (Squires), 371 Sudan Medical Specialization Board, 389 Sudanese—faith in western medicine, 27, 111, 298, 386 Sutherland, Bey. Alic, 181 Swinnerton, Iain, 68n2, 71n4, 84n26, 256n44 Symes, Sir Stewart, 247, 381, 386 Symons, John, 167n71 syphilis, 9, 16, 111, 302, 314 ‘Tabloid’, 17 Taenia nana, 366 Tandy, William (Bill), 357–358 Tanzania, 45–46, 366, 386 tattooing, 156, 308–309 Taxol, 302 Taylor, Martin, 385 Taylor, Sir Frederick JBC thinks Taylor too old, 254

index member of Commission, 242–243, 249–250, 258, 262, 265 Terapia, the, 222, 225 The First Hundred Thousand, (Hay), 227 The Lancet, 11, 19, 35, 38, 92, 261, 273, 276, 279, 287 The Sudan Medical Service: An Experiment in Social Medicine, (Squires), 122 Thomas, Sir Garrod, 240–241, 259 Thorne, Yorkshire, 52 Three Gorges Dam, China, 385 tick fever, spirillum fever see relapsing fever Titanic, 74, 203 Tod, Dr., 314 Tottenham, P.M., 196 Tour of Duty, (Symes), 381 transport, in Sudan, 8, 172 Transvaal, 70, 293 Travers, Dr. (of Kuala Lumpur), 134 tribal markings, 156, 308–309 Tropical Diseases: A Manual of Diseases of Warm Climates (Manson), 6, 44 Tropical Diseases Bulletin, 11, 304 Trouville, France, 262 trypanosomiasis, 14, 136, 167 tse-tse fly, 8, 136 Tubby, Alfred Herbert, 260 tuberculosis, 365 Tucker, Jonathan, 97 turmorgis (male nurses), 369 Turner, William, 72, 92, 196–197 Turstig, Mr. (photographer), 146 Tutankhamen, 383 Tweedale, Geoffrey, 17 typhoid, 9, 89 Acland treated Wingate for, 125 in Serbia, 220–221 typhus, 9, 220–221 Udal, John, 356n18 Udal, N.R. re Burges, 197 in retirement, 356–357 on death of JBC, 361 Ulverston, 50–51, 325 Unitary Theory of Disease, 376 Universities Mission in Central Africa (UMCA), 332, 346, 386–387 University of Colorado, USA, 263 Uskub, Macedonia, 217

427

Vaccination, 103, 105, 111–112, 115–117, 137, 206, 301 Variola, 101 Variolation, 97, 117 banned by act of parliament, 101–102 venereal disease, 40–41, 290, 301 Vianna, Gaspar, 32n3, 278, 303–304 Victoria, Queen, 25, 81, 141 Vorbeck, General von Lettow, 8 Voyageurs, Canadian, 25n55 Vrnjacka Banja, 217, 220, 226, 233 Wad Medani, 387 Wadramleh, 159, 164 Walker, Norman, 242, 249, 265 Wall, Monroe, 302 Walney Island, 50–51n6 Wani, Mansukh, 302 Warburg, Gabriel, 367 Warspite, 247 Waterfield, Noel E. among first doctors, 27 among JBC’s friends, 192, 201, 372 and Michu problem, 187 in France, 253 moves to Port Sudan, 194 Phipps’ attitude to, 182–183 Waters of the Nile, The, (Collins), 316 Watt, Sir Thomas, 294 Watt, Steven, 95 Watts, Sheldon, 8 Wellcome Bureau of Scientific Research London, 339 Wellcome Laboratory on the Nile, 36, 143–144, 146, 379–380 Wellcome Research Laboratories functions of, 144 Wellcome, Henry and Balfour’s Reports, 155 and Burroughs, 16 and marriage, 143 and Sheffield Neave, 165–167 enthusiasm for Africa, 142 offers to fund new lab in Khtm., 381 picks Balfour, 145 Wellcome Empire, 388 Wellcome, Syrie, 143 Wenyon, C.M., 304 Wherry, George, 328–329 Whitehead, Ian, 266 WHO (World Health Organization), 116, 365

428

index

Wiley, Major C.J., 286, 288 Wilkinson, Lise, 47, 162 Willcocks, Sir William, 316–318 Willis, Justin, 332n22 Wilson, Nursing Sister Freda, 332 Wingate, Lady Kitty, 101, 119 and JBC, 340 and Joyce, 234 and protocol, 336, 368 rides in the first car, 180 Wingate, Malcolm, 377 Wingate, Ronald, 378 Wingate, Sir Reginald, 2, 12–13 after Sudan, 377–378 and appointment blunder, 122, 125 and Freemansonry, 181 and morning parades, 28 and Phipps re JBC, 133–134, 193–194 and Slatin, 226 and the first car, 119 attitude to JBC, 20–21, 95, 126, 369 commends JBC to Cromer, 114 Council of Secretaries, 175, 182, 186–191, 193–194 Court of Enquiry issue, 195–200 friendship circles, 208 his public relations, 342–343 in 1904 Egypt Report, 117 military vs. civilians, 367 on JBC’s character, 67–68, 118, 210

on pacification of ‘natives’, 21 re the Cathedral, 203 re the Fothergill issue, 211–212, 373 re Wm. May, 207 visits the hospital, 101 writes to JBC, 239, 244–245 Wingate, Victoria, 180 With Kitchener to Khartoum, (Stevens), 142 Wolff, Gertrude L., 310 Wolff, Mabel E., 310 World Journal of Gastroenterology, 28 X-ray (Röentgen) room, 89, 92 Yangtze River, 385 yaws, 9, 332–333 yellow fever, 9 Yersin, Alexandre, 14 Zaki, (Zeki) Hassan Eff. and the smallpox outbreak, 104–105, 107, 112, 114 and the Third Report, 153–154, 156 as colleague and friend, 192, 201, 308, 338–339, 372 remembered by Dr. Halim, 390 Zapatieh, 111–112, 112n40 Zeitgeist, 269, 274, 373 Zoo, the London, 333 Zughayr, M., 311