Excerpts from Random Musings by Dr. Alaf Khan

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Excerpts from Random Musings
by Dr. Alaf Khan
A slice of life in Scotland-III

Prof. Stanley Alstead took me as Registrar in his University Department of Medicine and Therapeutics at Stobhill General and Ruchill Hospitals in 1966. He was one of the 49 Regius Professors in the UK. His was a prestigious post since each Regius Professorship is created by the British Monarch of the time and appointments to those Chairs are approved and signed by the King or Queen of the day. Regius Chairs are distributed among Britain’s Ancient Universities as follows: 

Scotland—34

England —15

Prof. Alstead assigned me a number of research projects, responsibilities for teaching senior medical students, and writing the chapter on Cardiac Glycosides for the 22nd edition of Dilling’s Clinical Pharmacology. He also assigned me, over three consecutive years (1966, 1967 & 1968), the task of surveying world literature and updating 13 sections in the British Encyclopedia of Medical Practice. Computers and Internet then lay in the distant future. Retrieving References for writing any medical book or paper was a tedious job. Current and past issues of medical journals in our own library, Index Medicus and World Medical Abstracts were our only resources.


Dr. Alaf Khan

Prof. Alstead was the overall Chief, but my immediate consultant was Dr. T. J. Thomson. To all of us he was simply TJ. He, as President of the Royal College of Physicians and Surgeon of Glasgow, was knighted by the Queen and became Sir Thomas Thomson. As President-elect of the Glasgow Royal College, he and his wife (Jess) visited us in 1982 for several days in our 9 Dabgari Gardens home in Peshawar. We took them to Shagai Fort, F.C. Mess in Landi Kotal and the Torkham border. Sir Thomas later gave several illustrated talks on Pakistan, Peshawar and the Khyber Pass to large audiences in Glasgow University and in the Royal College. There existed a measure of formality between me and some of my other seniors. They were Dr. Rogen, Dr. Fraser or Dr. Kennedy to me and I was Dr. Khan to them. Comradeship between me and Sir Thomas Thomson was more of an intimate friendship. He always called me Alaf and I addressed him as Tom, except in formal gatherings when he would be Sir Thomas to everyone.

Prof. Alstead and T. J. kept me involved in one project or another. My paper on Cushing Syndrome Associated with Carcinoma of Pancreas was published in the British Postgraduate Medical Journal. The so-called Ectopic ACTH Syndrome had been reported previously in association with cancer of the lung. Mine was the first report of this syndrome linked with the cancer of the pancreas. Another paper, Diet in the Management of Ileostomy, was published in the Journal of British Society of Gastroenterology jointly with Sir T. J. Thomson and the late Dr. John Runcie (GUT: Vol II, p.482, 1970). 

Rigid steel pipes had been the standard instruments for looking down the food pipes and stomachs. T. J. Thomson and I introduced the first ever flexible fiberoptic gastroscopy and sigmoidoscopy in the UK. These instruments had detachable cameras that took beautiful colour photographs of the patient’s interior. This pioneering procedure was first launched in our gastroenterology unit in Ruchill hospital in Glasgow. Within a decade, it became as common, and as easy to use, as using a toothbrush. Thousands of RMP are now peeping daily into patients’ stomachs in Pakistan alone.

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J.H. Hutchison, Stanley Alstead and T.J. Thomson molded my professional attitude and taught me clinical skills that served me well in the decades to come. The influence of three other pioneering stalwarts was no less formative. Sir Charles Illingworth, Sir Edward Wayne and Mr Bryan Jennette were men of international repute. I was lucky to be their student and House Officer during 1959-64. 

Sir Charles Illingworth was Regius Professor of Surgery at the University and Head of the Department of Surgery at Glasgow Western Infirmary. He tutored our batch of five students in surgery for two terms of three months each in our fifth and final years. He had just built the world’s first Hyperbaric Oxygen Chamber (HOC) in the parking lot of the Infirmary. At that stage, the chamber was used mainly for treating carbon monoxide poisoning and gangrene. It was hard to say no when, as fourth year students, a few of us were asked if we would volunteer to be guinea pigs inside the chamber for a few hours a few times.

Sir Edward Wayne had acquired international fame as a young medical scientist while working in Leeds and Sheffield. He had worked on the drug-body interactions, i.e. what a drug does to the human body, and what the human body does to the drug. His most significant work, from a clinical point of view, was the isolation and purification of digoxin from the crude digitalis leaf that had been the standard treatment for congestive heart failure for ages. Thyroid disorders had also engaged his interest and he had experimented with radioactive iodine in disturbed thyroid function. His classical monograph, Clinical Aspects of Iodine Metabolism, was based on his own research. His most daring venture was the dose standardization of digoxin and its effects on the human heart and body. The human subject used for these experiments was the very Edward Wayne himself. It was a joy to be tutored by Sir Edward at the bedside twice a week for three months in our fourth year. Developing a Thyroid Index was Sir Edward’s ongoing project at that time. Measurement of thyroid hormones (T3, T4 & TSH) had not been born yet. Evaluation of signs and symptoms, coupled with Basal Metabolic Rate (BMR) and serum cholesterol level, was then the sole means of diagnosis. The Thyroid Index was a product of Sir Edward’s observation on large number of human subjects over several years.

Bryan Jennette, a neurosurgical genius, looked so ordinary that few would think he was a doctor, let alone a genius. Bunches of wise old men had turned him down as not good enough for the consultant posts that he had applied for several times. I was going through my surgical Residency in Stobhill General Hospital in 1963 when Mr. Jennette was posted as Consultant at Killearn neurosurgical hospital. Killearn was a small countryside cluster of old army huts used for neurosurgical trauma during World War-II. Mr. Jennette was allotted a few beds in the surgical ward of Stobhill where I was a House Surgeon. He came twice a week to assess his patients. I learnt more clinical neurology from that neurosurgeon than from all the neurologists put together. Mr. Jennette launched his protocol for developing the famous Glasgow Coma Scale soon after he got a foothold in Glasgow. That scale is still in use the world over. He always personally checked the patient’s responses against our entries in the printed score sheet. Tiring him was a dream at best. Within a few years he had developed one of the world’s most sophisticated Institute of Neurosurgical Sciences at Glasgow Southern General Hospital. A man considered ˜not good enough by three Selection Boards gave his country the world’s best in neurosurgery.

(To be continued)