Recalling Prof. Milroy Paul

Milroy Paul

            Prof Milroy Paul was a veritable legend during our times. He finally retired when our batch was doing it’s internship in the year 1965. In his last days I saw him once seated inside a car outside “Cargill’s Food city” in Union Place, Colombo. He had lost his vision by then. He was seated very rigid, holding a cane, inside a Fiat 1100. I could see the emotions dancing on his face, because I am sure his mind was active and he would have been creating something in his mind, with his vivid imagination. I felt too timid and awed by his presence to talk to him. Our batch mate Sankaranarayana had once gone and started a conversation with him. Sankar said that he was very receptive and communicative to him.

            Prof Milroy Paul was a very dynamic man, with a flamboyance in words I have still to see anyone, equal. Here are some of the stories I had heard about him.

            Prof.Bibile related how when he was doing his appointment with Milroy as a medical student, he had got late in the morning. He was bicycling along very fast when Milroy overtook him in his car. Young Bibile took a shortcut and was with his clinical batch doing the appointment, before Milroy arrived on the scene. He had announced on arrival

”I saw one of your chaps trying to make headway on the road when I overtook him. He is out of my class. Let him come here and I will repeat him”

Young Bibile being tall was easily visible in the batch but obviously Milroy did not connect him with the bicyclist. Bibile waited with a sober face and subsequently related the incident to his colleagues, once the class was over, to much hooting and laughter.

2De Silva in a De Silva lane

            Prof. Milroy Paul had a very vivid imagination. He used to illustrate a point in clinical anatomy by drawing on everyday life.

            One day it was about the obturator nerve. He said:-

“The obturator nerve lies in the obturator canal, a groove in the pubic bone. It is like a De Silva living in a De Silva lane.”

3.About Prof Nakayama.

            During our student days, Dr.P.R.Anthonis was at the peak of his career. He had gone to Japan and worked with a Gastro-enterologist called Dr.Nakayama, who was a top surgeon in Japan. Dr Nakayama visited Ceylon in his turn to be hosted all round. Vagotomy for Peptic ulcer was in it's hey-day. Nakayama did a highly selective vagotomy preventing a pyloroplasty or gastro-jejunostomy. He also did a removal of the carotid body ostensibly to cure bronchial asthma. Both types of surgery have now become obsolete.

            With all the fanfare surrounding Nakayama, Milroy took a lecture to us during this time. While referring to Nakayama he made the following observation:- 

            “Nakayama is a good surgeon, but the poor fellow does not know his anatomy”. This was typical Milroy ploy. Raise the person to the skies and bring him crashing down with the latter part of the sentence.

6. Forging Milroy’s signature

            There was always a problem before the final MBBS of submitting the record books of students. These record books issued on entry to the Medical Faculty to each student, carried the signatures of people under whom the requisite appointments were done. These had to be completed and submitted to the Dean’s office with the application form for the final MBBS exam.. Unfortunately collecting signatures at the last moment was a very tricky occupation. The particular consultant may have retired died, or simply refused to sign up that particular student for low attendance or unsatisfactory work. As in any sample there was a fringe group of students who would take any risk, including forging a signature, which they considered as a harmless pastime, forging a consultant’s signature was practiced discretely by some.

            One of the scenes I remember was where a “forger” was seated comfortably on a table with a blank sheet of paper and pen with correct colour of ink and shape of nib, for those were the days we used ink pots and “G”nibs on nib-holders for official work. There was a chap with a blotting paper standing by, to blot out the excess ink on the signature. The forger had a specimen signature of the particular consultant in front of him and started to imitate it on the blank paper, repetitively. As the imitation appeared perfection, he would shout “now” and the record book would be put in front of him to place the signature there at the appropriate place. The blotting paper was applied and now the record book was ready for submission. I do not recall any one having got caught. With the passing years quite a few of the “forgers” and the record book holders, are very honest respected citizens

7.Like Eskimo’s in the Sahara palpating a camel

            Once Miroy got a student to palpate an abdoman to detect and describe an intra-abdominal lump. This first student not making much headway a second student was asked to do it while the first student stood by. The second student was no better. Milroy observed "You chappies are like a couple of Eskimos left in the Sahara, attempting to palpate a camel".

9. The miracle of the cancer pancreas

            Prof Milroy Paul once told us a story. He had met a gentleman at a party. The gentleman had introduced himself and told Prof.Milroy Paul,

            "Professor, you told me 20 years ago, after an operation, that I would not live more than an year, as I was suffering from cancer of the pancreas. I prayed to God to give me a new life. I am living 20 years after your death sentence. Don't you think that it is a miracle?"

            Milroy then asked us whether we believed it was a miracle. Quite a few said yes. Milroy then told us:-

"That is no miracle man. That was CHRONIC PANCREATITIS".

            As a practicing surgeon I know the difficulty of differentiating between the feel of a hard pancreas of a carcinoma, from hardness felt in a chronic pancreatitis..

             

10. Milroys retinal detatchment & small pox vaccination Later when I was at the Medical Faculty in the 1960’s, our respected Professor of Surgery, Prof Milroy Paul, related how he went to the UK to get treatment for a retinal detachment, sustained by a strike of a tennis ball on the eye. On the advice of the Eye Surgeon in Ceylon he avoided a repeat of a small pox vaccination. At the airport in UK he was asked why there was no valid small pox vaccination. by the airport medical officer. When he told him about his eye injury, the MO had told him “You do your vaccination on the arm man. Not on your eye. Prof. .Milroy had to tell him that he was Prof. of Surgery and he was thinking of various immune reactions which might have interfered with a detached cornea.

            Milroy always stressed the need for a PR examination, in examining patients presenting with bleeding per rectum. The idea was not to miss an early cancer of the rectum. "Putting your foot in it" was one of his recurrent idioms. It literally meant getting into a mess. One day he told us "If in examining a carcinoma of rectum patient presenting with bleeding per rectum, you do not put your finger in, you have put your foot in." 

            One day Milroy asked an intern who was finishing his six month appointment what he intended doing in the future. After much hesitation the intern said that he intended studying to become an Eye surgeon. Milroy said:-

"What have you got to study in eye surgery. There are only two eyes in the human body, and one of the eyes is just like the other eye."

            In the same vein he once remarked that a pathologist

            "Sits on a stool and looks at stools"

            These remarks reflected the thinking in his time, of a General Surgeon doing everything from top to toe. Most of the Surgeons in his era had a very big ego and really played at being God.

11. We do not operate with cow dung on the floor in OT. Nothing special in NSU OT.

            It was the time they were building a brand new Neuro-Surgery operating theatre. The Neuro-Surgeon and the other surgeons were having a conferance about design of the theatre. It was stressed by the Neuro-Surgeon that you needed absolute sterility inside a neuro-surgery theatre. Milroy raised his objection to this by saying:-

"All surgery must be done in absolute sterility. Do you think that the General Surgeons operate with cow-dung on the floor of their operating theatres?"

12. Like the  Chinese coming over the Himalayas.

            It was the days of the Indo-China war. The troops of India and China had fought fiercely on the hostile Himalayan border. The Chinese pushed the Indian troops and outnumbered them in the Himalayan area and the Indians were in full retreat.

            At this time Milroy took a lecture on injuries to the large bowel - the colon. He  said that there were a large number of disease forming bacteria inside the large bowel. These deadly bacteria were kept inside the large bowel by the anatomically intact wall of large bowel, away from the sterile peritoneal cavity inside. Once the wall of the large bowel was breached by injury then the deadly bacteria inside the colon would come out, . "Like the Chinese over the Himalayas".

            This showed the attitude of terror created in newspaper reports, about the feats of the Red army of Communist China, among the intellectuals in Ceylon. It also showed how vivid the imagination of Milroy was.