By
Durham Smith
Picture supplied by Prof. John Hutson
Douglas Stephens died on 10th December 2011
at the age of 98 years. There are some scientists who have an encyclopaedic
knowledge of a subject, or who systematize a body of existing knowledge, but,
valuable as this may be, they do not necessarily advance that science. Frank Douglas Stephens was one who broke
through barriers and made such original observations that our understanding was
advanced into new directions. He was a
master of the patho-embryology of developmental processes in congenital
abnormalities. In the areas of the
urinary, genital and ano-rectal systems, he was the most prolific and
significant contributor in the world.
Education and war service
After secondary schooling at
Melbourne Grammar School he graduated in Medicine from the University of
Melbourne in 1936, attending Trinity College which he represented in football,
tennis and cricket. On completing Residences at the Royal Melbourne and Royal
Children’s’ Hospitals he served Australia with great distinction in a Forward
Operating Team in the AIF, 6th Division, 2/3 Field Ambulance, in the
Middle East, in the siege of Tobruk, and in the SW Pacific. At El Eisa in 1942
he was awarded a DSO in the field for exceptional bravery attending wounded
under heavy enemy fire, an honor he never spoke about. After the War he returned
to the Children’s’ Hospital, but his enquiring mind was recognized by the award
of a Nuffield Research Fellowship for three years at the Hospital for Sick
Children in London, where he began studies of major congenital anomalies,
working with (Sir) Denis Browne, T Twissington Higgins (Urologist) and Martin
Bodian (Pathologist).
Melbourne Career
On return to Australia in
1950, he was appointed as a Consulting Surgeon at the Royal Children’s’
Hospital in Melbourne, but from the beginning he combined research with clinical
surgery. He was made Director of
Surgical Research in 1958 in a fulltime position, As a clinical surgeon, with
Russell Howard, he did the first recto-sigmoidectomies for Hirschsprung’s
Disease in Australia in 1950, in which disease he had already co-authored a
seminal paper in 1949 on the pathology of the disease, following the original
work of Orvar Swenson in Boston. At the
same time he was a Consultant at the Royal Women’s’ Hospital for 25 years, a
significant appointment as it afforded him access to studies on the newborn and
to pathological material from embryos and stillborn infants. In 1965, having been a Fellow since 1943, he
was elected to the Council of the Royal Australasian College of Surgeons,
becoming Treasurer 1969-1975, and Editorial Secretary of the Australian and New
Zealand Journal of Surgery for 16 years. At the age of 61 years, in 1975, his
international status was recognized and he was invited to a Chair in Surgery
and Pediatrics of North West University of Chicago, working at the Children’s’
Memorial Hospital, where he was also Director of Surgical Research. He returned
to Australia to retire in1986 but continued to research and write.
Research
His research encompassed the embryology and
pathological development of anomalies of the urinary tract, especially ureteric
reflux, dysplasias, duplications, ureterocoeles and urethral valves; of the
genital tract, including cloacal and vaginal anomalies; and of the vast range
of ano-rectal anomalies in which his work defined the detailed anatomy of each
type and especially the controlling sphincter muscles in relation to each
type. In each area, his contributions
led to new surgical procedures, and in the case of ano-rectal anomalies, a
radically new orientation of surgery which greatly improved the results at that
time. This paper, published in 1953, was
not fully appreciated till almost 20 years later. Modern techniques by Alberto
Peña and others have refined the approach, with better exposure, but his
detailed studies of the vast range of anomalies were fundamental. In urology, also, his early research was
years ahead of its time; for example, that dilatation was often a result of
congenital dysplasia in utero, or a functional problem in the motility of the structure,
without the implication of obstruction, and therefore not necessarily requiring
surgery, as had previously been done for “obstruction” at the utero-vesical
junction or bladder neck. This saved
many children from unnecessary surgery.
Dr Lowell King, Chief of Surgery at Children’s Memorial Hospital in
Chicago was one who realized the significance of Stephens’ contributions, which
led to the invitation to work in America.
His technique of investigation
commenced with observation of the abnormalities in clinical patients and in
operative surgery; every detail was described, drawn and photographed; and series
of patients with variations on the theme were then assembled to provide a
spectrum from which steps in a process of embryological development could be
postulated. These were then correlated
with the dissections of pathological material of embryos and still-born foetuses
to trace the beginnings of the disease process.
His office walls were lined with scores of volumes of accurate drawings
and notes of his painstaking dissections and of literally thousands of
histological sections. His originality
lay in the marriage of clinical observation and dissections, and the postulates
to link the two. He possessed a capacity
for prodigious energy, enthusiasm and original innovative ideas. Even into his late 80’s he was revising the
text of a new edition of his monumental 1996 book on Congenital Anomalies.
As Director of a Surgical
Research Department in both Melbourne and Chicago, he took his training
responsibilities very seriously; he had a constant stream of young surgeons
coming through, all stimulated to pursue some research project. He has been responsible for personally
molding more than 100 post-graduate surgeons directly, and many more
indirectly, in a critical approach to surgical problems. His stimulation was uncompromising and
demanding in the quality he expected, and yet these same students now
acknowledge that time spent with him fundamentally changed their career
objectives. No part of Douglas’s
character will be remembered and loved more than his generosity of heart, mind
and spirit for the surgeons whom he trained.
His help was quite specific and in detail. Behind the scenes he put work into their hands,
finding specimens to dissect, suggesting a facet to research. In the preparation of papers to be published
or presented, he would spend hours with them, rehearsing, vetting every
sentence. He made opportunities for them
to lecture and present their work, and in their publications he frequently
omitted his own name on them, even though many of the ideas came from him. His generosity was extended to private
entertaining of trainees and their families, with especial care of young
surgeons from developing countries.
Racism was a word he did not know.
Honours
His formal Honours include AO
(Officer of the Order of Australia), 1987, Honorary Membership in major
Surgical and Urological Associations in Australia, UK, USA, Brazil, Argentina,
Canada, Japan and India. He was an Arris
and Gale Professor of the Royal College of Surgeons of England, received the
Triennial Research Medal of the British Medical Association, Australia, 1962,
and the Denis Browne Gold Medal of the British Association of Paediatric
Surgeons, 1976, the highest honour in this discipline of surgery. In addition, his CV reads like a map of the
world where he has been invited as a Guest Lecturer or Professor throughout
almost all the States in the USA and Australia, in UK, Canada, Mexico, Germany,
Austria, Italy, Poland, Brazil, India, Ivory Coast and Japan.
He is the author of more than
100 articles in peer-reviewed Journals, but there are as many articles again
published by research workers from his Departments, which do not bear his name. He has published 5 books, as sole author or
as the major contributor, each being the standard world reference text in the
congenital anomalies of the ano-rectal, urinary and genital tracts, and each
received “rave” reviews in their time.
They represent, as one reviewer in 1983 commented “over 30 years (now
over 50 years) of penetrating research by an acknowledged master of the anatomy
and embryology of the urinary tract”.
His ideas were always stimulating, but as one reviewer of his major work
remarked “this is not easy night-time enjoyment, but a book to be savoured
through methodical and careful study. In
brief, it is a work of art”.
Leisure pursuits
With all his energies devoted
to surgery and research, Douglas was no recluse. Although generally a private man, he loved a
party and was a generous host.
Friendship and warmth always accompanied the professional
association. He had a happy family life,
with a loving and very tolerant wife, Rosalie, (she once quipped “Nothing was
more lovingly caressed than the puborectalis!”) for over 50 years until her
death, and with his 3 children. He and
Rosalie had always painted together, and his passion for watercolours has
continued in his second marriage to Victoria Cooke, herself an outstanding
painter in oils. Their holidays revolved
around painting trips and painting groups, and he has staged several
Exhibitions of watercolours. He was an
avid fly-fisherman, a modest golfer, and an excellent tennis player, playing
into his 96th year. He was always loyal to his friends, bore no
malice or envy and humbly brushed aside any reference to his achievements. He had great charm, dressed immaculately,
(even in the operating theatre where he always wore a headlight as if it were a
crown), and enjoyed company, although in recent years a hearing defect made
conversations difficult.
Stories always collect around
great characters, especially those like Douglas who had a touch of gentle
eccentricity. His wit had a puckish
quality about it. One sister recalls calling him about some possible heart
trouble, asking him for a good reference.
He detailed the excellence and experience of a particular Specialist,
saying he was the very best and a great friend.
Then added, “First, better see if he is still alive”! At a dinner in Perth, Douglas arrived early
and received his drink from the bar just inside the front door. As more and more guests arrived, he was
pushed further and further back, and, his glass now empty, he could not get
back to the bar. Nothing daunted, he
jumped out a rear window and came round through the front door again! On a ward round, he wanted to show a new
procedure which he had developed for hypospadias, and, as usual after surgery
on this organ, the tissues may swell. As
he threw back the bedclothes to receive the acclaim of the assembled minions,
he said “There, what do you think of that”?
On this occasion the swelling was positively horrendous and the organ
almost unrecognizable. Everyone was
stunned into dead silence, until our Indian Registrar, himself a model of
courtesy and decorum, said “Sir, ecstasy can be expressed in silence”! Three
weeks before he died, when he was clearly in terminal failure he said to me
“I’m on the way out, and the quicker the better”. But days passed and just 2 or
3 days before death in a brief lucid interval, he seemed to realize he was
still lingering on, and he whispered to me “I’ve buggered this up, haven’t I?”
This was quintessential Douglas, direct, uncomplicated and self-effacing.
Here was a remarkable man of
originality of thought, prodigious energy and output, an encourager to a host
of young surgeons of many nationalities, a brave man in war, a humble and
gentle man in peace, and an utterly generous friend. As Douglas advanced into old age, to quote
from an obituary penned for his father, a phrase from Cicero sums Douglas up
–“the minds of such stand out of reach of the body’s decay”. He was of the Ciceronian elect, and it was
his ever youngish outlook which enabled him to utilize his rare gifts to such
great advantage.
Durham Smith was
associated professionally with Douglas Stephens for 55 years