THE EARLY PHYSICIANS OF IBADAN MEDICAL SCHOOL: PROFESSOR ALEXANDER BROWN

Abstract

The paper chronicles the life and times of Professor Alexander Brown, the Foundation Professor and Head of the Department of Medicine at the University of Ibadan. The official opening of the University College Ibadan, Nigeria on 20 November 1957 as well as the graduation of the first set of clinical students in 1960 were glorious moments for Alexander Brown who laboured for 12years to witness these. He was also instrumental to the creation of the Department of Paediatrics (1962), Department of Radiology (1963) and the Medical Illustration unit of the hospital. Paediatrics and Radiology were initially units in the Department of Medicine. He played significant role in the development of postgraduate programmes in Cardiology, neuropsychiatry and nephrology units of the hospital and substantial role in the development of nursing education in the hospital. He was the brain behind the famous Ibarapa Community Health Project.

INTRODUCTION

This paper is the first in the series that is aimed at highlighting the beginnings of clinical medicine (Internal Medicine) in Ibadan, Nigeria. It is intended to chronicle the life and times of early Physicians that helped to give a solid foundation and shape the Department of Medicine, University of Ibadan/University College Hospital, Ibadan. This first paper will focus on Professor Alexander Brown, the first incumbent of the chair of Medicine at the University. ¹

His Birth and Family

Alexander Brown was born on the 9th of August 1910 at Falkirk, Scotland. ² His parents were William Brown (a clock maker) and Jessie Jane Lewars. He married Helga Marie Elizabeth, daughter of Eimund Berg, a schoolmaster, and they had two children, a son William (who is also a doctor) and a daughter, Elissa.^3,4

Education

He had his early education at Falkirk high school and his medical education was at the University of Edinburgh from where he graduated M.B; Ch.B. with honours in 1933 at the age of 22. Being the most outstanding undergraduate of his year, he was awarded the Ettles scholarship and the Leslie Gold Medal.^3-5 He later held house appointments at the Royal Hospital for sick children, the Royal Infirmary in Edinburgh and Glasgow Royal Maternity and women’s hospital. He lectured briefly in physiology at the University of Edinburgh.^3,4

In 1937, Dr Brown obtained the membership of the Royal College of Physicians of Edinburgh (MRCP.Ed) and was a clinical tutor and thereafter an associate physician in the wards of Sir Derrick Dunlop at the Royal Infirmary of Edinburgh. In 1963 he obtained the MRCP. He was elected FRCP (Edinburgh) and FRCP (London) in 1943 and 1968 respectively.^3,4

His Military Careers

Between 1946 and 1947, Dr Brown served as a specialist physician (a Major) in the Royal Army Medical Corps (R.A.M.C) during the second world war in Sierra Leone with the Royal West African Frontier Force. During this time, he became acquainted with West Africa.^3,4

Appointment to Chair of Medicine in Ibadan

In 1946, the British Colonial Government had set up the Asquith Commission to look into the possibility of providing higher education in the colonies. The Elliot Commission specifically directed its attention to anglophone countries in West Africa which led to the establishment of University College, Ibadan and, as part of this, the Faculty of Medicine. The first Principal of the College - Dr Kenneth Mellanby arrived in 1947 and College commenced academic activities in 1948.⁶ The return of Dr Brown to civilian life coincided with the establishment of the University College. He was appointed to the foundation chair of medicine. Thus, Professor Alexander Brown, his wife and two children arrived Nigeria in late 1948. He stayed briefly at the Yaba School of Medicine. He soon left for Ibadan when the then Yaba Medical School was transferred to Ibadan; first at Adeoyo General hospital for 9-years before University College Hospital was completed in 1957. Figure 2 shows Alexander Brown and other teachers with their students at the Yaba Medical School in 1948.

Figure 2A:

From left, Mr J.A Akinleye, the Chairman of Ibarapa District Council; Dr J.M Weir, Associate Director. Rockefeller Foundation, Professor Kenneth Dike, the Vice-Chancellor; Professor T.O Ogunlesi, the Director of the project. 2B. A family visit at Igboora. 2C. General view of the Government Health Centre as it was (1962) (Source: Reference-10)

Brown committed himself to the task of producing a university of internationally accepted standards under conditions of some difficulty and at the far end of long and often uncertain supply lines. At the beginning only pre-clinical training could be undertaken in Ibadan. Prof. Brown and his colleagues had to go United Kingdom to negotiate for clinical placement for the early medical students until a befitting teaching hospital was built at Ibadan. The Nigerian government voted 3.5million pounds for a 500-bed hospital. Work on the University College Hospital started in October 1953. First clinical students fully trained in Ibadan were admitted in 1957 and graduated in 1960. This was a glorious moment for Alexander Brown who laboured for 12years to witness it.

On several occasions he acted as the Vice Chancellor of the University and was a member of the University Governing Council. He was also a former Dean of the Faculty of Medicine (1949-50 and 1952-56), member of the old provisional council and subsequently of the constituted Board of Management of the University College Hospital. ^1,6-8

Other Achievements

He was instrumental to the creation of the Department of Paediatrics (1962), Department of Radiology (1963) and the Medical Illustration unit of the hospital. Paediatrics and Radiology were initially units in the Department of Medicine.^1,6 He played significant role in the development of postgraduate programmes in cardiology, neuropsychiatry and nephrology units of the hospital and substantial role in the development of nursing education in the hospital.^1,6 He organised overseas students exchange programmes for medical students and contributed immensely to the beginnings of the Society of Health of Nigeria and the Association of Medical Schools in Africa.^3,4 Prof. Brown in his later years from 1963, sought for new fields for development. His energy was directed towards the development of Ibarapa community health project in Igbo-ora (a town about 60-kilometers from Ibadan) for the purpose of teaching and research. “He saw and understood the necessity of training doctors in Africa for the Africa of today and tomorrow, still taking pride in our tradition and institutions” ^3,4

The Ibarapa Health Project was founded on February 9, 1963, as “a collaborative and cooperative health development project of the University of Ibadan, the Western Nigeria Government, and the Ibarapa community”. The Rockefeller Foundation provided generous seed funding for the project, while the Liverpool School of Tropical Medicine and the London School of Tropical Medicine and Hygiene provided technical support to medical staff. The funding and technical support were facilitated by Alexander Brown and the then Vice Chancellor, Prof Kenneth Dike. The three specific objectives were as follows to “teach medical students and doctors, through practical work, the principles and practices of community medicine; to study the problems of health care delivery in the Ibarapa Community and to develop the health services of the district into a model of what an integrated local health service should be, in collaboration with the Government of Western Nigeria and in a manner that can be applied to other districts in Nigeria and other developing countries and to carry out research into various aspects of health and disease in the community and thus to build up a body of knowledge on the various factors which are involved in health promotion and disease prevention.” The Project has since evolved into the Ibarapa Programme.^1,6,9-14 Figure 3 and 4 shows Brown in Igboora and pictures from the Ibarapa Community Health Project respectively.

Figure. 3:

Temporary offices of the Ibarapa Community Health Project (left to right): Dr Joe Wray of Cali, Columbia; Professor TO Ogunlesi, Director; Dr. JM Weir, Associate Director of Rockefeller Foundation; and Professor HM Gilles. (1963)

Photo by the Medical Illustration Unit, University College Hospital, Ibadan, Nigeria. (Source- Reference 10)

Figure. 4:

4A. Alexander Brown Hall, at the University College Hospital, Ibadan, Nigeria; 4B. Bust of Late Professor Alexander Brown sitting in the student quadrangle of the Hall on the ground floor of E Block. (Was donated by the Lebanese Community in Ibadan).

His love for Nigeria and her people

Professor Brown gave his best to Nigeria as well as his unalloyed loyalty. For instance, at the break of Nigeria’s civil war in 1967, he was at the International Airport at Ikeja, Lagos enroute to United Kingdom but had to cancel his flight and returned to Ibadan. “He loved things that are Nigerian, her people, traditions, customs and especially her music.” ¹⁵ About six hours before his death, he attended the baptismal service of the son of a Nigerian colleague. ¹⁶

Recognition

His wonderful contribution to medical education was rewarded by the award of the Commander of the British Empire (CBE) by the British Government in 1963. It also received international acclaim, when the Government of Burma invited him in 1964 to advise her on the founding of a new medical school in Rangoon. ^2-4

“He attended a select gathering of a few acknowledged world authorities on problems of medical education in developing countries at Lake Como on his way home on what proved to be his last leave. In the midst of recognition, he remained totally unaffected and open to argument.” ^3,17

His death

Professor Alexander Brown died in his sleep on the 22^nd day of February, 1969.

“After his death, his Nigerian colleagues paid him the tribute of asking that he should be buried in the cemetery within the University campus, so that in years to come staff and students might learn something of their foundation by noting from his gravestone that their first Professor of Medicine occupied the Chair for 21 historic years, thus establishing an academic record of which any University would be proud”.^2-4

A Befitting Farewell and Funeral Oration

During the burial of Alexander Brown, the then Vice Chancellor called upon the dean of the medical school Professor E. Latunde Odeku who concluded his address (laden with “masterpiece of eloquence and poetic elegance” in these words: ⁸

… Farewell “Sandy” Brown!

    We will miss your erudite way

    The deep insight, the patience,

    The agile resourcefulness,

    Your singular understanding of men;

We will miss your wisdom to counsel us

    In time of need

    At the cross roads of our daily struggles;

We will miss your clarity of mind

    That always saw a problem where it was,

    The quick whispered words

    The sensitive simplicity of your helpful ways;

We will miss your depth of language

    priceless anecdotes that were always ready,

    your brilliant wits none could surpass.

We will miss your delicate shuffling and tale-tale steps;

    The unmistakable ring in your voice

    Nevermore, from the corridors of Medicine!

Scotland has lost a most illustrious son. We have lost a most illustrious and diligent friend. We have lost a great physician, a philosopher, a good man and a great teacher.

And yet can we call this a loss- his life so full of achievements, so full of realities, so full of dreams, so full of visions? You have left some unfinished symphonies when you left us, but this is not a tragedy as you would not have it so; because when you left you have also left a powerful orchestra and a great band of composers to carry on the music. Your colleagues and proteges here and throughout Africa will carry forward the great touch which you lit” We say, farewell, “Sandy” Brown, Farewell!

Memorials and Memorabilia

1. Alexander Brown Memorial Lecture

When Alexander Brown died, his friends, colleagues and former students, at the invitation of the Department of Medicine, University of Ibadan, by contributions endowed an annual memorial lecture in his honour. It is the first memorial lecture to be inaugurated to commemorate one of former staffs of the University of Ibadan.⁵ The first lecture was delivered in March 1972 by Dr A.A Quenum, the then Regional Director of the World Health Organisation and he spoke on “Medical Education in Developing Countries” while the most recent lecture was delivered on the 12^th of May, 2010 by Professor O Walker. Table 1 shows the previous lectures and lecturers. ^{5,7,9,16,18-24}

Table 1:

Alexander Brown Memorial Lecture Series^{5,7,9,16,18-21,24,25}

SNO	YEAR	TITLE	LECTURER	AFFILIATION
1	1972	Medical education in developing countries	Dr A.A Quenum	Regional Director, World Health Organisation (African region)
2	1973	Graduate medical education	Professor (Sir) Melville Arnott	Department of Cardiology, University of Birmingham, United Kingdom
3	1974	University and medical education in Nigeria	Professor H.C Kodilinye	Department of Ophthalmology, University of Nigeria
4	1975	Foundation and Roots: Planning Medical Education for a Changing Society	Professor H Scarborough	Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
5	1976	Contrasting patterns of Medicine in Nigeria and Britain	Professor T.W.G. Kinnear	Department of Medicine, Royal Infirmary, Hull, United Kingdom
6	1977	Medical Education and Social Needs	Professor J.C. Edozien	School of Public Health, University of North Carolina, U.S.A
7	1978	University Medical School and the Community	Professor T.O. Ogunlesi	University Medical School and the Community
8	1979	Rheumatology as a Worldwide Problem	Professor F. Dudley	Rheumatology Unit, Department of Medicine, University of Edinburgh
9	1980	Facing the challenges of medical research in research in Nigeria today	Professor C. Nwokolo	Department of Medicine, University of Nigeria, Nsukka (Enugu Campus)
10	1981	Science against Tropical Diseases	Professor A.O. Lucas	Tropical Disease research Programme, World Health Organisation, Geneva, Switzerland
11	1982	Ibadan in Nigerian Medicine: Then, Now and Quo Vadis	Professor O.O Akinkugbe	Department of Medicine, University of Ibadan
12	1984	Great expectations: vaccines against liver cancer	Professor T.I. Francis	Department of Medicine, University of Ibadan
13	1985	'Cardiotonic Drugs in the Management of chronic Congestive Heart Failure: Digitalis Revisited'	Professor G Onuaguluchi	Department of Pharmacology and Therapeutics, University of Nigeria, Nsukka (Enugu Campus)
14	1988	Medical Education in Nigeria: Forty years after Alexander Brown	Professor B.O. Osuntokun	Department of Medicine, University of Ibadan
15	1991	Meeting the Challenges of the African Health Crisis in the Decade of the Nineties	Professor G.L. Monekosso	World Health Organisation Regional office for Africa
16	2010	Human Health Capital Development within the Context of National Development	Professor O. Walker	World Health Organisation Intercountry Support team for East and Central Africa

2. Alexander Brown memorial Prize

The prize is awarded to the best essay by any undergraduate medical student in any medical school in Africa in any aspect of Community Medicine. ^2-4

3. Alexander Brown Hall (ABH)

The then Clinical Students Hostel in the University College Hospital, Ibadan, was named after him- Alexander Brown Hall. The Bust of Alexander Brown lies on the ground floor of E-block of the hall.^2-4 Figure 4 shows the entrance into the Alexander Brown Hall, University College hospital as well as the bust of Alexander Brown on the floor of E-block of the Hall. The bust was donated by the Lebanese community in Ibadan.

Collections of Professor Alexander Brown

Collections of Professor Alexander Brown especially minutes of medical staff rounds at University College Hospital, Ibadan are archived at the repository of the Royal College of Physicians of Edinburgh.²

Tributes and eulogies^3,4,15

Below are some tributes sent to reputable Journals when Prof Brown died in 1969.

T. K. wrote⁴:

“When Sandy Brown went to Nigeria in 1948 the University College of Ibadan was housed in an abandoned military hospital and the University College Hospital was a jumble of buildings through which goats and chickens wandered freely. There were no clinical students, and senior and junior medical staff and technicians were hard to recruit. The situation must have been daunting, but Sandy never wavered in his determination to see established in Ibadan a medical school of international repute. The aim has been achieved, thanks to the efforts of many people, none of whom has made a greater single contribution. In the early days he carried a heavy clinical load, and as dean of the faculty of medicine had the responsibility for planning the first medical school in Nigeria. When the new hospital opened and clinical teaching began, he turned his attention to the wider aspects of medical education in Nigeria. Convinced that instruction in the wards of the teaching hospital was inadequate training for young Nigerian doctors, he planned a community project in a rural area about fifty miles from Ibadan where senior students could live for two months at a time, carrying out epidemiological research and treating patients in their own environment-or, as he put it, ‘shooting with live ammunition’. After years of hard work and delicate diplomacy, involving the university, the Western Nigerian Government, the Rockefeller Foundation, and the London and Liverpool Schools of Tropical Medicine, the Ibarapa project became a reality, and training in community health has been a part of the students’ curriculum since 1964. It is characteristic of Sandy Brown’s self-effacement that he was not among the speakers at the opening ceremony.”

“It was his vision and initiative which brought about the annual meetings of representatives from the medical schools of Africa and the exchange schemes for undergraduates and postgraduates between Ibadan and British and American universities”. Though not a research worker himself, he took pains to provide in his department the opportunities and facilities for others to pursue their ideas, and he delighted in their successes. “ He enlivened any company with his gaiety, wit, endless fund of stories, and out-of-the-way pieces of information on a wide variety of topics. He was a keen and skilled photographer, and his collection of photographs of all aspects of Nigerian life was made during his extensive travels through the country which he loved so much. He was never boring, selfopinionated, or pompous. More than any other expatriate of his time in Ibadan, he earned the respect and deep affection of Nigerians of all classes, tribes, and opinions. During his later years he could, had he wished it, have taken high office in the university. He preferred to stay in the background as an elder statesman to whom members of all faculties came for sound and temperate advice.”

H. S. wrote⁴:

“Many, of course, have made their contribution to University College Hospital, Ibadan, but none a greater one than Alexander Brown who devoted the best part of his professional life to it. The hospital and its medical departments have been almost his sole interest throughout so many years, first through the difficult and trying times at Adeoyo and then on the magnificent site at Orita-Mefa. To all these tasks he gave himself. “He was shy and retiring, and few were privileged to know him intimately. But he had many Nigerian friends and his knowledge of the country, its people, and customs was witness of his great affection for it. Even through the present troubled times he believed ardently in the country’s future. Many Nigerians, by no means all connected with the university or hospital, and many visitors from all parts of the world will remember 9 Amina Way and the dry, rather cynical, wit of their host. When I saw him off on the last of his many journeys no more than a fortnight ago, neither of us realised that this was to be the last goodbye. He is buried close beside his home on the campus of the university-a fitting resting-place. If it is right to seek a monument for a man after his death, University College Hospital, Ibadan, is truly his and he would have wished no other.”

M. R. added⁴:

“Prof. Alexander Brown once described to me how he had seen the first sod turned when building began at the University of Ibadan. He lived to see the university, medical school, and hospital grow into flourishing modern institutions with his graduates occupying high staff appointments. Many of us from the University of London, who were privileged to visit Ibadan, appreciated the remarkable way in which Sandy had developed the teaching of medicine and how he had evolved a curriculum suited to the needs of the local community. The number of Nigerian doctors who come over here and obtain higher postgraduate qualifications is eloquent testimony to the sound grounding that they received at Ibadan. He loved Nigeria, was loved by all, and inspired all those who worked at Ibadan with his enthusiasm and fate in the future”

O.O.A. and B.O.O. wrote from Ibadan⁴:

“Alexander Brown was an excellent physician and teacher. His memory for clinical cases was photographic. He made modesty his duty, carried his attributes lightly, and was always ready to insist that some members of his staff far junior to him knew more about things than he did. A pragmatist rather than a theorist, he was more interested in research of practical value than in esoteric subjects that bore little relevance to the alleviation of suffering. Those whom he made and formed in medicine-and there are scores of them are in their various fields leaders of the profession in Nigeria and elsewhere today. “In his long period in the University of Ibadan, influence and power came to him effortlessly because of his exceptional competence, and his interest in professional politics and in university affairs. He was once dean of the medical faculty, and he acted as the Vice-Chancellor of the university and was a member of its governing council. In committee his expertise was keenly sought; his contributions were crisp and lucid, and he dispensed his rich harvest of experience with bonhomie. He was endowed with a common-sense approach to difficult problems. He never sought the limelight, yet he spoke in public and at meetings with an authority that compelled attention. As a raconteur he was brilliant. He sometimes disagreed with other people’s views but these differences were always amicably composed and he never harboured rancour. He had friends in every grade in the hospital, in the University, and in Nigerian society. “ He gave to Nigeria his best efforts and his unwavering loyalty. “

CONCLUSIONS

The foundation of the Department of Medicine, University of Ibadan was laid by Professor Alexander Brown. The eminence the Department achieved over the years in the University in terms of men and materials is an excellent testimony of the commitment of Professor Brown.¹⁵

He was a great teacher, a most distinguished and dedicated educator and administrator. He was a prime mover who took efforts in seeking and obtaining the right kind of staffs. He was described as an impeccable judge of men and talents. He attracted variety of very capable clinicians from all parts of the world to work in Ibadan. He guided and inspired his students and colleagues. He was an excellent teacher with photographic memory of cases and the depth of his knowledge transcended medicine. He was a top-level personality who possessed exceptional competence and was endowed with common-sense approach to difficult problems.¹⁵ As a committee man he was a most valuable man, succinct and clear-headed. As a planner he was almost incomparable. In foresight, he was avant garde-years ahead of his time. His humour and wit infective and enormous.” ¹⁵

His greatest principle was that the need of the country must be paramount and Nigerian trained doctors could be able to work in remote areas, be versed in preventive medicine and must be able to improvise. Despite being the best graduating student in his class at the University of Edinburgh, he forsook a flourishing career in United Kingdom but chose rather to identify with Nigeria and her people by helping to build and mould the first public University Medical school in West Africa.¹⁵

His undying spirit should, therefore be a shining example and beacon of light to all who came to learn or teach Medicine in Ibadan.⁷

Figure 1 A and B.

are Photographs of Professor Alexander Brown Professor Alexander Brown. C.B. E; M. B; CH. B; FRCP, FRCP.Ed (09.08.1910-22.02.1969). (Source –References 15, 21)

Figure. 1 C:

Photograph of clinical students from The School of Medicine, Yaba, and some of their university teachers at the end of the 1948/49 academic year. Sitting left to right: S. L. Adesuyi, Dr H. Walker; A.A. Azie; Prof. Beatrice Jolly; V.G. Ene; Prof. Alex Brown; J.O.J. Okezie; Prof. O. Ajose; A. Okuboyejo. Standing left K. Diete-Spiff; G. Onuaguluchi; F. S. Obioha; J. Nwokolo, P. Ofili; L.C.D. Beregha. right: M.O.E. Thompson; M.U. Ozo; A.C. Anazonwu; M.S.G. Douglas; F.A. Olapade; E.B. Ekong, Source: Reference no.7)