Robert Collis (1900-1975), early champion of paediatrics

SUMMARY

Robert Collis, son of a solicitor and descendant of a prominent medical family, was born and spent his early years in Dublin. He received his secondary education and medical training in England, France and the USA, and played in Ireland’s national rugby team. Whilst working in King’s College Hospital in London he was inspired by Sir George Frederic Still to specialise in paediatrics and returned to Dublin to initiate substantial improvements in the provision of services for the health of children. He also became involved in campaigns to improve living conditions in the inner city and, at the end of the Second World War, he was among the first physicians to enter and work in the concentration camp in Belsen. Later, he played important roles in the creation and administration of medical schools in Nigeria as it became an independent state and finally returned to county Wicklow for his retirement. (Figure 1)

Fig 1.

Portrait of Robert Collis. Reproduced by kind permission of the Royal College of Physicians of Ireland.

EARLY LIFE AND SCHOOL

William Robert Fitzgerald Collis, more usually known as Robert Collis, was born at Kilmore House on Killiney Hill in county Dublin on the 16^th February 1900, a grandson of Maurice Henry Collis, Surgeon to the Meath Hospital, Dublin, and of John Barton, Surgeon to the Adelaide Hospital, Dublin, and President of the Royal College of Surgeons in Ireland. Acquiring a love of nature through play in the extensive gardens of Kilmore, throughout his life he would invariably be greatly distressed by the sight of a wounded animal. From the age of 9, he and his twin brother attended Aravon School in Bray, county Wicklow, travelling by train each day along the scenic coast of South Dublin but with little appreciation of the beauty of their surroundings until they went on to Rugby School where they were appalled by the contrasting ugliness of the English midlands. At Aravon they were drilled in arithmetic and spelling, were introduced to rugby football, and heard history lessons almost exclusively confined to events in mediaeval England, with only a brief mention of Ireland as represented by “the great Earl of Kildare and his battles”. Then in January 1914 came the move to Rugby, where Robert immersed himself in developing his skills at rugby football on the games field, and his understanding of the Irish Question by daily reading of the newspapers in his private study. Back in Killiney for his first summer vacation, all political differences in Ireland now seemed to be obscured by the common causes of hatred of Germany and fears for Belgium, and for the autumn term he returned to a profoundly altered school, from which the older boys and many of the younger masters had departed for the Great War. School routine was disrupted, the standard of teaching declined, and all pupils were compulsorily recruited into the Officers’ Training Corps (OTC). This did not suit Collis’ temperament, but his rapidly-developing expertise in “rugger” earned him exceptional status and privileges in his school House and he came to enjoy the life so much that he had mixed feelings about going home at the end of term for Easter in 1916. ^1-3

Collis, his twin, and their two sisters picnicked in the Wicklow Hills on Easter Monday, knowing nothing of the Rising until their train journey home that evening was delayed and eventually curtailed. Passengers in a train travelling in the opposite direction brought news of great destruction and chaos in Dublin. Cycling into the city the following morning to see for himself, he was surprised to find few signs of disorder until he reached College Green, and then he heard rifle fire for the first time in his life as shots flew above him between opposing parties in Trinity College and Grattan’s old Parliament Building. As he returned home, the city became strangely quiet and the streets were deserted, but fighting resumed on the following day and subsequently intensified. Collis acquired a Red Cross armband and assumed the role of first-aider in both the streets and the Meath hospital, using his OTC badge to enable him to pass through the British lines. Seeing a collie dog shot dead in the street distressed him more than anything else he had encountered during the fighting. Within a few days, peace and near-normal life returned quite suddenly, but afterwards Collis noticed a much more sombre mood among the citizens when news emerged of execution of some of the leading rebels. ³

Back at Rugby again, Collis discovered he was now identified by the other boys as an Irishman, regarded as sharing some responsibility for what had happened. Before long, however, news from the Western Front came to progressively dominate their thoughts of the world outside, their House tutor leaving only to be killed a few days later, and frequent services commemorated the deaths of old friends and fellow pupils who had, as Collis put it, gone “out to fight on reaching the killable age”. Conventional lessons at school had little appeal for him, rugby football assuming greater importance while fifteen hours a week of military training and helping the work on local farms occupied much of the time in his final year and a half. It was only in his last term, in the spring of 1918, that he started to find his lessons stimulating, and at the same time he was honoured to be appointed captain of the school rugger fifteen. Leaving Rugby, he had a brief holiday in Ireland before returning to England to train for six months for a commission in the Irish Guards, not quite completed when the armistice was signed. ³

MEDICAL EDUCATION AND TRAINING

At that time, he had little desire to return to Ireland, and in 1919 entered Trinity College Cambridge to begin his study of medicine. His director of studies was Edgar Douglas (later Lord) Adrian (1889-1972) (who, with Sir Charles Scott Sherrington (1857-1952), would be the joint recipient of the Nobel Prize for Physiology or Medicine in 1932) and assisted another distinguished physiologist, the Newry-born Sir Joseph Barcroft (1872-1947) in his experiments to investigate prenatal life and hypoxaemia. Time was spared, of course, for membership of the Rugger Club, and he was soon playing regularly for Cambridge. In January 1920 he was picked to play for the South of Ireland against the North in Belfast and during the following season, despite having caught (undiagnosed) rheumatic fever and feeling weak, he was determined to travel over to Dublin and earn his second International Cap in the North versus South match. Returned to Cambridge, his fever continued and after ten days he developed erythema nodosum, with the fever continuing for nearly three weeks. After the rheumatic fever abated, Collis had a further three weeks’ convalescence on the French Riviera, then travelled north to join some Cambridge friends at the Anatomy School in Paris, where they continued their dissection studies through the Easter vacation. Arrangements were made for Collis to spend the academic year 1921-1922 at Yale University on an exchange scholarship but, taking a few days off in New York City, he developed pleurisy, was then found to have tuberculosis and, after two months’ rest in a friend’s home in North Carolina, returned to Yale to collect his effects and took ship for Ireland. ^3,4

Arriving home as the civil war was getting under way, Collis concealed the knowledge of his tuberculosis, wishing to return to Cambridge for the summer term to take his final examinations rather than being sent to Switzerland. Before registering as a medical student in hospital, he regained strength during an extended vacation in Bavaria, Austria and the Dolomites as well as Ireland. His reputation as a ‘Cambridge Blue’ qualified him to be head-hunted for a scholarship at King’s College Hospital, said to be the most modern in London at that time, and there he soon became captain of the rugby club while continuing to play for Ireland. Newly-qualified, his first six months as resident house physician in King’s were followed by transfer to the new department of “Nerves and Children” where, on one side, he acquired the skills of neurological diagnosis and thought to become a psychiatrist until, in the Children’s Ward, exposure to the expertise and dedication of Sir George Frederic Still (1868-1941) changed his mind and prompted his desire to specialise in paediatrics. Moving to Bloomsbury, he became the last resident to work for Still before the latter’s retirement at the Hospital for Sick Children in Great Ormond Street. He qualified MRCP, and then spent over a year on a Rockefeller research fellowship in the Paediatric Department at Johns Hopkins Hospital in Baltimore, Maryland. At that time, it was impossible to obtain the sort of post he wanted in Ireland, so he went back to Great Ormond Street to undertake research funded by the Medical Research Council and a philanthropic donation intended for investigation of the cause of rheumatic fever. The necessary experiments on animals distressed him as much as the suffering and deaths of his young patients; together they provided him with the material and insight for two outstanding papers. In those papers, published in 1932 and 1933, he resolved a current controversy about erythema nodosum by demonstrating it could accompany either streptococcal infection or tuberculosis and finding the latter to be the more frequent cause at that time in both London and Dublin. His investigations were, however, sometimes hindered by the reluctance of relatives to confirm the presence of tuberculosis in other members of a household. ^3-6

PROFESSIONAL LIFE IN IRELAND AND ABROAD

While the papers on erythema nodosum were being prepared, an unexpected letter arrived from Dublin‘s sole children’s physician, Brian Crichton (1887-1950), announcing his impending retirement (to return to Sligo and manage the family seat) and offering to sell his house and practice in Fitzwilliam Square, an area where many prominent physicians and surgeons had their consulting rooms. (Figure 2) As well as paying for the house, Collis’ father (who was Chairman of the Hospital Board) insisted he start work immediately at the Meath Hospital, where his duties in the Out-Patients frequently required refilling or maintenance of artificial pneumothoraces in numerous tuberculosis patients. At the same time, he applied to fill the vacancy in the nearby National Children’s Hospital (Figure 3) where he was included in the trio of candidates short-listed for the post. The Board, “composed chiefly of ancient Anglo-Irish aristocrats”, was unable to choose between them and all three were eventually appointed after lengthy discussion. ⁴

Fig 2.

26 Fitzwilliam Square, Dublin.

Fig 3.

The National Children’s Hospital (1887-1998), 87-91 Harcourt Street, Dublin.

Bethel Solomons (1885-1965), Master of the Rotunda Lying-in Hospital in Dublin from 1926 to 1933, who had also played for Ireland in international rugby matches, wanted Collis to organise a neonatal department in the Hospital. Brian Crichton had been the first paediatrician to be appointed to the Rotunda and during his time there (from 1927 to 1933) an infant ward was opened and the care provided successfully reduced the infant mortality rate. ⁷ Collis had briefly worked there before, when he had taken a month out to gain experience in midwifery while a student at King’s College Hospital. Having resigned from the Meath (but retaining his appointment as a Visiting Physician in the National Children’s Hospital), in his new role, he and Sister Maudie Moran soon developed a special incubator for premature babies. Such was the level of esteem in which he was held, a specialist neonatal unit was built in the hospital grounds. This gradually grew, and new techniques were developed in treatment and surgery for newborn children. ^1,2,4

In 1936 Collis started to write for a wider readership and published his autobiographical The Silver Fleece ³, which brought plaudits from literary Dublin and introductions to several of its leading members. In this wider social circle, he came to meet a Jesuit, Father Joseph Canavan (1886-1950), who asked him to help rouse public opinion about the living conditions in poorer areas of Dublin, first seen by Collis as a student. A committee named the Citizens’ Housing Council, comprising prominent people from a variety of religious and political backgrounds, was formed to report and agitate about the state of the city’s slums, and Collis wrote an influential letter to the Irish Press in 1936. ⁸ These activities in turn led Frank O’Connor (1903-1966) to ask Collis to write a play about the problem. Marrowbone Lane was declined by the Abbey Theatre but performed at the Gate Theatre in 1939 and again in 1941. ^1,2,9 Its success stimulated the creation of a fund that contributed, inter alia, to the Fairy Hill home established in Howth, county Dublin for treatment of children with tuberculosis from Dublin’s tenements, and to the formation of the National Association for Cerebral Palsy, known today as Enable Ireland. ⁴ In his Carmichael Prize essay “The State of Medicine in Ireland”, published in 1943 ¹⁰ , Collis placed special emphasis on the contemporary problems of tuberculosis and child health, both of particular concern to him. He also noted the disparity between city and rural areas in the ratio of patients to dispensary doctors, being 6220 in Dublin and an average of 2300 in the remainder of the nation. At the time he returned to work as a paediatrician in Dublin the rate of infant mortality in the city was considerably greater than the average prevailing elsewhere in Ireland, and it did not start to fall substantially until the late 1940s onwards. He wrote in his essay:

“It has been said that the infant death-rate is the best measure of the child health in the community, or indeed the best single measure of the general standard of health of the community. Child health depends upon social conditions, combined with knowledge of the factors causing disease in childhood, together with a scientific attitude to their prevention and treatment. Hence when considering the wider aspects of social and preventive medicine it is necessary to give this subject very special consideration.”

Comparing infant mortality in several different states on both sides of the Atlantic, he noted rates were much lower in those nations where paediatrics was formally included as a major subject in the undergraduate medical curriculum. In Ireland, the rates of both infant mortality and neonatal mortality have continually fallen since the essay was written (Figures 4 and 5).

Fig 4.

Infant mortality in Ireland from 1922 to 2000, expressed as numbers (under 1 year old) per 1000 live births (calculated from data in the Annual Reports of the Registrars-General for Northern Ireland, Saorstat Eireann and the Republic of Ireland).

Fig 5.

Neonatal mortality in Ireland from 1922 to 2000, expressed as numbers (under 4 weeks old) per 1000 live births (calculated from data in the Annual Reports of the Registrars-General for Northern Ireland, Saorstat Eireann and the Republic of Ireland).

During the Second World War, Collis contributed two articles about tuberculosis to The Bell magazine ⁹ and, as the war ended in Europe, he arranged to travel with other Irish doctors (including a surgeon at the Adelaide Hospital, Nigel Kinnear, and Patrick MacClancy, another paediatrician at the Rotunda who also used the Collis house in Fitzwilliam Square for his practice) to work for the organisation Civilian Relief assisting the British Red Cross in North Holland. Moving on to the Belsen concentration camp near Hanover, to be joined by a group of Dutch volunteers (which included a young lawyer and nurse, Han Hogerzeil (1920-2005)), they acted rapidly to save countless young lives and to restore them to normal family environments as soon as possible. As well as bringing some of the children from Belsen to convalesce at Fairy Hill, Collis brought Han back to Dublin and in 1947 they published a book about Belsen. ¹¹ Parting from his wife Phyllis (née Heron) (1901-1993), he married Han and after she too had qualified in medicine at King’s College Hospital they went to work in Nigeria in 1957, initially in a new medical school in Ibadan and subsequently in Lagos and at the Ahmadu Bello University. ¹² He wrote two books about his experiences in Nigeria ^13,14 and on his return to Ireland in 1971 he re-wrote and updated his autobiography, To Be A Pilgrim, but he died on the 27^th May 1975 after a fall from his horse in county Wicklow, shortly before the book was published. ^1,2,4 Robert, Phyllis and Han were all interred in the graveyard at Calary Church of Ireland in county Wicklow. ¹⁵ (Figure 6)

Fig 6.

The grave of Robert Collis, Calary Church, county Wicklow.