|  In volunteering to live and work in Borneo, I suppose I
should have been prepared for the bizarre. I had been trying to settle
back in England after giving up my job in Hong Kong as manager of the only
British-owned pharmacy there. But dispensing NHS prescriptions seemed tame
after the Far East and one Friday I turned to the overseas situations vacant
section of The Journal. There was just one advertisement, under the heading “Sarawak”.
On impulse I typed an application and posted it the next morning. That
lunch time I went along to the library in Exeter to find out where Sarawak
was. Somewhat to my surprise, I discovered that it was situated in the
north western corner of Borneo. The country had, until 1947, been ruled
by members of the Brooke family of Devon, referred to as the “white
rajahs”. Head-hunting by the Dyaks, the main indigenous race in Borneo,
had been common until the 1930s when, after a long struggle by the Brookes,
it was thought to have been eradicated, although there was a resurgence
during the Japanese occupation in the 1939–45 war, encouraged from
1945 onwards by the Allied guerillas dropped behind the Japanese lines.
After the Japanese surrender, the last of the rajahs, Vyner Brooke, returned
to Sarawak, and soon realising the impossibility of putting the country
back on its feet with the slender resources at his disposal, he handed
the country over to the British government. The Labour government of the
time was more concerned with getting rid of its legacy of British colonies
than with acquiring new ones, but the tradition of upholding the white
man’s burden was strong, and plenty of old colonial hands responded
to the call.
Sarawak’s new director of medical services, Dr W. Glyn Evans, appointed
in 1953, had served in Malaya since the early 1930s. He had been imprisoned
by the Japanese in the notorious Changi camp on Singapore island and survived.
Glyn Evans had a high opinion of pharmacists, the two who had been with
him in Changi having rigged up a soil elutriation plant that produced as
the end product a light powder that was used as a substitute for kaolin
in treating the ever-present dysentery cases. Glyn Evans had been used
to having government pharmacists working with him in Malaya and had advertised
for one for Sarawak.
By the time I arrived I thought I had done my homework. I was prepared
for daytime temperatures in the 90s that fell only to about 85F at night,
and for humidity that was mostly around 90 per cent. I knew that there
was only one stretch of asphalted road outside the capital, Kuching, where
I was to be stationed, and that all medical supplies were distributed by
river and sea. I was fully prepared to share my house space with mosquitoes
and its walls with lizards and geckos. I was not alarmed, even when switching
on a light in the evening produced an instant invasion of flying “ants” (in
reality, termites of the order Isoptera), which crashed into the light
bulbs, immediately shedding their wings, and then crawling all over the
floor and furniture. But a hospital full of appendicitis patients? That
was not on my list.
Gerald Pinsent
Dr Gerald Pinsent arrived a few months after me. My memories of arriving
in a strange country and staying in the impersonal government rest house
were still fresh, so I invited him and his wife to dinner. The Pinsents
were Anglo-Indians, handsome and impressively tall. We got on well and,
after their diet of endless curries in the rest house, they liked my
cook’s chicken pie. A few days later the Pinsents moved on to Sibu,
Sarawak’s second town, where Gerald was taking over as the new
divisional medical officer. I was due to visit the Sibu hospital to meet
the dispensary staff and, after giving the Pinsents time to settle in,
I flew over. After I had met my Sibu staff and checked that all was in
order in the dispensary, Gerald Pinsent invited me to the operating theatre
to watch an appendectomy. After the patient was anaesthetised he made
a tiny incision at McBurney’s point and fished around inside with
his little finger before producing a surprisingly grey-looking appendix
which he then ligatured and snipped off. He was obviously proud of his
skill, and claimed that the incision was an only an inch and a half long.
It was certainly small; the only other appendectomy scar I had seen had
been about three times the length.
Gerald had another area of expertise, with the camera. He enthused over
the photogenic potential of the mighty Rejang river, well over a mile wide
at Sibu and busy with exotic river traffic that included Chinese junks,
Malay proas and Dyak dugout canoes. From the impressive photographs he
showed me, it was clear that photography was a consuming interest. He had
been lucky, he said, in finding a photographic supplier in Sibu, a Mr Chakravarty,
who stocked a wide range of supplies and equipment. An even greater boon
was that Mr Chakravarty had offered Gerald the use of his darkroom whenever
he needed it.
I had been back in Kuching a month or two when the first request for extra
cylinders of nitrous oxide anaesthetic gas came from Sibu. It was inconvenient,
since our anaesthetic gases arrived in a monthly shipment from Singapore,
and there would be a delay in replacing them. However, since Gerald was
obviously working flat out in the operating theatre and corresponding with
him would have caused a delay (there was no telephone link with Sibu at
that time), I sent the cylinders without query. A week later the monthly
indent arrived from Sibu hospital and it included double the usual number
of nitrous oxide cylinders. By then we had increased our own monthly order
from Singapore and, concluding that Gerald was catching up with a backlog
of surgery (there had been a some months between the departure of his predecessor
and Gerald’s arrival), I sent the additional cylinders. Within days
of the delivery, I received a telegram at the office. “Urgent,” it
read, “Please send 12 nitrous oxide by first vessel. Appendicitis
epidemic in Sibu. D.M.O.”
The mention of an epidemic set off alarm bells and I knew that it was time
to alert my boss, Glyn Evans. When I showed him the telegram, he snorted
and shouted through to his Malay clerk to book him on the afternoon plane
to Sibu. Soon after I got home from the office the next day, there was
a telephone call from the rest house in Kuching. It was Gerald Pinsent: “Glyn
Evans has suspended me. He’s sending us home.” I feigned shock,
but I had seen Glyn Evans that morning, after his return from Sibu, and
I knew the verdict. To the demoralised Pinsents, “Come round for
dinner”, was all I could say. A procedure to increase virility
Glyn Evans had a nice Celtic sense of the dramatic. He told me how, when
he had got to the Sibu hospital, he had found a ward full of Chinese
men, with more lolling on chairs in the corridor. He had gone down the
ward prodding each patient in his abdomen. No one had yelled, presumably
being mesmerised by the appearance of a pugnacious supremo in their midst.
Glyn Evans had said at each bed to the ward sister in tow, “Out!” He
half grinned at me in explanation, “You know what it’s all
about, don’t you?” I had no idea. “Chinese men think
that having the appendix removed makes them more virile.” He was
right but what he said applied, of course, only to uneducated Chinese
in this part of South East Asia.
This was a new angle on Chinese aphrodisiacs. I knew that the list of
things that Chinese men believe would act as sexual stimulants was endless,
the
most notorious being the powdered horn of the white rhinoceros. Another
example had stared at me when the P&O liner carrying me to Singapore
on the way to Sarawak had put in at Penang, where huge billboards proclaimed
the merits of Waterbury’s Compound. This was a bogus tonic I vaguely
remembered as being on the scene in the early days of pharmacy but which
had long since disappeared in the United Kingdom. Its popularity in Malaya
rested on the bright idea of the local agent who had suggested in the advertisements
that it had aphrodisiac properties. Appendectomy as an aphrodisiac took
some believing, but Glyn Evans was an old Far East hand, with over 20 years’ service
in Malaya and there was not much he did not know about the Chinese and
aphrodisiacs, and a lot more besides.
When the Pinsents came to dinner that evening we did not discuss the Chinese
connection between appendectomies and aphrodisiacs. Instead, I listened
to Gerald’s protestations that his appendectomy patients, although
all Chinese, male, and between 30 and 60 years old, had presented with
the three diagnostic symptoms for appendicitis: severe pain at McBurney’s
point, an elevated white cell count and a raised temperature. He really
believed that his overflowing ward of patients had somehow contracted appendicitis
on an epidemic scale. I could not help thinking that common sense should
have told him that this was unrealistic. Appendicitis is not contagious,
does not come in epidemics, and no infections specifically select Chinese
men aged between 30 and 60. I felt sure that the colonial office medical
board, which would be reviewing his case, would think so too.
Gerald was, in due course, suspended by the colonial office and required
to leave the service. I did not hear again from the Pinsents and, in the
circumstances, I had not expected to. I spent much time pondering the affair.
I had believed Gerald when he told me he had seen evidence of two of the
symptoms of appendicitis, the raised temperatures and white cell counts.
As to the third symptom, it was obvious that men anxious to boost their
sex lives would convincingly simulate abdominal pain. Raised body temperature
I later found out that the Chinese had the means of raising their body
temperatures. John Menon, the doctor who replaced Gerald, became a good
friend and on one occasion, when I was staying with him he said that
he was going to the hospital to see a 10-year old boy who had a raging
fever, dry burning skin, dilated pupils, but no symptoms of infection.
The boy’s parents admitted that they had been to the druggist in
Sibu and had been given some herbs. They had brewed them in hot water
and dosed their son with the resulting infusion. Would I go with him,
John asked, and see what I thought. When we got there the boy’s
temperature was 108F. He was delirious and critically ill and we agreed
that the symptoms were those of poisoning by an atropine-like substance.
The boy’s parents were there and John got a Chinese nurse to ask
them if they had any of the herbs left. They said that they had used
them all. John arranged for the treatment he had instigated earlier in
the day, pilocarpine by intravenous infusion, to be continued and we
left for the house of a Chinese police inspector who could help us find
out what herbs had been supplied.
By now it was after midnight and the druggist’s shop was battened
down for the night. After prolonged banging on the door, a light went on
and the herbalist appeared. A Chinese man and his wife had called yesterday
for medicine for their son, the inspector explained. Would he please let
us have exactly what he had supplied them with. The herbalist went to several
drawers in the shop and extracted dried herbs from each, which he put into
brown paper and handed over. I took charge of the packet until I could
get it airmailed to Singapore for analysis. The inspector now told the
druggist that the boy was seriously ill and warned him that in future he
should only dispense herbs that were safe. Although I had been in Sarawak
a few months, I was liaising with the government legal department and gradually
introducing medicines safety legislation based on UK precedents, but these
could not be applied to Chinese herbalists because of the difficulty of
identifying the traditional drugs, a problem that is still far from being
solved today.
By morning the boy was dead. A week later the report came from the analytical
laboratory to say that stramonium, a poisonous herb (known in Britain as
thornapple) containing atropine and the equally deadly hyoscyamine, had
been in the packet. All we could do was to get the government health inspectors
to issue warnings to Chinese druggists to limit severely the quantities
of potent herbs sold at any one time. This experience took me back to Gerald’s
appendicitis patients and the possibility, since they had access to Chinese
drug stores, that they had taken stramonium in small amounts to produce
convincingly high temperatures. It was possible but unlikely, I thought,
since their dilated pupils would have given the game away. A more likely explanation
A year or so later a more likely explanation came to light. John Menon
was called by the police in connection with a murder inquiry and asked
to take samples of suspected bloodstains found on the walls of the house
where the victim had met her end. John and I corresponded on a weekly
basis and he kept me informed of the progress of the case. In one letter
he told me that there had been a sensation during the trial when, Tan
Bin Law, the chief technician of his pathology lab, was obliged to admit
that he had not carried out the blood tests. I knew Bin Law, since before
he had been posted to Sibu he had been a regular at the badminton club
in Kuching where I played most nights. He was easily overawed, frightened
even, and although he was a more skilled badminton player than I, he
usually let me win. I told John that I was sure that he must have been
threatened by relatives of the accused and been frightened into silence.
Bin Law had been in charge of the pathology laboratory at Sibu hospital
at the time of the appendicitis epidemic, and I now saw a possible explanation
for the raised white cell counts that Gerald had relied upon. It would
only have needed one Chinese man, desperate to boost his virility and with
some knowledge of hospital procedures, to have threatened Bin Law for the
timorous technician to have obliged. Once he had succumbed, Bin Law would
have been blackmailed into performing the same service for others wanting
an appendectomy. Bribes or threats could have also made the ward nurse
produce the high temperature readings.
Gerald Pinsent had complied with medical practice in requiring raised temperatures
and white cell counts to confirm appendicitis, but he ought to have become
suspicious when Chinese men, all aged between 30 and 60, started flooding
into the hospital. The keys to Gerald’s lack of awareness were his
eagerness to perform appendectomies and the narrowness of his socialising.
For company, influenced by his Anglo-Indian background and his passion
for photography, he had relied exclusively on Mr Chakravarty. The small
expatriate community in Sibu had always enlarged their social circle by
befriending the leaders of the local Chinese community. Chinese friends
are loyal, and regard it as their duty to save any of their circle from
losing face. Had Gerald made friends with the local Chinese, they would
have alerted him to the reason for the rush of male patients with abdominal
pain, the only appendicitis epidemic in the annals of medicine. |
