MODERN LAPAROSCOPIC SURGERY
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SUTURING AND LIGATING - THE FIRST THIRTY YEARS
The Scope Looks Back
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DR. HENRY COURTENAY CLARKE THE ORIGINATOR AND INVENTOR: FAMILY HISTORY
In 1498 the Spaniards invaded the Caribbean island Trinidad. They killed or enslaved the Caribs and Arawaks who lived there. They established San Jose, now called St. Joseph, as the capital with a Port of Spain. In San Jose, the ruling Hernandez family, were Roman Catholics from Spain. They married the native inhabitants. These ancestors of Dr. Henry Courtenay Clarke married Venezuelans of similarly mixed race. Later, they were joined by the Rondon brothers: Marco, Dolotera and Tercera. These generals in the army of Simon Bolivar retired in Trinidad after the war of liberation of South and Central America and married into the Hernandez family. The Rondons were Sephartic Jews who had fled from Ronda in Spain at the time of the Inquisition. Bernadina Hernandez Rondon was the paternal grandmother of Clarke.
About 1790 Dr. John Henry Clarke, an Englishman, came off a British frigate and settled on the Castara plantation in Tobago. He married one of his slaves among the several hundred slaves of different races on his plantation and she bore him six children. His descendants assimilated the the English, French, Spanish, Scottish, Dutch, Portuguese, Danish, Swedish, Brandenburger and Courlander immigrants and slaves, the imported Negro slaves and the native Carib and Arawak peoples as well. John and Henry have been common first names in the Clarke family. The father of Dr. Clarke was John Henry Clarke of St. Joseph.
In 1834 when slavery was abolished Joseph Nakhid came to Trinidad in charge of a boat of indentured laborers from India to replace the Negro slaves who, now freed, refused to work on the sugar plantations. Joseph Nakhid from Lahore in India was a descendant of Youssef Nakhid of North Lebanon. Joseph was awarded the Maracas estate, a cocoa and coffee plantation in Trinidad. He married Mary McMillan of Grenada.
Mary McMillan was a mixture of Scottish, French, Dutch, Negro, Carib and Arawak. She had descended from Allan "Glenpean" McMillan who had led the Scottish Lochaber Emigration to Glengarry in Canada in 1802. One of the sons of Allan McMillan, named Alexander "Sandy" McMillan, had emigrated from Canada to Trinidad and then to Grenada ( Barrett, S.R., Family and Ethnic Bonds Between West Indians and Canadians, in: The Lochaber Emigrants to Glengarry. Natural/History Inc. Toronto, Ontario, Canada7:73, 1994).
Dr. Clarke's father, John Henry Clarke, who had descended from Clarke and Hernandez, married Vencenia Nakhid, who had descended from Nakhid and McMillan.
In this island of fifty square miles Spanish, Portuguese, English, Scottish, French, Dutch, East Indian, Negro, Arabic, Jewish, Chinese, Carib and Arawak bloods were blended together by a formula of selective cross-breeding which had developed in the old upper class families since the arrival of the Spaniards. This was necessary in order to correct the poor esthetic results and functional disabilities which had occurred with indiscriminate cross-breeding between the "ancestral races". This gave rise to a class system where the more selective families, fulfilling the sexual and cultural aspirations of all the "races", rose to the upper class of the society. (Clarke HC. Sexual Behavior in an Integrated Multiracial Community: Journal of Sex Research 10: 1, 1974). What began several hundred years ago in Trinidad, resulting in Douglas, Coalpot Douglas, Maroons, Shabeens, Halfbreeds, Potiguees, Cacacodens, Calipso Jews, Rednegroes, Creoles, Chinese Creoles, Highbrowns with blow hair, and other new "races", is now beginning in North America. From these have evolved the Golden people, the new hominiversalis. Dr. Clarke is of this new "race".
Clarke attended early schooling in St. Joseph and later in Port of Spain. He completed the External Examinations of the Universities of Oxford and Cambridge in Romance Languages. In 1945 he entered studies in science at Howard University and obtained the Bachelor of Science Degree, summa cum laude, in 1947. In 1952 he received the Doctor of Medicine Degree from Howard University and the Master of Science Degree from Georgetown University on the same day. This was dangerous at that time because of the great racial hostility between the "whites" and the "blacks". Clarke, the product of selective cross-breeding ( selective inter-racial marriages), attended the black Howard University and the exclusively white Georgetown University, simultaneously, without the knowledge or the hostility of either being aroused.
The Canadian High Commissioner in Washington D.C., whose help he sought,
immediately arranged for his escape to Canada, a welcome at the border, and a
medical internship in Montreal. Clarke was instructed to leave immediately, to
tell no one, and to drive to Canada. Here he had residency training in
Obstetrics and Gynecology, at the Reddy Memorial Hospital under Dr. A. D.
Campbell. In 1954 Clarke returned to Trinidad for the practice of Medicine.
THE CONCEPT OF SURGERY WITH MINIMAL TISSUE INJURY
In Port of Spain, Trinidad, Dr. Clarke ran a small private hospital and several free or low cost clinics supported by his own efforts. In the private hospital and at the Seventh Day Adventist Hospital he developed techniques and instruments for minimal tissue injury in surgery. This provided less morbidity and a shorter hospital stay. It was important to shorten the stay in hospital for patients who could not afford the cost. The daily wage for work in the foreign owned oil fields and the Asphalt lake was one dollar equivalent to 20 cents U.S. With independence and nationalization the worker got $15 per hour. In 1970, in the United States, Clarke applied the instruments and procedures which he had invented in Trinidad to laparoscopy to produce modern operative laparoscopy. (Clarke HC. A Simple Surgical Ligator: Archives of Surgery 701: 914, 1973). His concept of minimal tissue injury in surgery was later recognized as minimal invasive surgery.
RESEARCH IN NUTRITION
Dr. Clarke, while in medical practice, enrolled in the Department of Biological Sciences at the University of the West Indies for the Ph.D. degree under Professor Cope, an Englishman. His thesis was on Vitamin B2 deficiency, a disease common in Trinidad and developing countries.
Then came a "black power communist" revolution in Trinidad in 1970
sponsored from abroad in an attempt to weaken the elected government of Dr. Eric
Williams so that it would not nationalize the oil and asphalt industry. The U.S.
Armada, which had surrounded the island, failed to find an opportunity to land
marines to "save" the population from the terrorism of the rampaging communist
blacks. Without foreign support the "black power" revolution came to an end. The
oil industry and the Asphalt Lake Company were nationalized. The next day the
worker was paid $15 an hour.
HOSTILITY FROM ANCESTRAL NEGRO RACE IN TRINIDAD
At this time Dr. Byam, the Trinidadian Head of the Research Laboratory in Port of Spain, wrote to the University that "both Dr. Brinkman and myself have lost confidence in Dr. Clarke's ability to handle delicate equipment". Dr. Brinkman was an assistant from the United States. The University wrote to Clarke rejecting his work for the Ph.D degree since his facilities had been "withdrawn by a body unconnected with the University".
The Nutrition Research Laboratory had been set up by the Interdepartmental Committee on Nutrition for National Defense of the United States (ICNND). The laboratory and the equipment had been left to the Government of Trinidad after a nutritional survey of the population. The ICNND published the methods and findings of Dr. Clarke in their textbook (Laboratory Tests for Assessment of Nutritional Status. Riboflavin. CRC Press. Cleveland, Ohio. 1974).
Having already completed the research for his thesis, Clarke published
some of his work in the International Journal for Vitamin Research. Following
this the Medical Board of Trinidad attempted to penalize him for advertising.
Dr. Clarke, like many who left Trinidad at that time, was disillusioned by the
extreme racism of some of his black colleagues.
BUFFALO NEW YORK: TRAINING IN OBSTETRICS AND GYNECOLOGY AND RESEARCH IN MATERNAL - FETAL NUTRITION
In 1970, seeking facilities to continue research, Dr. Clarke traveled to Toronto. No facilities were available here. But on the way through New York he had been invited to meet with Dr. Clyde Randall the Chief of Obstetrics and Gynecology in Buffalo, New York. The meeting was under the clock in the Grand Central Station at five o'clock. Here, Dr. Randall had offered that Clarke would do specialty training in Obstetrics and Gynecology and at the same time complete work for the Ph.D. in the Department of Biochemistry. Dr. Clarke now traveled to Buffalo to begin training with the approval and under the auspices of the Royal College of Canada. At that time Dr. Randall was also president of the American College of Obstetrics and Gynecology. A strong Thesis Committee was set up under Professor Segourner, a previous Dean of the Medical Faculty, in order to avoid the problems which had occurred in Trinidad.
In 1971 Clarke published his work on Maternal-Fetal Nutrition. (Clarke HC. Relationship Between Whole-Blood Riboflavin Levels in the Mother and in the Prenate. Am J Obstet Gynecol 1971;3:43-6). In 1973 he was sent as a Delegate of the United States to the World Congress of Obstetrics and Gynaecology in Moscow to present his research. He had uncovered a cellular nutritional link between the mother and the fetus: the link between pre-conception maternal nutrition and fetal brain development. This was the key to understanding the apparently fixed capabilities of classes within and between nations. This key indicated treatment which could improve the capabilities of the lower classes and those of the developing nations.
Japan, where his work was presented at the World Congress of Gynecology
and Obstetrics in October 1979, had treated its population by accident the way
Clarke had prescribed. The population was now taller but also had improved
capabilities. Since then the key has been applied the wrong way in order to
reverse development in targeted countries.
HOSTILITY FROM THE ANCESTRALWHITE CAUCASIAN RACE IN THE UNITED STATES
Dr. Wayne Johnson replaced Dr. Randall as the Head of the Program of
Obstetrics and Gynecology of the State University of New York at Buffalo. He
immediately placed Clarke on suspension. This meant that after a month, as had
occurred with other residents, he would be discharged from the program, and
disqualified from taking the Examinations of the American Board of Obstetrics
and Gynecology, and those of the Royal College of Obstetrics and Gynaecology.
Four and a half years of hard work would be wasted. The resident staff were all
foreign doctors recruited by Dr. Randall to replace the American doctors who had
gone to war in Viet Nam. They were never meant to take the qualifying exams. If
anyone passed the written exams he would be qualified to practice in the United
States and later may take the oral exams. Dr. Johnson's job was to get rid of
the foreign residents before they became eligible to take the written exams.
Clarke sought an appointment with Dr. Johnson to ascertain why he had been put
on suspension. Dr. Johnson said "I don't know you, but you say that you do good
work, but others say that you don't do good work. You must have some degree of
intelligence or you would not have gotten this far. Since you have some degree
of intelligence you would agree that either you have a language barrier, a
social barrier or a personality problem". Clarke nodded ascent. Clarke told him
that in anticipation of this he had spoken to a number of professors who were
prepared to verify that he did good work if he, Dr. Johnson, called them on the
phone. Dr. Johnson reached for the phone, then he stopped an said angrily: " you
see you think that they are telling you that you do good work but they are not
telling you that. I am going away for a couple of weeks and, if you are still
here, I shall take care of you". His actions indicated that this was life
threatening coming from someone in authority from the Southern United States.
The Medical Faculty reversed Dr. Johnson's decision and Clarke was reinstated
and promoted as the Chief Resident the following month. Then Dr. Goperud told
him that he would have to choose between the Ph.D. in Biochemistry, which he was
about to obtain, and the Specialty of Obstetrics and Gynecology. Clarke chose
the latter and passed the written examinations of the American Board of
Obstetrics and Gynecology. With his wife Linda, daughter of the prestigious
Sahlen meat packing family of Buffalo, New York, Clarke found it prudent to
leave for Canada where his daughter was born.
THE EXAMINATIONS OF THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA
In 1972 Clarke had been invited to present his work in operative laparoscopy before a city wide group of Gynecologists at a Meeting in Toronto, Ontario, Canada. Later, invited to London, Ontario, he presented "New instruments for laparoscopic surgery" at The Nineteenth Annual Scientific Meeting of the Canadian Fertility Society (May 1972).
To be objective the Royal College held multiple-choice three hour examinations which were said to be the most difficult in the world. The candidate then spent a few minutes in a subjective oral examination. Five years of university in hospital training, passing objective exams of the United States and Canada can be nullified in a few minutes. Clarke discovered that it was common knowledge that coming from the United States one almost never passed. No matter how hard one studied the chances of passing oral clinical exams became less with time. This was because there was no opportunity for the candidate to improve his skills in clinical obstetrics and gynaecology and to prepare for oral exams, and the examiners were aware of this.
A colleague, a friend of Clarke, was taking the exam for the third time. He was known as a walking encyclopedia. The last time that Clarke took the oral exams the news came that his friend had passed out unconscious before the examiners. He was hospitalized in Montreal where the exams were being held, checked for brain tumor, then he was brought back and passed.
In November 1976 Clarke was invited to practice with Dr. Hutton, an Obstetrician and Gynecologist in Sault Ste. Marie, Ontario. Obstetric and Gynecologic privileges had been secured for him in the Department of Obstetrics and Gynaecology in the Plummer Memorial Hospital. After his arrival, the adjacent Catholic General Hospital gave him only family practice privileges. Dr. Hutton now showed no intention that Clarke would join his practice and offered no support. Clarke had been recruited by the "Down-the-hill" doctors to put pressure on their enemies, the " Up-the-hill" doctors in the Mc Nabb Clinic. The name Henry Courtenay Clarke had misled everyone into expecting the arrival of an Englishman. Shunned by both the "Down-the hill" doctors and the "Up-the-hill" doctors Clarke ran a gauntlet every day that he practiced. Humorous and at times dangerous attempts to frame something on him were attempted by nurses as well as doctors on the Staff at both hospitals. There was the pediatric nurse who ran in while Clarke was delivering a breech. She listened to the patient's abdomen with a stethoscope and exclaimed "ninety-nine , ninety-eight, ninety-six check the cord pulse!" She was not aware that there is no fetal heart to be heard in the abdomen at this time. She became very angry when Clarke did not respond. There was a pediatrician in the delivery room at the request of Clarke. She took care of the baby which was normal at birth had a normal neonatal course. Clarke was summoned before a Tribunal of the Pediatric Department to be accused of the poor neonatal condition of the baby. The attending lady pediatrician denied any such occurrence. Still, there was the threat"we will get you another time"by a member of the tribunal.
Clarke had heard that everyone who took the exams of the Royal College in
Obstetrics and Gynaecology from the University of Toronto eventually passed. He
was given permission to take the examinations of the Royal College again
provided that he trained for a year in an approved program and was supported by
a satisfactory in-training evaluation report. He applied and was
fully-registered with the University of Toronto in full-time, postgraduate
training. He was appointed as a fourth-year Resident in the Department of
Obstetrics and Gynecology for the year July 1, 1980 to June 30th,
1981. His training was to be at the Women's College Hospital and St.Michael's
Hospital. Accordingly, he closed his practice in Sault Ste. Marie and sold his
office and his home.
HOSTILITY FROM THE ANCESTRAL WHITE CAUCASIAN RACE IN CANADA
On July 1, 1980 Clarke entered Women's College Hospital to begin residency training. As he entered the lobby Dr. J. R. Taylor, Program Director, Post Graduate Education Department of Obstetrics and Gynecology, Faculty of Medicine University of Toronto, called him aside to explain that he could upgrade his knowledge of obstetrics and gynaecology but that he would not be permitted to take the examinations of the Royal College. It was now too late for Clarke to turn back.
He completed the year of training as a senior resident at Women's College and at St Michael's Hospital. On completion of his training, the Head of the Department of Obstetrics and Gynaecology at St.Michael's Hospital told him that he was not being permitted to take the specialty examinations but could give no reasons. A professor on the staff advised Clarke that the Head had orders which came from "higher up" and could not do otherwise. Eventually some reasons were given for not permitting him to take the examinations in a note from Prof. Harkins, Chairman of the Department and President of the Royal College of Canada, who had left town leaving a note for Clarke to sign to acknowledge receipt. This mentioned the management by Clarke of a case of hypertension in pregnancy.
He sought in vain to locate to practice medicine as he visited the small towns from Cornwall to Hearst, Ontario, where the need for physicians was advertised. A clinic in Toronto refused to employ him because he had a license to practice in Ontario. They preferred to hire South Africans and others who were not licensed and could not leave the clinic to practice elsewhere. One clinic with three white physicians claimed that they would be at a disadvantage competing against the other clinic in the town with four white physicians if they engaged a non-white. After waiting for three months for approval of a government grant to practice in the under serviced lumber camp town of Hearst, a friend uncovered from the doctor who approved the grants, that he was holding the position for a graduating medical student who may choose to practice there. Clarke's name was posted on the door of the small hospital as the sole attending physician. But, if he practiced before the approval of the grant he would not be eligible. The need for physicians in some small towns in Northern Ontario was advertised by the physicians in practice there. But once there, Clarke found that he was invited only to booster the standing of the host, to pressure another physician in the town, or he was directed to a more remote place such as a Red Cross station in a smaller town. The Northwest Territories did not respond to his application in spite of their advertised need for physicians. Clarke suspected the action of a poison pen.
In 1982 Clarke was accepted for family practice in the Clinic of Dr.
Brunner in Kingsville, Ontario, population 6000. In March 1984 his paper
"Erythema infectiosum: an epidemic with a probable post erythema phase" was
published in the Canadian Medical Journal. It was shortly after sending it in
for publication in 1983 that he had the first Peer Review of the College of
Physicians and Surgeons of Ontario. The Reviewers explained that this was
irregular since Clarke had been in practice for a short time, working under the
direction of Dr. Brunner and using his files. They found his work
satisfactory. (Letter from the College dated October 24, 1983)
On October 5th, 1983, Dr. R.E. Mc Girr, Chief of General Practice, and Dr. J.A.Taylor, Chief of Staff, of the Leamington District Hospital, with whom Clarke had little previous contact, called him in and requested that he resign from the hospital and go back to medical school. He asked for the basis of their request. "We are your peers. We don't have to give you any reasons. We shall take away your license to practice medicine and run you out of this country" Dr. Mc Girr replied angrily. A letter outlining their recommendations followed six weeks later dated November 18, 1983.
Dr. Brunner asked that Clarke leave his clinic. He explained that pressure from "higher up" had been exerted on him and he had no choice but to ask that Clarke leave his clinic. Dr. Brunner confided that he had been a classmate of Dr. J. W. Hannah, the Chief of Obstetrics and Gynaecology at Women's College Hospital, and that he had corresponded with Dr. Hannah about Clarke working in his clinic.
Shortly after, there was a second Peer Review (interview) by the College at Clarke's office, in his home in Kingsville. This involved a comprehensive testing of his knowledge from basic sciences to the practice of medicine. This was again satisfactory. (Dr. Gary Piper, September 19, 1984).
Now, false and incriminating notes by nurses began appearing on the charts of the patients of Dr. Clarke at the Leamington District Hospital. He considered it dangerous to continue on the staff of this hospital. He resigned and applied for Family Practice privileges at the Salvation Army Grace Hospital in Windsor. He was refused privileges. On February 16th, 1984, he went before the Medical Advisory Committee of Grace Hospital He inquired "why don't you give me privileges?" The answer from Dr. Johnson, Chief of Staff, was "We don't know". "What would you do in a circumstance such as this" Clarke inquired. Someone in the Committee advised that he get himself get a lawyer. On May 9th 1984, before the Board of Governors of the Salvation Army Grace Hospital The reply to his lawyer's question, as to why the hospital did not give him privileges, was "We don't know. We are not a detective agency".
On November 23rd, 1984 a third Peer Review (interview) was conducted by Dr. Dixon and a member of his Staff in the Offices of the College of Physicians and Surgeons in Toronto. Dr. Dixon explained that this was in order to "find something in which to upgrade you". It would require his attending a clinic two or three times a week in London, Ontario. "Why was this necessary?" Clarke inquired. Dr. Dixon replied that "this was in order to make you more congenial with your colleagues". They were unable to find something in which he needed upgrading. It was to be arranged for Dr. Moore in the Education Department of the College to give him a "quiz to find something in which you needed upgrading". Clarke agreed to take the quiz. He has received no notification of the appointment for the "quiz".
Following a prescribed protocol after appearing before the The Board of Governors of the Salvation Army Grace Hospital Clarke applied to the Hospital Appeal Board of Ontario. This Board met in Windsor on April 9th and 10th 1985. To summarize the Report "the Board accepts the evidence of Dr. Clarke where it conflicts with the evidence of Dr. McGirr..." The Board ordered that Dr. Clarke be granted full Family Practice Privileges including Obstetrics at the Salvation Army Grace Hospital.
Presented to the Board was a letter from Dr. Hannah of Women's College Hospital, dated December 22nd, 1983. It quoted from the Royal College Assessment Form filled out with respect to Clarke's residency between January and June 1981 at Women's College Hospital. "We noted that his clinical skills related to the specialty in use and care of equipment were in the average range as was his sense of responsibility, team relationships. However, he showed below average characteristics in self assessment ability, and performance under emergency conditions and his judgement and decision making was regarded as unsatisfactory". It was brought out before the Hospital Appeal Board of Ontario that Dr. Hanah was not qualified to form such a judgement since he was not a psychiatrist.
Also presented to the Board was a letter from Dr. Taylor:
"His performance was less than satisfactory, he appears to have suffered adversely from his years away from this specialty and his patient management and decision making rest on a very insecure base, his technical skills however are adequate." Here, Dr. Taylor who also had little contact with Clarke is justifying his decision not to let him take the specialty examinations. A decision Taylor had expressed to Clarke when he entered the Residency Program.
Why would medical doctors, who had little or no relationship with Clarke, lie in an attempt to realize their threat to run him out of the country and take away his license to practice medicine, refuse him privileges at a hospital and claim not to know why, and give questionable reasons to substantiate a decision, taken in advance of his training in the University of Toronto, in order to prevent him from taking the Specialty Examinations of the Royal College of Canada?
A letter from the College of Physicians and surgeons of Ontario in August 1994 stated:-
"The Peer Assessment Program is selecting physicians for assessment as they reach their 69th birthday. You have, therefore, been identified for assessment in 1994 since you will reach 69 years of age this year. Your practice was previously assessed in 1983 and it is the policy of the Peer Assessment Program to exclude practices which have been assessed within the previous ten years. Since it is now over ten years, you are eligible to be considered for assessment in 1994". Clarke was 69 years of age in November 1994.
In December 1994, Professor James Mc Berry was the Peer Reviewer. He told Clarke that his practice of medicine was "very good" and gave him his word that he would report this to the College. However, he reported that his practice was "acceptable but..." Dr. Mc Berry was head of a Clinic in London, Ontario, where Medical Doctors work while being trained or upgraded to be Licensed. Was this the clinic where he was destined previously by the College to be upgraded?
Professor Frederick A. Jewson, the Peer Reviewer in April 1996, told Clarke that his practice of medicine was "perfect" and he gave him his word that he would report this to the College. The College report indicated that Dr. Jewson kept his word. What could Clarke expect next?
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Henry Clarke © January 15, 2000 |
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