Vol 59 No 1 2019
Page 4
The Life Story of Dr. Robin Cooke, Former Editor of the IAP News Bulletin
Introduction
Dr. Robin Cooke has served ably and commendably for 23 years as editor of the News Bulletin of the IAP, and editor of the Australasian Division News Letter. As editor of the IAP News Bulletin from 1995 to 2018, Dr. Cooke, with the assistance of Luke Perkins (Australia), handled the collection, selection, design and assembly for each bulletin. Originally intending to retire from his role as editor after the 2016 Cologne Congress, Dr. Cooke stayed on until the new editor, Dr. Shivayogi Bhusnurmath (St. George’s University, Grenada), was selected in 2018.
In this endearing autobiographical piece, Dr. Cooke shares on events in his early life which influenced his professional life. He reflects on life in Australia over the past 80 years, and speaks on his formal education from medical school and junior residency to his post graduate training, which included six years as Director of Pathology Services in Papua New Guinea and two years at Hammersmith Hospital, London.
Dr. Cooke also shares about being the Director of Anatomical Pathology in Brisbane, his freelance private practice, teaching undergraduate and post graduate students, writing paper and electronic media publications, and his activities with the Royal Australasian College of Pathologists and the Australasian Division of IAP. He also touches on his recent battle with a life-threatening medical condition.
This is his story.
Early life
At birth I was given the name Robert Arthur Cooke, after my two grandfathers. But I have been called Robin ever since, and I have become accustomed to this name.
My parents had a small general store in Petrie, which was then a country town 16 miles North of Brisbane, the capital of the State of Queensland, Australia. As was the usual practice at that time, the living quarters were part of the store, and there was a door that connected the store with the family dining room.
From an early age, I began to join in the business of the store by refilling the shelves with items for sale such as packets of tea and tins of various food products. Items such as sugar were delivered in 56 pound jute bags, poured into wooden bins and then weighed into smaller packets for sale.
The inhabitants of Petrie and the surrounds were dairy farmers, day labourers who worked on the railway or for the Local Shire Council, and some men who had jobs in Brisbane. We had a shop assistant, who was related to many of the towns people. He used to come to work in the morning, and sit on the entrance step to smoke and read the paper before sweeping the shop, refilling shelves and serving customers. As people passed the store on the way to the railway station he would greet them with “Good morning, Tom” or whatever their name was. Quite soon, I would echo this greeting.
My father had a great love of horses. Soon after coming to Petrie, he bought two horses to be used as work horses in the business, and then, later, as entrants in the annual Agricultural Show. He then started to breed Welch ponies, and these used to win prizes both in the local show and also in the much bigger annual Brisbane Show. I was put on a horse as soon as I could sit up, and I learned to ride at an early age.
Papers were delivered around the town in the morning and in the evenings on horseback. By the age of seven I was doing the paper runs.
We also rode horses to collect grocery orders from the local housewives. Sometimes I accompanied Frank, our assistant, on such trips. Being tradesmen, we would use the back steps to enter the kitchen. Professional people, such as doctors always used the front entrance. The women were always addressed as Mrs. So-and-So. Frank would go through a list of about 20 items and record these in a small account book. In retrospect, some items of interest were cigarettes, tobacco (which came in small tins), and tobacco paper, in which a sample of tobacco was wrapped. The thin wrapping paper was licked to make a ‘roll your own’ cigarette. Quite a few men smoked a pipe, and these needed either leaf tobacco or solid ‘plugs’ from which the user would cut flakes to put in the bowl of the pipe. The stem of the pipe needed soft, metal cleaners to clean its stem of saliva.
Both forms of smoking needed packets of matches. The matches were also needed to light the fire in the wood burning kitchen stoves. Nearly all the women took at least one APC powder, called Bex powders, each day. This was recommended as a pick me up. The tobacco resulted in many cases of lung cancer, including for Frank, and the phenacetin in the APC powders resulted in chronic renal failure from the effect of phenacetin in the Bex powders. I never smoked because I could not stand the smell, and the smoke gave me asthma.
In the afternoons, the orders were prepared and delivered to the kitchen tables using the truck which my father purchased when they took over the shop in 1933.
In the store, we stocked almost everything that was needed by households, including work clothes and boots, some patent medicines and bandages (because there was no doctor in the district), and fabrics: cottons and wool for the women, many of whom used to make the clothes and knit jumpers for the family.
There was a two-room, two-teacher school that was a five-minute walk from our shop which was at the centre of the town. My mother, who was a teacher before marriage, taught me to recognise the letters of the alphabet and then words, by using the large headlines that would come with each delivery of daily papers. I started school at age four. There were 11 students in the class.
My mother taught me and her children to swim in a stretch of the river that passed through the town. This was also a popular picnic spot for Brisbane people who came on weekends from Brisbane. My mother wanted me to have some ‘cultural subjects’ such as music and dancing that were not taught in Petrie. So when I was nine, she sent me to a school in Brisbane that was easily accessible to the bus and train from Petrie. Both buses and trains ran hourly and the trip took an hour each way. Thus began my five days a week travelling to Brisbane for primary, secondary and university education. The buses were always crowded, with standing room only. I used to read my textbooks standing up and holding the overhead straps.
My first day at the Brisbane primary school was memorable. The headmaster, who took my enrolment details, asked if I could swim. My mother said I could. The interschool swimming championships are on next week, could he have a trial against the current entrant for the under 10 competition?
The headmaster took me to meet the class on the second floor. I was impressed by the worn wooden steps, and by the awesome prospect of being one of 60 students. Then to the public swimming pool about 800 metres walking distance from the school. I had never seen a swimming pool, let alone dive in from the starting blocks. However, I won easily, and after the first school exams, I was top of the class. My fears abated, and I began to enjoy the school activities.
Primary school 1942 to 1949
These years were very pleasant. There were school activities, study, violin and performances, swimming and, at home, shop duty and horses.
These were the years of World War II, with the Japanese Imperial Navy and Army forces invading from the north, and General Douglas McArthur setting up his headquarters in Brisbane. A large contingent of US soldiers set up camp in the bushland around Petrie. There was an airstrip with an occasional aeroplane crash, and soldiers coming into the shop. Like many other citizens in Brisbane, my mother arranged singsongs around the piano and mini concerts in our home.
These soldiers came from New Orleans, and they spoke like many of the actors in the American cowboy movies with which we were familiar. We, therefore, found their accents easier to understand than they did our version of English.
Secondary school 1950 to 1953
These were post-war years when the population increased. Mining, particularly coal mining, took off, and Government revenues increased so that it was able to invest in infrastructure, education, health and social security. Private business also improved.
While there were government scholarships for education, I think the teaching was not very good. It took a few years to train qualified teachers.
There was a school syllabus set by External Examiners from the University. There were state-wide external examinations set by these examiners for the end of the second and fourth years of secondary school. English, Math and Latin were well taught. French was taught by teachers who had never heard a Frenchman speak, and who were one page ahead of the students for each daily lesson. Science, in particular, was not well taught. We were told that all we needed to do was to learn by heart the lecture notes given by the teachers, and the textbooks composed by the University lecturers who examined. We observed a few experiments performed by the teacher in front of the whole class.
Photography, History and Dancing
My mother used to take photos of significant family events using an early Kodak box brownie camera. They were printed in black and white, and she used to write the names and date on the backs of the photos. The photographs shown already were taken by her. She also added some comments (a habit I adopted). I became interested in taking some of these photos, and she gave me a very basic camera when I was nine. I took some photos of events at both the primary and secondary school. This led to my lifelong interest in photography.
One of the prizes I got at primary school was in history.
In my fourth year in medical school, I found the optional short course in Medical History to be fascinating.
During primary school, I learned ballet and national dancing, and sat for the relevant examinations. I kept up the practice for tap dancing, Russian Cossack dancing and Scottish Highland dancing. I performed in university student concerts, and in later life, when I visited pathologists around the world. The latter performances frequently allowed me to be invited home for dinner where I was able to engage in discussions that would not have been possible during a normal working day. Two really memorable occasions were dancing at the Doctors’ concert at the European society of Pathology Conference in Ljubljana, Slovenia in 2003, and at the opening ceremony for the 2004 International Congress of the IAP in Brisbane.
An important event at secondary school
Another event that has ever since played a significant role was that I met a young swimmer, Roma Allan, at the swimming club to which we both belonged. She became an Australian champion in 1953 when she and three other young women broke the Australian record for the 4x100 metres freestyle relay.
We courted throughout our University courses. She studied arts with history honours and teaching. We married a week after the medical graduation, and celebrated 59 years of marriage in December 2018.
Medical School 1954 to 1959
I joined the medical course at the University of Queensland in Brisbane. My choice of medicine was accidental. Because I got a good result at the end of secondary school, it was usual for students with such a result to study one of the professions. It was a six-year course, and there were 100 students in first year; of these, fifty graduated.
One of the first-year subjects was medical physics. The lecturer introduced us to the fact that ultraviolet radiation was a cause of skin cancer. It took many years before this message became public knowledge. In these immediate post-war years, it was not fashionable to wear hats, and ‘sunbaking’ for hours at a time on the beautiful sandy beaches was a desirable thing to do. As a result, skin cancers became very common in Australia.
As a Pathologist, I became one of a team that helped to demonstrate the pathology of melanoma in relation to ultraviolet light. A highly successful publicity campaign commenced in Australia in 1981 to educate the public to ‘cover up’ when working or playing in the sun. This was orchestrated by the Government and the Queensland Cancer Fund.
I am sorry to say that I was not stimulated by my classes in the first two years of the University Medical course. My experiments in physics, chemistry and physiology never worked, and the microscopic specimens that were demonstrated never showed what they were supposed to show. The specimen would always be moved by students peering down the mononuclear microscopes, and demonstrators were forever trying to get the field into view again.
We had formalin-fixed bodies on which to perform dissections, without gloves or proper dissection instruments. I was put off by the formalin fumes and the effect of the formalin on my hands and respiratory system. No one showed us how to dissect, so anatomy became a rote learning of the various anatomical structures and their relationships to adjacent structures.
The main subject in third year was pathology. The lectures were dry and monotonous. However, the gross specimens in pots were supplied with well written histories and descriptions, and I found this part of the course interesting and useful.
A course that did interest me was Bacteriology. Lectures were given by two young scientists who had recently returned from postdoctoral studies in the USA. The lectures were followed up by practical classes. Not only did they speak about the organisms that cause diseases, they also introduced us to the new subject of Immunology.
The lectures on Rickettsial diseases were given by Edward (Ted) Derrick. His lecturing style was rather dull, but he had by then identified a new disease he called Q Fever. At first, he thought that this was a disease peculiar to the workers in the abattoirs of southeast Queensland, but it was soon shown to be of worldwide significance. He gave good lecture notes, which I still have, but nowhere did he mention that it was he who did all the original work on this topic, and he gave no references.
Many years later, in 1992, I found his original laboratory notes and copies of his publications and lectures on the topic. I was able to delve into them and put his observations into chronological order. He did everything except crack the mode of transmission of the causative Rickettsia. My report was printed in the special Christmas Edition of the Medical Journal of Australia in 2008.
Fourth year of medical school brought our first contact with clinical subjects. I began to enjoy the course. We were now divided into small groups of six or seven. We got to know these students well in the three years till graduation. John Tyrer, the newly appointed Professor of Medicine, and his three assistants gave good lectures that were illustrated by clinical photos taken by the full time professional photographer, Graeme Jurott, whom he had appointed.
Anatomy dissections were presented by newly qualified surgeons who demonstrated the relevance of the anatomy. Suddenly, I found anatomy interesting and useful.
Every Friday afternoon at 4 pm, there were pathology demonstrations by the registrars, who were doing the postmortem examinations for the hospital. Most of these were Medical Registrars (called residents in the USA), who were spending one year in pathology. They presented the clinical histories and then the pathology. The Medical Superintendent of the hospital and the Professor of Medicine always attended these sessions, and there was lively discussion on the cases.
In fourth year of Medical training (1956), there was a course on Tropical Medicine and Parasitology that was combined with one on Public Health. The latter was accompanied by Saturday morning visits to such places as the sewage treatment plant, the quarantine station, the ‘lunatic asylum’ and the water treatment plant.
The topic of Epidemiology was included in the curriculum.
The Public Health course included lectures on Forensic Pathology by the three forensic pathologists.
In fourth year, I became aware of a scholarship, offered by the Commonwealth Government of Australia, for students who would agree to work in Papua New Guinea (PNG) for six years after graduation. This interested me and I was accepted.
One condition of the scholarship was that the student would spend the six weeks of the Christmas vacation working in a hospital in PNG. This, too, was an attraction. I was not to know how much this would influence the rest of my professional life.
Sixth year of medical school was marked by sickness of both my parents that required more time at weekends working in the shop. On top of this, my fiancé developed a bilateral pneumothorax while working as a teacher in a small town 300 miles north of Brisbane. She nearly died and spent many months in hospital.
However, I graduated with reasonable results under the circumstances, and married a week after graduation.
The first two years after graduation
To obtain medical registration, it was necessary for every medical graduate to spend one year in a hospital. I obtained an appointment at the Mater Hospital, the smallest of the three teaching hospitals in Brisbane. I chose this because it offered rotations in all the disciplines, and some super specialties as well. I thought that this would be good training for working in a one-doctor hospital under the primitive conditions that existed in PNG at that time.
My wife and I rented a small apartment near the hospital. She had a hard and rather lonely time because I was very busy and worked long hours at the hospital.
In the second year, I obtained a position as the only registrar in pathology. The pathologist input was by two pathologists who had a private practice about 10 minutes drive from the hospital. I was responsible for doing the grossing of the surgical specimens and for the 100 plus autopsies in that year. These included general medical and surgical cases, paediatric and neonatal cases. The younger of the two pathologists came one Saturday morning and showed me how to do an adult autopsy. The newly qualified paediatric surgeon at the Royal Brisbane Hospital showed me how to dissect paediatric cases for autopsy.
The pathologists took it in turn to spend about 2 hours each morning reporting the surgical cases with me. I made preliminary reports on these before they arrived.
I did about 100 bone marrow aspirations and reports with the younger pathologist Redmond Quinn.
I learned how to do blood cross matching, and I was responsible for the ordering of blood from the Red Cross blood bank.
I prepared the frozen sections for the pathologist who came from the city when I notified him that a frozen section had arrived in the laboratory.
I learned how to do all the tests that were done in all the departments in the laboratory. Mycology and chromosome analyses were recently introduced to the Lab in 1960, and I learned how to do these.
A young, newly qualified photographer was appointed to the hospital. Her studio was close to the laboratory, and I joined her in doing clinical and specimen photographs. This was very valuable experience.
By about midway through the year, I was the face and voice of pathology in the hospital.
Summary of the first 40 years
My first 40 years provided the basis on which my second 40 years were built.
My introduction to horse riding was perhaps not very significant, but on a lecture tour in Indonesia in 1990, I was able to create a very good impression on my Indonesian hosts when they took me to the active volcano, Mt Bromo in Java. There were men with Timor Ponies they were using to transport visitors to ride up the wall of the volcano so they could view the smoking crater more closely. Having got a tourist into the saddle, they led the ponies slowly up the wall and then down again. I asked my hosts if I could take a pony for a ride in the flat area around the base of the volcano. With some incredulous hesitation, this was agreed. I adjusted the stirrups to my size, took the reins, mounted and cantered off into the distance. After about 100 metres, I turned and rode back again. There was general applause from the owner and onlookers.
Leigh Owen, the Senior Scientist I took with me for this trip, took a picture of me riding back, and he gave me a mounted copy as a gift at my farewell party.
The subjects in years three to six of medical school that were to be of most value for my time in PNG were Tropical Medicine and Forensic Medicine.
As a minor hobby, I began taking clinical photographs with a new single lens reflex Voitlander Zeiss camera.
My interest in history and photography set the stage for composing and illustrating News Bulletins.
The training I had in laboratory techniques and management at the Mater Hospital prepared me to be Director of Pathology Services in PNG, and the experience there made me a strong contender for the position of Director of Anatomical Pathology at the Royal Brisbane Hospital.
Working in Papua New Guinea 1962 to 1967
I flew on a super constellation aircraft to Port Moresby, the capital of PNG in January, 1962. My wife followed me about six weeks later on the “Bulolo,” the ship that serviced the ports in PNG and the adjacent islands.
I was met at the airport, and taken to meet the Director of Public Health who would tell me where I would be working. He said, "I want you to be the Director of the Pathology Services for the country, and you will be based in the Port Moresby General Hospital. You will replace the pathologist who has been there since 1946. He is blind from macular degeneration, and for some years I have been looking for someone to take over and get the pathology service functioning properly."
I said, “Yes, sir” and off we went. Such is the confidence of youth that I had no doubts at all that I would be able to do that. Such a thing would be unthinkable now.
In retrospect, I can see that the subjects that I liked in the medical course, and the experience I had at the Mater Hospital did qualify me for the job.
As well, when I first visited PNG at the end of my fourth year of medicine, I was very fortunate to have been allocated to work in Madang with Dr. Len Champness. He and his wife took me under their wings, and Len and I talked medicine all the time. Len also told me how the public health department operated.
Len ran the ‘European’ hospital in town, and I went to the ‘Native’ hospital, which was a short walk away. There, the Matron who was also the theatre sister and the medical assistant who administered the hospital and gave the anaesthetics, took charge of me and let me do many clinical and surgical procedures that a medical student would never be allowed to do in Australia.
In my six weeks with Len, as a medical student, I met almost all the administrators who were heads of departments by the time I arrived in Port Moresby as a graduate. This made it relatively easy “to get things going.”
The laboratory in Port Moresby was housed below the wards of the ‘European’ hospital.
A medical school was established adjacent to the ‘Native’ hospital in 1961. There were four departments - Haematology, Bacteriology, Biochemistry and Anatomical Pathology. The first three were each staffed by a senior, well-trained overseas graduate supported by a few local staff who had had some rudimentary training.
I ran the Anatomical Pathology (AP) section, and did the bone marrows. I also did the administrative work and liaising with hospital staff in Port Morseby and all the other centres in the country.
Quite soon, I was preparing specimens for a teaching museum. The retired pathologist had already taught one man to cut sections and to make perspex pots. None of these men could speak much English, and their preferred language was Pidgin, of which I had a rudimentary knowledge.
There was an older man, Lalai, as a mortuary attendant. He managed the reception of bodies from the hospital, and the collection by undertakers. He did not speak any English, but we managed to communicate well, and became quite attached to each other. The mortuary had an overhead fan but no air-conditioning. There was always a crowd of onlookers who would peep through the louvers that we kept closed. So the room was always very hot. At the end of each postmortem, Lalai would invite relatives into the mortuary and demonstrate the pathology to them.
He accompanied me on the small aircraft that took us and a policeman to perform forensic autopsies in villages all over the country.
I kept careful records of the reports I made and assembled a considerable database of the diseases I encountered. In association with the Papuan Medical College physicians, I ran weekly Grand Rounds where we compared notes on our experiences.
I circulated reports of these meetings to doctors in one-doctor hospitals throughout the country with my pathology reports.
There was no formal, in-depth record of the diseases of the people in PNG at this time. We were assembling valuable information that formed the basis of the teaching we gave to the medical students.
During this time, I was very greatly supported by the staff at the School of Public Health and Tropical Medicine at the University of Sydney, both with technical assistance and professional help with difficult cases.
Before I arrived in 1962, the School of Public Health and Tropical Medicine at the University of Sydney was receiving all of the biopsy and postmortem specimens that were taken in PNG. A Tumour Registry was established by Dr. Leicester Atkinson, Radiotherapist at the Prince of Wales Hospital in Sydney, and copies of the pathology reports were sent to him for recording. This was one of the first such Tumour Registries.
In 1960, Prof. Rolf ten Seldam, from the University of Western Australia in Perth, joined the reporting team for specimens from PNG. He, too, sent copies of his reports to the Tumour Registry.
Prof. ten Seldam was particularly helpful to me with reports, and in his enthusiasm for the material I was getting. We became lifelong friends.
By about June of 1962, I had established a good pathology service to Port Moresby and to the country hospitals.
In 1963, the scientists and I had developed a curriculum for teaching the national technicians, had it approved by the Papuan Medical College, and began lectures.
In October 1963, I and some of the other young doctors my age were allowed to spend two years overseas to gain postgraduate degrees and experience. The general practitioners went to Sydney to the School of Public Health and Tropical Medicine. Those who were looking for college fellowships went to the UK. I went to the Royal Postgraduate Medical School in London to attend a 12-month, full-time course leading to a Diploma of Clinical Pathology Degree from London University.
This course and degree were specially established to provide training and a degree that would be recognised as a specialist degree in pathology in all the Commonwealth countries.
The course was rigorous and wide ranging. Being a student of the Medical School, I was allowed to attend any and all the postgraduate lectures that were being given in the hospital. At that time, it was recognised as the best place in the UK for preparing for the Fellowships of Surgery, Medicine, Obstetrics and Gynaecology, and Radiology. Three courses were run each year. They started every day with an 8am lecture, and I went to all of them in each course.
The pathology department had postmortem demonstrations every day, and each Wednesday, there was a midday Grand Round in which there was a clinico-pathological presentation of a difficult case. Often, there was an invited expert from another London Hospital who would be invited to comment on the case and come to a diagnosis. These cases were reported in the British Medical Journal as clinico-pathological conferences (CPCs) from Hammersmith.
Experts from all over the world came as visitors to Hammersmith, and often gave special lectures that were open to all.
The Diploma of Clinical Pathology (DCP) course had 12 students, each from a different Commonwealth country.
There were lectures every day by the world experts from the various departments. Each one of them would then be available in the practical lab to have discussions with the students. At the end of the year, there were written and practical examinations in each of the disciplines.
Each Saturday morning during the AP block, we had quiz sessions on gross specimens from the museum and from the current surgical and postmortem specimens. These were entertaining and instructive.
There were also visits to other institutions—the London Hospital for some lectures on forensic pathology, and the Army Medical School at Millbank near the Houses of Parliament for Tropical diseases.
At the end of the DCP course, I was very fortunate to be able to have a job as a Pathology Registrar in the Pathology Department at Hammersmith. The Professor had a cabinet of liver biopsies that were used by Prof. Sheila Sherlock in the preparation of her seminal book on liver diseases. I spent time examining all of these.
He also had some paraffin blocks that had been given to him by DCP students from various parts of Africa and elsewhere in the world. I was allowed to come early and cut and stain new sections from all of these. I cut two H&Es, one for him, and one for me. This gave me a basic collection of Tropical Diseases that I could use for teaching my own students, which I did.
The Department had a Museum curator, who was also a good photographer. I was allowed to photograph many of the specimens, and I gained some more photographic and technical expertise from him.
On some Saturday mornings, I visited the Pathology Museums at the Wellcome Institute in London. This was an historical Museum, and it also had a very good, and well displayed collection of Tropical Diseases. This museum was used for teaching in the Diploma of Tropical Medicine course run by the London School of Tropical Medicine.
I also visited the Hunterian Museum at the Royal College of Surgeons, and on a brief visit to Edinburgh, I visited the Museum of the Royal College of Surgeons of Edinburgh.
1966 and 1967 in Port Moresby, PNG
In these two years, the work in the laboratory increased, and I had to spend some time preparing for the Examination for Membership of the Royal Australasian College of Pathologists. I was successful in this in October 1966.
There were medical students to teach, and I was photographing patients and specimens and preparing specimens for the museum. By the time I left in December 1967, there were about 700 specimens in the museum and a nucleus of clinical photographs in the University Department.
When I visited Port Moresby in 2015, the specimen jars had lost a great deal of their fluid fixative and the specimens had become discoloured. A grant from the Royal Australasian College of Surgeons enabled a rejuvenation program to be undertaken and the newly appointed scientist / curator, Martin Ata’o, opportunity to travel to Australia to receive training in the process. Since returning, Martin has continued the repotting program and replaced the old display cabinets.
Forensic work was increasing, and the laboratories in the main towns needed to be strengthened to cope with their increasing workloads. I established a cervical cytology service for the Port Moresby Hospital.
Papers were written for the Papuan Medical Journal and the Medical Journal of Australia.
With the establishment of a University of PNG, its Medical School and an Institute of Medical Research, there was a steady stream of advisers passing through. There were Professors from Australia and from overseas. There were surgical teams for treatment of chronic pulmonary TB, and external examiners in all the disciplines. These contacts resulted in my forming of friendships with many of the senior medical people in Australia.
One of the special visitors was Carlton Gajdusek who was investigating the neurological disease that was unique to a small group in the Eastern Highlands of PNG. It was reported in the world press as the ‘laughing sickness’.
When Carlton was visiting Okapa, the centre of the Kuru district, he would send his equipment ahead of him addressed to the Pathologist, Port Moresby. When it appeared, I stored it in my office. We had quite a few meetings like this, and later in Australia. He won a Nobel Prize in 1976 for showing that Kuru was caused by a ‘slow virus’, now called a prion. I was visiting his laboratory at the National Institutes of Health in Washington on the day the prize was announced.
By mid 1967, it was clear that PNG would become an Independent Nation very soon. There was a choice of staying on in PNG or leaving for a position in Australia. After giving this due consideration, my wife, who was pregnant with our first child, and I decided to leave for Australia if an appropriate job became available. Unexpectedly, the position of Director of Anatomical Pathology at the Royal Brisbane Hospital in our home town was advertised in October 1967. I had had an opportunity to look at all the Pathology Positions in Australia except Brisbane. In spite of this, I decided that the one in Brisbane would be the ideal one. I applied, with references from PNG, from London and from senior pathologists in Australia, and I was successful.
Summary of my PNG and London experiences
I went to London in 1963 with a list of conditions that I had encountered in PNG, and I left with a list of ways to investigate them further when I returned.
It was not until I was preparing my Doctor of Medicine thesis in 1974 that I realised that I had been given the privilege of being able to record the diseases that affected these stone age people of PNG at the time of first contact with Western Culture and Medicine.
My interest in, and contact with PNG has continued to this day. I have received consultations regularly, and visited for short periods as an external consultant lecturer and examiner. I have been able to document—with photographs—the changes in disease patterns in the people as they adopted the Western life style, and some of the diseases that resulted from this. It has also given me an opportunity to get to know the next few generations of doctors in PNG.
Director of Anatomical Pathology, Royal Brisbane Hospital 1968 to 1991
On this one campus, there was a General Hospital, a Children’s Hospital, a Women’s Hospital, the cancer treatment centre for the State, the Queensland Institute of Medical Research, the Medical School and the Professorial departments of Medicine, Surgery, Obstetrics and Gynaecology and Child Health.
I joined a group of Specialists in all fields, and we upgraded the services until they were recognised as being equivalent to any in Australia and almost anywhere else.
One of the attractions of the job was that there was a full-time photographer, Brian Stewart. He was about to look for a more rewarding job when the advertisements for a new Director of both Pathology and Anatomical Pathology were announced. He decided that he would wait and see what the new boys were like. We became firm friends and produced the book, ‘A Colour Atlas of Anatomical Pathology’ in 1987 that went to three editions and four foreign language translations. Brian developed a reputation as a Medical Photographer, and became an adviser to the hospital staff on all things photographic.
I was a foundation member of the Australasian Division of the IAP and contributed actively to all its educational activities. I did a term as President (1986-1987), and for 23 years, I produced two Newsletters each year.
I was an active contributor to the educational activities of the RCPA, and established the first Quality Assurance Programme in Anatomical Pathology. I did this for 6 years and then published a report on the results. After this, I arranged a slide exchange scheme for continuing education for one-person pathology laboratories in country cities. When digital cameras became available, I converted this slide exchange to a digital format.
In 1991, I took the option of ‘early’ retirement and was given the title of Emeritus Consultant for the Royal Brisbane Hospital as a parting gift.
Private Practice and other Professional activities from 1991 onwards
Having left the responsibilities of a full-time job, I was able to pursue other interests that I had developed during my time at the Hospital.
Firstly, I established a solo private practice in Anatomical Pathology, something I wanted to do while I still had the energy.
I did this for 10 years, and then I did locum work in regional laboratories throughout the State.
When I turned 70, I stopped doing front-line reporting, and spent more time with the IAP News Bulletin, and preparing teaching material for undergraduate and postgraduate students.
In 2008, I published ‘Infectious Diseases: Atlas, Cases, Text’ the culmination of a long and varied career in pathology, interests in photography and history, and commitment to teaching.
News Bulletin of the IAP
Since 1994, I have been Editor and producer of International Pathology—the News Bulletin of the International Academy of Pathology (IAP).
It is published quarterly and features articles and pictures of both contemporary and historical people and places.
The objective of this publication is to inform members about the pathologists who work in the 55 different countries that are represented by the IAP. It is regarded as being a very useful contribution to international understanding and goodwill. The print version has had a circulation of about 23,000 worldwide.
Copies of this publication from 1996 are now on the webpage of the IAP.
Recently, I have helped the Assistant Secretary of the IAP, Charles Ramey to place all the editions of the News Bulletin—from the first edition in 1906—on this webpage. Like the Australasian Newsletter, this collection of News Bulletins is searchable by a Google search and it is an historical record of the IAP. Photographs I have taken of pathologists since 1994 are a particularly useful record.
I resigned as Editor with the publication of Vol. 4, 2018.
IAP Congresses
In 2004, I won a competitive international bid to host an International Congress of the IAP on behalf of the Australasian Division in Brisbane. I became the President and chief organiser of this highly successful and award-winning Congress. Since then, I have been heavily involved in organising further National and International Conferences.
Order of the British Empire (OBE)
The OBE was inaugurated by King George V and Queen Mary in May 1917 as a new Order of Chivalry. The King wanted to recognise the many members of the British Empire who had rendered special service to King and Country during World War 1. Prior to this there was only an Order of Knighthood, and this was reserved for members of the aristocracy and the military. King George wanted to recognise people of all classes of society who had worked with outstanding dedication during the War.
In 1991, Australia, together with other British Commonwealth Countries, introduced their own orders of chivalry. The Australian Order is called the Order of Australia. I received an OAM in 2001 for distinguished service in the field of Medicine, in particular the teaching of pathology.
In 2002, I was awarded an O.B.E. by the Government of Papua New Guinea for service to Health in Papua New Guinea.
I found that there was an Association of the OBE in Queensland, so I joined it, and my wife and I attended the social events that the Order celebrated during the year.
The members of the Association were then mostly over 80 years of age, and the mortality rate was high, and increasing. In 2010, I was invited to become the President of the Queensland OBE association. It was thought by past Presidents that I was young enough to be able to “see the Association out”.
Having become President, I contacted the Secretaries of the Associations in the other States of Australia to see how they were faring. As it happened, they all told me that their Associations had either just recently ceased to function, or they were about to, because the main organisers were too old, or had died.
As well as finding out about the other Associations in Australia, I decided to find out more about the Order by calling on the Secretary of the Chancery of the Orders of Knighthood, whose office was in St. James’s Palace in London. I visited a number of times, and each time he arranged for me to visit various aspects of the Palace that are not open to the public.
In Brisbane, as President, my wife and I were invited to many functions held by the Governor at Government house, a Heritage listed stately building set in spacious and well-manicured grounds and gardens. There were also invitations to special occasions, such as the celebration of the Diamond Jubilee of the Queen, the visit of Prince Andrew, and a very special occasion when I was one of 80 people to have lunch with the Queen and the Duke of Edinburgh when they visited Brisbane in 2011.
The highlight of 2017 was an invitation to attend a special ceremony in St. Paul’s Cathedral attended by the Queen and Prince Philip to celebrate the centenary of the establishment of the Order. I led a delegation of four Queensland members of the OBE Society to this ceremony.
The British Order has regular functions in St. Paul’s, but the Queen and the Duke only attend one in every four years. This would be the last delegation of Australians to this four-yearly ceremony, and the last one that the Queen and the Duke would attend.
The Secretary of the Chancery was responsible for running this ceremony, so he promised to get us good seats.
There were 2,400 people in the cathedral and we were given the privilege of front row seats, four away from the Queen and the Duke of Edinburgh. We had an unobstructed view of the spectacular ceremonies, and the best position in the Cathedral to appreciate the wonderful acoustics designed by Christopher Wren in the 1600s.
The Queen arranges a Royal Garden Party in the grounds of Buckingham Palace every May. The one for 2017 was the day before the ceremony in St. Paul’s. Over 7,000 invitations are issued for this function, and tickets are highly sought after. The Secretary arranged for us to have tickets. This was a really exciting occasion. People were asked to wear their medals. The military wore uniforms. The others wore dinner suits or business suits. National Costumes were also encouraged. Ladies wore hats, most of them being broad brimmed.
The atmosphere was enhanced by two military bands from the British Grenadiers. Sandwiches, cakes and tea or coffee were served at a large food tent. The afternoon started grey with very light rain showers, but in the second hour, the sun broke through the clouds and brightened the colours of the flowers and the clothes. The Queen, the Duke and the senior Royals and their secretaries and equerries walked around mingling with the crowd, despite tight security.
My recent Illness
When I tendered my resignation as Editor of the News Bulletin at the IAP Congress in Cologne in 2016, I had no idea that the following year I would develop Polymyalgia Rheumatica, followed by a very aggressive form of bilateral Temporal Arteritis.
The management of these conditions, and complications of high dose corticosteroid treatment to prevent permanent loss of vision resulted in my suffering a severe and prolonged delirium for the first seven months of 2018. I have no memory of this period of my life.
I am extremely fortunate to have received the highest quality of medical care from my ophthalmologist, Dr Diana Conrad, and the many other medical specialists and nurses during this time in hospital and supported care.
I am happy to report that I have made an extraordinary recovery from these very serious conditions. Thanks to the tireless efforts and daily attention of my daughter Deirdre and support of my wife Roma during this last year, I am now happy to be home and able to resume most of my previous activities.
I thank my wife Roma of 59 years for her support throughout my life journey.
by Robin A. Cooke, OBE, OAM, MD (Qld), DCP (Lond), FRCPA, FRCPath, FACTM
Dr. Cooke is Emeritus Consultant at the Royal Brisbane Hospital, Australia, and Associate Professor at University of Qld, James Cook University, Griffith University, and the University of Papua New Guinea