LETTERS / LETTRES
PROFESSOR B. OLUWAKAYODE OSUNTOKUN AND HIS NUNC DIMITTIS
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Keywords : Oluwakayode, Osuntokun
Professor Benjamin Oluwakayode Osuntokun died in Cambridge, England on September 22 1995 after a protracted illness and was buried in his native Okemesi, Ekiti, Nigeria on October 7, 1995. His death robbed Nigeria of its leading neurologist and one of its icons of modern medicine; Africa of one of the Foundation members of the Pan African Association of Neurological Sciences (PAANS) and the World Federation of Neurology of one of its most prolific writers and productive researchers on tropical neurology. Born in January 1935 Osuntokun started his elementary school education in 1940 at the Holy Trinity School, Ilawe Ekiti, where he was born, and finished it in 1945 at Emmanuel School Ado Ekiti. He entered Christ’s School Ado Ekiti in 1946, the famous and prestigious secondary school which moulded many Nigerians who later won prominence in various walks of life; thereafter, he studied medicine at the University College, Ibadan, then a College of London University.
His academic career was a remarkable string of distinctions and honours: he was top of his class at Emmanuel School at Ado Ekiti; in 1951 at Christ’s School he passed the London Matriculation Examination and then the Cambridge School Leaving Certificate Examination with several distinctions and in 1961, he graduated in medicine with the MBBS degrees of London with honours in Pathology and in Obstetrics and Gynaecology. After house jobs at the University College Hospital, Ibadan, and the mandatory stint as Medical Officer in the then Western Nigeria Ministry of Health, Osuntokun went to the Professorial Unit of Harold Scarborough in the Welsh National School of Medicine in Cardiff in 1963 as Senior House Officer to study for the MRCP which he passed in London at his first attempt in 1964. I visited him in Cardiff during his stay there. « One does not seem to get tired studying in this cold climate », he confessed to me with his usual good humour as he lapped up the immense opportunities and congenial academic ambience which the post in Cardiff offered. And after passing the MRCP London, we spent together a memorable and delightful weekend of relaxation, celebration and carousing in Lancaster and visiting parts of Yorkshire. He returned to Ibadan in 1964: eager to join his young family (his first child, a daughter, was born in 1963) and to take up appointment as a Rockefeller Foundation Medical Research Training Fellow in Neurology in 1964 and settle into a career in Ibadan.
But he was not quite ready to do so. With his young family and a Smith and Nephew Fellowship in neurology, he returned to the United Kingdom towards the end of 1964 to hone his skill at clinical and experimental neurology. He spent most of the time in Newcastle-upon-Tyne where he came under the tutelage of two giants of neurology: the legendary and avuncular Henry Miller, a raconteur who laced his neurology with wit and wisdom and John Walton, now Lord Walton of Detchant, a man with a penchant for details and depth in neurological knowledge bordering on the encyclopedic. I visited him in Newcastle and was privileged to attend one of their joint neurology – neurosurgery sessions at the Royal Victoria Infirmary at which Mr Hankinson the neurosurgeon was present. Osuntokun spent a short spell at the National Hospital for Nervous Diseases, Queen Square, London before he returned to Nigeria at the end of 1965 and was appointed Lecturer in the University of Ibadan.
Thus ensconced in the Department of Medicine under Professor Alexander Brown, Osuntokun started a career in neurology that was to spawn a cornucopia of scientific and scholarly publications, solely and jointly on epilespy, nutritional and toxic neuropathies, cerebrovascular diseases, headaches and pain problems, neoplasms of the nervous system, the neurology of diabetes mellitus and of the hameglobinopathies of Africa. The coda of his neuroscientific research was neuro-epidemiology which engaged his attention in his last days with the same success that attended his foray into neurology in his prime. Preeminent of his work in neuroepidemiology was the study of community dementia among the Yorubas of Nigeria in comparison with the blacks of United States. In the interest and service of neurology, he visited diverse places in every part of the world and held many appointments. Of particular interest to this paper, he was Foundation Member, Nigeria Society of Neurological Sciences and was Secretary from its inception in 1966 to 1970 and later President from 1983 until his death in 1995. He was also a Foundation Fellow of the Pan African Association of Neurological Sciences (PAANS) which was founded in Nairobi in 1972.
In his postgraduate and more mature career, Osuntokun gained a string of postgraduate degrees and professional qualifications: PhD (Ibadan) 1969; MD (London), 1971; FRCP (London) 1974; FMCP (Nigeria) and FWACP, 1976 and DSc (London) 1977. In Nigeria, he was made an Officer of the Federal Republic (OFR) of Nigeria in 1978 and in 1984 he received the highest award of his country, the Nigerian National Merit Award (NNMA) for distinguished contribution at national and international level in the Sciences, Medicine, Literature, Arts and Culture. In addition, in the same year, the University of Maiduguri awarded him DSc (Honoris Causa) and in 1985, shortly after his 50th birthday, two Chieftaincy titles were conferred on him in Ekiti, the district of his origin.
In January 1995, he turned 60. On the menu which he served guests at the diamond jubilee was an unusual item: copies of his curriculum vitae in which he detailed his background, professional experience; appointments at national and international level; membership of learned societies; scientific conferences attended from 1964 to 1994; papers presented; guest lectures given;, bric-a-brac of his other attainments and a list year by year of his 321 publications. He titled the booklet « Nunc Dimittis » of Oluwakayode Osuntokun.
The publication was the quintessence of diligent detailed documentation, so comprehensive that Osuntokun asked on its front cover, and certainly with some justification, « Need anyone say more? » I doubt if any more, in terms of broad factual details can be added to this « Nunc Dimittis », a salutary lesson to all those aspiring to pen their autobiography to do not too long after the age of 60 years, certainly before the mind starts getting fickle and the memory becoming blurred.
Some aspects of the booklets are worthy of comments. His father died aged 66, his most senior brother at 69 and he in his 61st year – all in contrast to Osuntokun’s beloved mother who died at the ripe old age of 90.
His religious and spiritual upbringing started much earlier than his mates at school imagined. It started, antenatally, from the miracle of his birth wrought by prayers; it continued in the childhood years which he spent in the compound of the apostolic church: at the age of six years, he was precocious enough to read the native edition of the Bible from cover to cover. One suspects that the regular religious knowledge classes which we all had at Christ’s School Ado Ekiti must have been child’s plays to him!
The education in Christ’s School gave its students more than a religious philosophy to prepare them for the battles of life. The school imbued them with a disciplined mind, love of hard work and industry, self-confidence and the grit to meet challenges. Osuntokun was an archetype of that generation. Some of us who made successful careers in the sciences left Christ’s School without physics and chemistry, and like Osuntokun « saw a bunsen burner for the first time » as medical undergraduates. It was from such an unprivileged and unpropitious origin that Osuntokun grew, an apostle of hard work, to attain the pinnacle of his profession.
The Nigerian National Merit Award which he gained in 1984 Was his deserving ultimate prize. What was puzzling was the citation that it was for his contribution to psychiatry and sickle cell anaemia (1). True, he wrote a few papers on these subjects but his monumental and enduring contributions were in clinical and investigative neurology. Recognition of merit is the kernel of a prize award; the citation that goes with it, usually the handwork of a committee, may go askew. Such was the ease of Nobel laureate, Egas Moniz of Portugal who was awarded the prize in medicine for his work on frontal leucotomy and not for his more substantial and far reaching introduction of carotid angiography in the diagnosis of neurological disorders.
It must be difficult to determine which of Osuntokun’s man publications are more significant and substantial than the others. One can use the yardstick of the frequency of reference to a particular publications recorded in the literature; future study of his booklet can accomplish that task. For now, and from personal knowledge, the two most notable of his writings are numbers 6 and 7 on page 49 of his « Nunc Dimittis », which incidentally were both written in 1968 when Osuntokun was 33 years old, the age when most artists and achievers are at the peak of their productivity.
« Congenital pain asymbolia and auditory imperception » (2) was a unique case report, one of his earliest series of « First case in the African » which he published with the Italian academic, Lucio Luzzato, then Professor of Haematology in Ibadan, later at the Hammersmith, London and now in the United States of America and the legendary late Latendu Odeku, the African neurosurgeon. The disease has become a classic and named eponymously after Osuntokun, the first author (3).
The flagship of his scientific papers is number 6, « An ataxic neuropathy: a clinical, biochemical and electrophysiological study » which appeared in the journal, Brain (4). He carried out the research reported at Epe, Western Nigeria, near the sea coast where people consumed a monotonous diet of ill processed cassava without supplementation, leading to nutritional deficiency which manifests as an ataxic neuropathy. He mapped out the epidemiology of the disease. Encouraged by is then Head of Department, Professor Alexander Brown and ardently supported by Professor Joseph Edozien of Chemical Pathology, Osuntokun was able to carry out an exhaustive study of the basic science aspects of the neuropathy. Up till that time, the disease attracted as many theories as there were writers and the few investigators who looked beyond the clinical aspects of this neuropathy were at sixes and sevens about its aetiology. Osuntokun found that the disease was due to cyanide intoxication. To him therefore belongs the kudos of unravelling the biochemical basis of what up till the 1960s was a confused clinico-pathological entity. I remember his exultation the day he got the galley proof of the paper from Denis Williams, the Editor of Brain; he was over the moon with sheer boyish excitement. He read and re-read it many times; Odeku and myself also checked it to ensure that it was perfect.
With the appearance of that paper in Brain, Osuntokun immediately became a name to conjure with in tropical neurology. An editorial on Ataxic Tropical Neuropathy appeared in the British Medical Journal in September 1969. In the same month, he presented his work at the World Federation of Neurology Conference in New York. I remember him standing on the podium to be introduced to the New York audience as the authority on the biochemistry of ataxic neuropathy, then the latest phenomenon in tropical neurology. It was certainly his finest hour. A Thesis in 2 volumes of 449 pages which came out in 1969 on Chronic cyanide intoxication and a degenerative neuropathy in Nigeria earned him the PhD degree of the University of Ibadan. In 1971 that seminal paper in Brain earned Osuntokun the Sir Langley Memorial Prize of the School of Tropical Medicine, Surgery, Hygiene, Sanitation, Entomology and Parasitology for the year 1968 to 1971. On the whole, he produced 34 papers on his famous neuropathy in his life time.
Recipients of copies of his « Nunc Dimittis » marvelled at the prodigious attainments which his life incarnated. Olufemi Illori, one of his classmates at Christ’s School complimented him on his achievements, wondering if Osuntokun had not burnt out himself in the process. Hippocrates, acknowledged father of medicine, had in 406 BC, defended Osuntokun in one of his famous aphorisms in which he exclaimed Ars longa Vita Brevis (Art is long life is short), a sentiment redolent of Osuntokun’s own observation that « Excellence lasts for ever ».
Although Osuntokun in his life time interacted with many Nigeria’s moguls, he opened the list of his alter egos with Fola Alade. By that gesture, Osuntokun took us back to Christ’s School Ado Ekiti and the halcyon days we passed there. Alade, Osuntokun, myself and a few others belonged to the Francis Adeagbo Boys Club where Prefect Adeagbo took us under his wings and protected us from the buffeting and hectoring of the tyrannical, terrifying senior boys of those days. The « Adeagbo boys » grew up together, playing hard, working hard, getting involved in this and that and constantly striving for excellence in all we did.
Soccer was Osuntokun’s best game at school, a sport which brought to the fore his gregarious spirit whenever he was in the company of his football colleagues in the School First Eleven team shown in Fig. 1. Standing in that picture and first on the left is Stephen Faloye, inside left forward and master dribbler from Akure. He was the first of the many Faloyes from Akure to play football for Christ’s School. Vincent Faloye the bespectaled goalkeeper and William Faloye (standing second from left in Fig. 2) played for the school in 1952.
Next to Stephen Faloye was Ephraim Oye who put his facility as the fastest sprinter in the school in 1951 to goo use as a midfield player. Then came Joseph Oyinloye, the thickset ponderous right full back with oak-like legs and a barrel chest. In the centre of the line up was Osuntokun, the centre forward and striker of considerable skill and success. His forte was unleashing terrific shots from just outside the penalty area. His trademark was a scarf tied round his neck and he christened himself Orlando Terror to intimidate the goalkeepers. On his left was Lalu Akinyemi, the fleet-looted outside left whose role model was Titus Okere, Nigeria’s golden boy and outside left of the 1940’s. Next was Lolu Adamolekun, the rather diminutive left full back, a nuisance to his opponents, quick to defending with both feet and given to irritating strikers by his funny noises and unprintable close-ranged utterances. I stood next to him in the picture, the inside forward, having earned my place in the 1951 School Team by successfully captaining Dallimore House Junior Team in 1950 to a resounding Cup victory as a prolific striker and centre forward. I captained the School Team in 1952, sitting second from the left on the right hand of the Principal, Rev. Mason in Fig. 2.
Kneeling and sitting in Fig. 1, first from the left was Ezekiel Ogunleye, one of the half backs. He was resting his body on our Games Master, the late Mr Theo Oni, one time First Master and de facto Deputy Principal of Christ’s School when, as he figuratively and proudly put it « he decided the fate of school boys and teachers alike ». Mr John Porter was fourth from the left. He was Acting Principal for three turbulent months in 1951 when as Rev. Mason later observed, « he ran Christ’s School like a battleship ». Two Europeans who helped to coach us sat on either side of Mr Porter. Then came Simeon Adu, captain of the School Team in 1951, and the outside right forward. His mercurial and sometimes volatile temperament inevitably coloured his game; he left nobody in doubt that he was the captain and to be obeyed. When he was in his element, Adu was an unstoppable attacker, tearing through any defence like a hurricane and drilling the ball past goalkeepers with his characteristic fierce low carpet drives.
He always successfully converted penalties with his big broad right foot. Adu was the father of the famous Sade, the singer and artist famed for the album « No Ordinary Love » featuring Sweetest Like a Taboo. Kneeling and resting against Simeon Adu was his towns mate from Ikere-Ekiti, Emman Olamosu, the tough, tenacious and tactical centre halfback who was to be in the School Team longer than any of us, having started from Form III.
The debonair goalkeeper, sitting stylishly with the ball was Edward Bisi Lawrence. Lithe and agile, Bisi Lawrence was as good at goalkeeping as he was at writing English essays. He was the School Librarian who taught Ben Oluwole and myself the magic of the English language. Osuntokun, like the rest of the 1951 Senior Class, respected Bisi Lawrence for his literary ability. When he was leaving school in 1951, Lawrence gave me a penguin book on which he inscribed the words of Goethe, the German philosopher, on the aristocracy of knowledge, power and wealth. I never saw Bisi Lawrence again since then, but read his regular essays in the Nigerian Vanguard. He did an article on Christ’s School about ten years ago in which he referred to the Osuntokun Academic Dynasty headed by the late Minister, Chief Osuntokun, our Games Master in 1952 (Fig. 2).
It is appropriate that pre-eminent on the list of Osuntokun’s « greatest teachers » are Rev. (later Canon) Leslie Donald Mason, Principal of Christ’s School from 1948 and Chief Joseph Osuntokun, his senior brother and our geographer teacher. Like Paul of Tarsus, Archdeacon Henry Dallimore « planted » Christ’s School, Ado Ekiti, but it was Rev. Mason, gentleman school master from Igbobi, and Master of Arts in Classics who, like Apollos of Alexandria, « watered » the school and transformed it to a modern famous school and one of the best in Nigeria.
Chief Joseph Osuntokun saw his junior brother, Kayode, settled into school in 1946 and 1947 before the Chief left Nigeria in September 1947 for Sierra Leone where he spent three academic years to gain the Bachelor of Arts of Durham in record time and added the Diploma of Public Administration as the icing on the cake of his academic success. We were all delighted when the Chief returned to Christ’s School in 1950 as the Geography master for the senior classes of the school. He was a walking Dudley Stamp, a textbook of world geography which he knew almost by heart as we realised when he taught
us the geography of the maritime provinces of Canada. We saw from a distance many visitors to the house of our Geography master during the last illness of their father David Osuntokun. He died in 1951 and Kayode shared his grief with me in a poignant poem he wrote in praise of his father.
After leaving Ado Ekiti, lawn tennis supplanted soccer as Osuntokun’s favourite sport. One of his playmates who became very close to him was Bayo Akinnola, a Chief of Ondo who was the best man at the grand ceremony on December 15 1962 when Kayode married Dr Olabopo Cameron-Cole, his eternal wife who in the reincarnation, he « will marry again and again and again. » Osuntokun was to remain as alert and able on the tennis court as in the clinic, both in Nigeria and in the United Kingdom as his colleagues and friends from Cardiff, Eldryd Parry and Keith Peters commented in the obituary notice in the Independent of UK of September 30, 1995 (5).
Another Ondo close colleague of Osuntokun was Professor Oladipo Akinkugbe whom he succeeded not only as Head of Medicine at Ibadan in 1971 but also as Dean of Medicine in 1974. Akinkugbe, the gentle giant of renal medicine used his dulcet voice and subtle diplomacy to great decisive and manipulative effect in the administration of Faculty of Medicine. It was from him that Osuntokun learnt a lot of finesse in Health Administration that his 1984 Nigeria National Merit Award specially cited and recognised.
I last saw Kayode in 1994 at the University of Ibadan post office where we met to collect letters. That venue has become the meeting point for retired employees of the University of Ibadan, many of who have their private letter boxes in the University post office. At our last meeting, we talked about a few things – retirement days; our travels; our families and the death of my father in March 1992. Then we parted, with the promise of meeting again, soon, before resumption of our peregrinations.
My last visit to the University College Hospital (UCH) Ibadan took me twenty five years down memory lane to those days when Odeku, Osuntokun and myself used to have our neuroscientific chitchat about our individual assignments and corporate efforts in the definition of neurology and neurosurgery patterns. Osuntokun’s unique ways of announcing his arrival at the hospital was to whistle my name. Nobody else did – or does – that: it is a singular gesture of friendship that I miss. The meetings were held usually in Odeku’s office when inter alia he filled us in on American neurological surgery and the works of Edgar Kahn and Richard Schneider of Michigan. Naturally, our riposte was to talk of neurology and neurosurgery in the United Kingdom: Osuntokun on the works of Henry Miller, John Walton and others of Newcastle-upon-Tyne and I about Valentine Logue, Lindsay Symon and Wylie McKissock of Queen Square London. If Olufemi Williams of Pathology was in his office, on the ground floor of the hospital, he told us his neuropathology news on our patients. Thus, the Sunday meeting was always a learning and lively neuroscientific camaraderie, the genesis of the twelve papers the four of us presented in January 1972 at the Nairobi Symposium on « Tumours of the Nervous System in the African » (6) which Renato Ruberti of Nairobi hosted and after which PAANS was formed (Fig. 3).
In January 1996, UCH Ibadan was different. The few cars parked in the Consultant park were mostly departmental cars laden with dust of disuse. The first floor of the annex where I had my office was unusually quiet – there were no consultants around doing their paper work. With the entire building wrapped up in such an eerie calm, I could not spend too much time in my office, chock-a-block with books, journals, papers and some memorabilia. After achieving pretty little or nothing, I left and went down to the ground floor. Still, there was no familiar face to see along the Pathology corridor. Then as I was nearing the office of the Chief Medical Director, on a poster to my right was the picture of Osuntokun, life-sized, almost real, in his academic robe and smiling his usual relaxed smile (Fig. 4). I stopped dead, jolted from my absent-mindedness by the sudden appearance of an old and close friend. It was the poster that carried his obituary; it was his farewell and parting shot. It was then that the telephone call I received in Malawi from Professor T. Ige Ade Grillo of Cambridge on September 23 1995 about the death of Osuntokun assumed a merciless reality. I felt a lump in my throat as it dawned on me that Kayode Osuntokun had truly died and passed away.
I have had playmates