Gerrit BrasBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39552.447928.BE (Published 17 April 2008) Cite this as: BMJ 2008;336:896
- Tony Sheldon
As a 28 year old junior doctor, Gerrit Bras got to understand his later specialty of pathology the hard way after surrendering to the Japanese during the second world war. He treated his fellow prisoners of war, working on the infamous Burma railway, for cholera, beriberi, malaria, and dysentery. Despite appalling conditions and the most primitive self-made medical equipment, he saved many lives, earning the nickname “Dr Cholera.”
Bras was born in Java in 1913 in the then colonial world of the Dutch East Indies. His father supervised forestry work so Bras played in Java’s forests, gaining practical knowledge that held him in good stead in later years. In 1939 he qualified at the Batavia, now Jakarta, medical school, before studying pathology and anatomy. He met his wife, Puck Bitter, and the two began careers in medical research, studying parasitic worms about which they intended to write their doctoral theses.
Life changed abruptly on 7 December 1941, when Japan attacked the US base at Pearl Harbour and entered the second world war. Bras was called up to serve as a medical officer in the Royal Dutch East Indian Army. By March the Dutch had capitulated. Puck Bitter was imprisoned in the horrific women’s camp on Java while Bras, together with thousands of other prisoners, was shipped off to Thailand. There he joined forced labourers building the railway later featured in the film The Bridge on the River Kwai. It is estimated that 150 000 prisoners of war died from starvation, mistreatment, and disease.
However, Bras, the trainee pathologist, knew many of the victims of cholera could be saved if treated for their extreme loss of salt and fluids. He improvised, straining dirty river water through neck scarves and then boiling it on a wood stove, borrowing raw salt from the cook, and estimating roughly the concentration. He then used an empty quinine bottle, or a naturally sterile coconut shell, a rubber tube from an old stethoscope, and his only surviving needle to set up an intravenous saline drip.
His single set of equipment required him to move constantly on to the next patient, but his assiduous 24 hour care often paid off. He became known as Dr Cholera both among prisoners and the Japanese, who themselves feared the highly infectious disease.
Although undernourished, suffering from beriberi, and enduring primitive, unsanitary conditions with little artificial light, he still managed to make meticulous patient notes scribbled in tiny pencil marks in his notebook. The book survives, and even 50 years later he was able to inform relatives of the diagnosis and date, place, and cause of death of their loved ones.
Before the end of the war he was transported to the coal mines of Fukuoka on the southern Japanese island of Kyushu and from there witnessed, in the distance, the atomic bomb dropped on Nagasaki.
He returned to medical research, gaining his doctorate in 1950 with a thesis on the 1949 smallpox epidemic in Indonesia. With Indonesian independence, he moved in 1951 to become a founding professor at the department of pathology and anatomy of the University of the West Indies in Jamaica, which had been established in 1950 under the supervision of London University.
There he gained international acclaim for his work on the pathology of veno-occlusive disease of the liver that was endemic on the island. He found it was related to the toxic effects of the Crotalaria genus of bush teas, a local herbal remedy for colds and stomach pains.
In 1971 he became professor at Utrecht University, where later, with veterinarian Morris Ross, he carried out research discovering that rats fed on a low calorie diet lived twice as long as, and had far fewer cancers than, normally fed ones.
He went on to build up the Institute of Pathology, attached to Utrecht University Hospital, developing a fearless reputation. In the 1970s he nearly provoked a riot by insisting that two professors, Herman van Praag and David de Wied, should be allowed to use his institute to discuss what, were then, controversial new developments in drug treatment for psychiatric illness. They had been denied the chance to speak at the hospital because of fears of disorder by radical students who passionately believed psychiatric illness did not have a biochemical cause but was related to social decay.
Bras’ former colleague and successor at the institute, Professor Dr Jan van Unnik, said: “There was a fine riot but the meeting went on.” He felt it was typical of Bras, a colleague who could be extremely loyal, supportive, enthusiastic, and authoritarian at the same time, to “act if he felt something was unjust.”
Another ex-colleague, professor of anaesthesiology Dr Bob Smalhout, emphasised that Bras was not just a very good pathologist but a full-blooded clinician. “We shared an old fashioned idea that medicine is more than just the specialism you practise. He was interested in the total illness of patients, their social background, and their complications.”
He believes his actions in Burma reflected a personal interest in every patient fuelled by his Christian religious belief in each individual’s worth.
Bras was a member of the editorial board of the Dutch Journal of Medicine and since 1972 a member of the Royal Netherlands Academy of Sciences. He retired in 1983, though remained active, riding his bicycle until the age of 92.
He leaves his wife, Puck; a son, Paul, also a doctor; and a daughter, Phyllis.
Gerrit Bras former professor of pathology University of the West Indies and founder of Utrecht University Hospital’s Institute of Pathology (b 1913; q Jakarta 1939; PhD), d 5 January 2008.