International Day to End Obstetric Fistula, 23 May

Friday 23 May has been designated International Day to End Obstetric Fistula by United Nations Population Fund (UNFPA), and is the subject of the recent blog by RCOG President, David Richmond. Dr Richmond highlights the good work being carried out by the College and its Fellows and Members to provide training and treatment for obstetric fistula in many countries all over the world, and this brought to mind the work of one College Fellow back in the 1950s and 1960s, Professor John Chassar Moir.

Professor John Chassar Moir [RCOG Archive, copyright unknown]
Professor John Chassar Moir [RCOG Archive, copyright unknown]

John Chassar Moir (1900-1977) was the first Nuffield Professor of Obstetrics and Gynaecology at the University of Oxford, a post which he held between 1937 and 1967. He was a foundation Member of the British College of Obstetricians and Gynaecologists in 1929, a prominent member of the Gynaecological Visiting Society, and described by RCOG President, Eardley Holland as one of ‘the two British Gynaecological Top-dogs’ (the other was Dugald Baird). Chassar Moir is known most for his work on the effects of the fungus ergot and its derivatives on labour, resulting in the isolation of the substance ergometrine, widely used for the reduction of haemorrhage after childbirth. However, Chassar Moir was also a great pioneer in improving techniques of repairing fistulae between the bladder and the vagina, and women were sent to him from all over the country for the operation. In 1961, Chassar Moir published ‘Vesico-Vaginal Fistula’ which was based on the experience he had gained through the years, and he disseminated the monograph to his contacts world-wide. Correspondence held in the College Archive reflects the esteem with which Moir and his work was held, and the monograph was regarded by many as invaluable for their own work in treating fistula.

Fistula instruments used by Professor Chassar Moir, RCOG Museum
Fistula instruments used by Professor Chassar Moir, RCOG Museum

Among the records of Professor Chassar Moir held in the RCOG Archive is an invitation to him made in 1963 from a doctor in Newmarket to witness an operation on a 10 year old mare who had suffered a fistula with her first foal. A veterinary surgeon had learned a technique of repair in America and was attempting it for the first time rather than take the usual course of destroying the mare once the foal had been weaned. Chassar Moir wrote to the vet:

‘I should like to thank you very sincerely for allowing me to watch the most interesting operation on the mare last week. As you know, I have a good deal of this sort of work in the human female and it was therefore extremely interesting to see a similar condition in a horse…I am really very ignorant of matters in the veterinary world, and this is a great pity for I think we could learn a great deal from each other.’

Chassar Moir also supported the work of College Fellows, Reginald and Catherine Hamlin, who had moved from Australia to Ethiopia to establish a midwifery school in Addis Ababa, but had responded to the widespread need to treat fistula by opening a fistula unit instead. A leaflet in the collection describes the ‘fistula pilgrims’ of Ethiopia, women travelling by train, bus, truck and foot to the unit to seek a cure for the fistula which often made them social outcasts and discarded wives. Catherine Hamlin still lives and works for the unit, and over the years many College Fellows have supported the work of her and her late husband, including countless scholarships and grants being awarded to Members and students to go out to assist with fistula in Africa.

So the work continues, and the legacy of RCOG Fellows and Members is remembered today.

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