SAGES

South African Gastroenterology Society

Professionals

Solly Marks Tribute

A tribute to prof I. N. Solly Marks



This booklet was compiled to celebrate the special tribute to Solly Marks at the 2004 SAGES Banquet on 7 August in recognition of his outstanding and life-long contribution to gastroenterology.

We were fortunate to receive many contributions which are a small sample from the many people who shared his remarkable professional career.

We hope that this tribute will be a special momento of this occasion and to be kept for posterity.

"Enjoy!"

CONTENTS

   
2. The GI Clinic and a South African perspective
  Flip Bornman & Jake Krige
   
10. An international perspective
  Peter Cotton
  Richard Hunt
   
15. A prots perspective
  Irvin Modlin
   
17. Past GI Clinic colleagues
  Simmy Bank
  Gil Barbezat
  Ben Novis
  Jonathan Clain
   
23. Cape Town & practice perspective
  Andy Girdwood
   
27. GI Staff
    Laboratory - Gerry Young
    Secretary - Maureen Bloch
    Nursing - Helene Negrine
    Research trial nurse - Wendy Lucke
   
31. Messages from colleagues around the globe
   
33. Classic "Sollyisms"
   
   
   
   
   
 
1. 2004 A Tribute to Prof I.N. Solly Marks
   
 

A TRIBUTE TO I.N. (SOLLY) MARKS

By Flip Bornman & Jake Krige
 
Israel Nathan (Solly) Marks was born on 23 October 1926 in Cape Town, one of 5 children of Philip and Leah Marks. His school education began at Victoria Road, followed by Mountain Road, SACS, ST Andrews in Bloemfontein and Woodstock High in Balfour street. Then for reasons, which only Solly can explain he was sent to Union High School in Graaff Reinet where he matriculated as the top student in 1942, winning the Papenfus award. He returned to Cape Town in 1943 to commence his studies in medicine at UCT obtaining a BSc in 1945 and MBChB in 1949, which was followed by three years internship/senior house officer at Groote Schuur Hospital (1950-1952). Solly left the shores of South Africa in 1953 and did his post graduate training as a medical registrar in the Gastrointestinal Unit at the Western Hospital Edinburgh and then in 1956, having received the Ames Award in Gastroenterology, he took up the Fels research post and instructor in Gastroenterology at the Temple University Hospital in Philadelphia.

After 9 years absence, Solly returned to Cape Town in 1959 with a wealth of experience in both clinical and basic research in gastroenterology which included pioneering studies he did with Wilfred Card in Edinburgh on the relationship between parietal cell mass and acid output in the stomach. With these new skills he tenaciously pursued the goal of establishing a GI Clinic, which would provide a scientific basis for gastroenterology in Cape Town. He made maximum use of the abundant clinical material and the excellent spirit of collaboration between the Departments of Surgery and Medicine, which laid the foundations of the GI Clinic.

The Clinic's beginnings were humble; funds were scarce, there was limited space [2 rooms in J1 which was situated in the bowels of the old GSH] and very little endoscopic and laboratory equipment. But not for long; Solly soon surrounded himself with handpicked medical, nursing and laboratory staff who supported him in his vision of the Clinic, becoming a leader of gastroenterology in South Africa and achieving international recognition.

These goals were achieved in record time with the remarkable partnership between Solly and Simmy Bank who joined him in 1961 as the Ben May Fellow in Gastroenterology and which lasted for 18 years. Many others were to join as consultants and career registrars during the formative years of the sixties and early seventies, and together they became a formidable team which provided an
excellent service with outstanding research and publication output. Every effort was made to strengthen overseas ties by participating in international congresses. The Clinic became a veritable frontier at the tip of Africa and a Mecca for overseas visitors and researchers with an interest in gastroenterology.

The way in which Solly sought and nurtured the invidious relationship with the Department of Surgery is yet another example of his visionary genius in building a unique integrated medico-surgical GI service and collaborative research programme to the benefit of both Departments. In the early days Prof Jannie Louw provided the majority of sessions, and much of the moral and academic support for him as Head of the GI Clinic. Solly also jealously guarded the interests of nursing, laboratory and administrative staff who were incorporated as an integral part of the Clinic from the beginning. He was a father figure to all, creating an atmosphere of a big happy family.

Prior to 1962 South African gastroenterology meetings formed part of the annual Medical Association congress. In 1962 Solly drummed up sufficient support around the country to consolidate gastroenterology in South Africa and form a society specific to the needs of the speciality. Founder members included Solly, Simmy Bank and Mike Moshal. At the inaugural meeting in Durban Solly was elected President of SAGES and remained in the chair from 1962 to 1977 and was then voted Life President. With characteristic vision Solly encouraged a wider membership of the Society in the early 70's when many surgeons became involved in endoscopy and became members of SAGES. The effective partnership of physicians and surgeons remains an enduring strength of SAGES. As Life President Solly continues to dispense sage advice.

No better example can be found of his loyalty to the Clinic when he took up the headship of the Clinic again in 1978 at a time of crisis with the exodus of senior members of the Clinic. Solly wisely reached out to young members of the Department of Surgery who showed an interest in gastroenterology and offered them space in the new GI Clinic. This move paved the way to formalize the surgical presence in the Clinic in 1982 when Prof John Terblanche appointed Flip Bornman as Head of Surgical Gastroenterology and Mike Elliot the Head of Colorectal Surgery. This unique partnership between medical and surgical gastroenterology ushered in a new era for the Clinic and allowed the Clinic to become a truly integrated medico-surgical Clinic.

Realising the lack of expertise in the rapidly developing field of interventional endoscopy, and the need to fill the hiatus left by the exodus of medical gastroenterologists, Solly managed to solve the crisis by attracting superbly trained gastroenterologists from Peter Cotton's GI Unit at the Middlesex in London (Adrian Hatfield, Mark Denyer and Tony Mee). This move helped to turn the tide and steady the ship and, moreover, ensured that the new generation of gastroenterologists would receive adequate training in interventional endoscopy. Solly also had the wisdom of allowing the medical consultants to find their own niche and expertise in the Clinic, most noticeably when he asked John Wright to take on the responsibility of the Inflammatory Bowel Disease Clinic, Stephen O'Keefe the Nutrition Clinic and more recently Japie Louw to spearhead the research in H.pylori related diseases. The era of subspecialisation had begun, both on the medical and surgical side, which benefited training and research output.

It was only fitting that the University of Cape Town recognized his life-long dedication to the GI Clinic and his academic standing nationally and internationally when he was appointed to the new Chair in Gastroenterology in 1986, a position he held until his retirement in 1992. There are few equals when it comes to his academic achievements. He is the author or co-author of more than 400 publications which include over 30 invited chapters in various text-books in gastroenterology, he gave 47 named and post-graduate lectures and attended innumerable national and international congress as invited lecturer or chairman.

Solly is amongst the select few who attended every World Congress of Gastroenterology and South African Gastroenterology Society meetings since their inception. Other prestigious awards to name but a few include; Fellow, University of Cape Town, Honorary Life President South African Gastroenterology Society, Honorary member of the British Society of Gastroenterology, Australian Gastroenterology Society, Pancreatic Society of Great Britain & Ireland and the Prout Club. In recognition of his services to Gastroenterology in South Africa he received the Salus Gold Medal from the Department of National Health in 1993.

It came as no surprise, that after his official retirement, Solly continued to keep a fatherly eye on the development in the clinic until this very day. He would not hesitate to express his concerns and at times annoyance when bureaucratic and political infighting threatened the fabric of the Clinic. It is difficult to imagine where the clinic would be today without Solly's guidance throughout its history. His guiding hand can be seen at every important phase of the clinic's development, particularly in times of crisis, of which there were many. Solly's ability to see the wood from the trees, to draw on available expertise or, if not available, to find it elsewhere was quite remarkable and reflects the qualities of a true leader. It is also difficult to imagine how much poorer we, his protégés, would have been without his remarkable mentorship. He taught us the nuances of gastroenterology and the skills to improve our clinical acumen.

Solly's "lateral thinking" and his ability to find weaknesses in data, conceptually and otherwise, was legendary " all this rubbed off on those around him including his puckish humour and unique philosophy of life. He had the ability to inspire enthusiasm for doing research, to write [and how to write] and, above all, to enjoy this even if it meant spending long hours during evenings and weekends crossing the t's and dotting the i's while Solly rewarded the flagging co-authors with slices of biltong. Other memorable moments included Solly conducting "ward rounds' in his magnificent garden and "inflicting" his unbridled passion and wealth of botanical knowledge on those present.

This tribute would be incomplete without recognizing the contributions of his gracious wife, Inge, who has loyally supported Solly throughout his professional career. Who will ever forget the social evenings with them at home, which in no small way fostered the camaraderie amongst members of the Clinic. "Man is a history making creature who can neither repeat his past nor leave it behind"* " Solly did it his way with aplomb. *Auden WH; The Dyer's Hand. 1963.

5. 2004 A Tribute to Prof I.N. Solly Marks  
 

  1. With Mom
  2. Terrible Three's
  3. With Siblings & Mom
  4. Adolescence
  5. Graaff Reinet Days
  6. MBChB Graduate
  7. With Parents
  8. Handsome Couple

  1. Family : Three Generations
  2. "In the Hot Seat"
  3. Solly's Passion
  4. Their "Pride"

  1. Gracious Hosts
  2. Early days with GI colleagues
  3. The "Godfather"
  4. Breakfast at Dunkeld Lodge with Simmy Bank
  5. Serious Business
  6. Mark Denyer (middle) & Adrian & Diane Hatfield

  1. Helene Negrine & Selwyn Odes
  2. Hosting Peter Cotton
  3. Ralph Kirsch, Israel Rachmelovitz, Solly Benatar
  4. Steve O'Keefe, Gerlad Burke, John Wright
  5. 1984 Reunion "Old Boys Club"
  6. Gaston van Trappen at Southern Cross House
  7. Inge looking after Mynhard Classen
  8. Ian Macleod (Durban)

TRIBUTES WITH AN
INTERNATIONAL PERSPECTIVE

Peter Cotton
 

 
I am proud, honored and delighted to participate in this celebration of Solly Marks' wonderful career in Gastroenterology. He is truly one of the giants of our profession. He has had an enormous influence in the field, through his own contributions, through the work of his trainees and collaborators, and through his influence on innumerable friends throughout the world.

We met first in 1973, when Mike Moshal arranged for me to visit Durban and Cape Town under the auspices of the Medical Research Council. That visit focused on developments in endoscopy, and a new technique called ERCP. Solly was never an ERCP afficianado, but it is one measure of the man that, unlike some of his generation, he did not dismiss it, but indeed encouraged several of his young colleagues to master the field. Many of them have made considerable contributions, and some are here tonight.

My personal bond with Solly has several strong roots. At the beginning I was much influenced by his work and clear writings on chronic pancreatitis, much of it in collaboration with Simmy Bank. His detailed clinical analysis of large series of patients struck a chord with me that some of the erudite ramblings of other Pancreatologists did not. We were also both interested in the frustrating subject of pancreatic function testing. He was a key contributor to the workshop which we organized in Cambridge 25 years ago on the classification of pancreatitis. Its conclusions were no more confusing than the ones that preceded and succeeded it.

The second element was my admiration for his ability to cut quickly to the key points in any topic and discussion, and his forthright ability to smell and expose BS. He did that to me once, in classic style, when he visited the Middlesex Hospital in the mid 1970's. His hand went up when I was in the middle of a naïve and pompous lecture on Sphincter of Oddi dysfunction. Expecting a shaft of scientific light, I yielded to the great man, who then deflated me by saying, "Peter, you are trying to sew flatus to moonbeams". While his sword was sharp and accurate, it was always wielded with sensitivity and humor, so that the wounds were superficial " almost enjoyable- and did not scar. His own lectures, often related to ulcer disease, were informative, pithy and amusing, and sometimes deliciously outrageous.

The third thing that impressed me about Solly, increasingly so as the years rolled by, was his indefatigable resilience in nurturing his baby, the GI Unit at Groote Schuur. As many here know well, there was considerable turnover of key faculty in the difficult middle years. Time and time again he had to drag himself back from his beloved proteas and orchids to regroup and rebuild. I'm not sure that he always got the credit for that persistence, but he certainly does here tonight. The Unit stands as a bright monument to his dedication. I was delighted when we were able to develop a closer relationship between it and our small unit at the Middlesex, through folks like Norman, Tony, Adrian and Mark.

The fourth and most important bond is one we all here share, that of friendship. Friendship is difficult to analyse, but easy to feel. And, that feeling certainly includes Inge. What a great couple, always cheerful, considerate, and fun to be with.

Thank you, Solly, we love you.

Peter B Cotton August 2004
Director, Digestive Disease Center
Medical University of South Carolina

11. 2004 A Tribute to Prof I.N. Solly Marks  

 
Dear Solly,

It is an honour and pleasure to congratulate you on the enormous contributions which you have made to gastroenterology over a long and illustrious career. You have been widely recognized by many of us working far from South Africa as an outstanding academic who has made their mark across the spectrum of our specialty as clinician, teacher and researcher.

Before we got to know each other, I had read many of your writings and we had been together at the Royal College of Physicians in London for the launch of Cimetidine. However, our first real meeting was at the European Congress in Hamburg, where you were chairing a session in which I presented. I recall your challenging and perceptive questions and our parrying responses which laid the ground for the next quarter century of discussion and debate.

During your extensive training in the UK and in the US you were mentored by some of the greatest names in gastric acid physiology and this provided you with a wonderful platform on which to establish the Cape Town unit. The concentration of talent and skill which you assembled was recognized from afar and your prodigious work contributed to the excellence in clinical and interdisciplinary care of patients with a wide spectrum of gastrointestinal disease for which you and the unit became so well known.

It was, therefore, no surprise that we were able to meet so frequently in such far flung and wonderful locations as Maui, Hong Kong, Shanghai, Sydney, Cairns and Victoria Falls to name just a few. Moreover, your contributions to the Hanbury Manor meeting were amongst the most important! But it was your wonderful welcome on my several visits to South Africa which I will always remember for the gracious and generous hospitality which you and Inge provided " even to providing me with my own telephone number in the Cape Town directory! In particular I will cherish your generosity of time, and our discussions " often over a prolonged breakfast in your garden or the guest house " with your unique blend of philosophy and science which has had a lasting impact on me and on all who have been privileged to train with you or know you.

Thanks from us all, Solly and very best wishes to you and Inge for the future. I look forward to continuing the next round! As ever, Richard

Richard Hunt
Professor, Division of Gastroenterology
McMaster University Medical Centre

12. A Tribute to Prof I.N. Solly Marks 2004

  1. Michel Cremer & Peter Cotton (Belgium & USA)
  2. Fred Halter (Switzerland)
  3. Richard Hunt (Canada)
  4. Guido Tytgat (Netherlands)
  5. Irvin Modlin, Nic Wright & Richard Hunt
  6. Mixing with the Nobel Laureate Cohen (left) of EGF fame


13. 2004 A Tribute to Prof I.N. Solly Marks  

  1. S Bardham (UK)
  2. H Conn (USA)
  3. Simmy Bank
  4. Travelling in the East
  5. Nic Wright (UK)
  6. George Sachs (USA)
  7. Anita & Stuart Saunders


14. A Tribute to Prof I.N. Solly Marks 2004

REFLECTIONS OF A
PRODIGAL PROTÉGÉ

Irvin Modlin

 
I was delighted when Phil Bornman asked me to reflect on my status as a protégé of Solly since I have long sought a venue to express my gratitude. The definition of the term "an individual who has received support and protection from an influential patron who furthers the protégée's career" more than describes the influence Solly has had on my life but fails to recognize the vast amounts of Kanonkop and Le Bonheur that were required to facilitate my understanding of the process.

It also fails to include the more recent usage of the term protégé as an opensource, Java tool that provides extensible architecture for the creation of knowledge- based applications supporting the editing of semantic Web ontologies, thus further defining Solly's role in representing to me the importance of communicating knowledge.

Until I met Solly I had long labored under the impression that Markovian analysis was a random process in which the probabilities of states in a series depended only on the properties of the immediately preceding state or the next preceding state, independent of the path by which the preceding state was reached. Such turgid misconceptions were dramatically altered by the pleasures of GI ward rounds and subsequent dinners that enabled Solly to explain to me that gastric acid secretion was a direct and finite extension of entropy and that this not only encompassed the parietal cell but included Komarov1, gastrin2, the Russian revolution 3 and the reflections of Card4 as opposed to poker5 which he held to be the basis of the moral decline of society6. He further opined that the exploration of peptic ulcer disease was not limited by either the bending of light in Parisian fountains7, which he proposed to be the basis of the development of endoscopy8, but could be extended to include aspects of chemical communication in the sexually deceptive orchid genus Cryptostylis8, although he did not exclude the possibility of gastrin also being implicated. Discussions of reflux9, Winkelstein10, the tablets (everyone knows which ones-not the Mosaic type11 but those you trade in for airtickets), Mt Sinai and the Oudtshoorn connection12 were deferred to desert and we never finished that part of the discussion because the Boks were playing"¦..

I, like everyone who knows Solly have luxuriated in his fertile wit, roared with laughter at his quintessially theatrical style and imbibed not only the pleasures of his table but the sagacity of a mind possessed of exquisitely refined fact and even some fable. The kaleidoscope of international persona that he introduced us to, the critical analysis of data, the Talmudic insight and the breadth of his humanity are only some facets of a complex and sensitive individual whose life and times encompass all in the room this evening who share the delights of his amity.

We are all enhanced to be able to count Solly as a friend and this Society will now and forever bear tribute to his contributions and a lifetime spent in the care and support of others.

I know that as he reads this he is muttering to himself "Mundus vult decipi, ergo decipiatur"or perhaps he's just humming "Popoculus nautus sum, Popoculus nautus sum, pugnabo ad finem, quod edero spinem, Popoculus nautus sum"¦."

Anyhow as the great American intellect and rapper Cutty Sark commented, "Solly you're da man!" "¦and I am proud to be your proDJ.

Tibi vero corde.
Irvin Modlin
Class of Clifton IV, 1975.

References:
  1. A life of Toil -Travels to and from Canada .R. Hunt 1934.
  2. Gastrin as the molecular basis of medical meetings. Edkins et al 1905.
  3. Why I left the Stettel. Collected memoirs of the Schmatter consortium. 1902
  4. Reflections on the physiological basis of the digestion of haggis. Ed. Card 1955.
  5. Poker-a moment of bliss, a lifetime of Acyclovir. B. Cairfool. 1975.
  6. Recreational pharmaceutical regulation of posturally induced reflux in the post orgasmic phase of nocturnal breakthrough. Personal communication Billie Bob.
  7. Parisian Nightlife-a retrospective review. S. Bank 1980.
  8. Life is an Orchid garden. S. Marks 1985
  9. What goes up must come down. Blood Sweat and Tears. 1973.
  10. I said it First. Asher Winkelstein. New York, NY 1934.
  11. Essays on mountaineering. Aaron et al. 2540BC
  12. Role of the Rose brothers in GERD. Apocryphi de inebriati, Atheneum 2004


16. A Tribute to Prof I.N. Solly Marks 2004

GI CLINIC COLLEAGUES "
REMINISCING ABOUT THEIR TIMES
WITH SOLLY IN THE GI CLINIC

 
 
Simmy Bank

In 1961 Solly and I (The "Gastric Juice") started "SAGES", beginning a partnership of twenty-six extraordinary years.

This is a time that I will never forget: Solly's incredibly sharp mind, invaluable skills and striking personality were a vast influence on me, and eventually stood me in great stead when heading a GI Department both at Groote Schuur and in the USA and still counting.

I would be unable to tally up the number of times that I have quoted Solly's
aphorisms, advise, personality traits and expertise to scores of Fellows, Residents, Consultants, Surgeons in the USA " to the point that he is as well know in America, through this as through his publications.

Those endless nights that we laboured till the early hours of the morning, over our plus-minus, two hundred and fifty publications and abstracts, doing our own statistics in now antique machines are still fresh in my mind " but most of all the smoking and endless slithers of biltong, deftly cut with Solly's pocket knife.

While completing our "Magnum Opus", on Pancreatic Disease in his Clifton flat, the record of "Arrivederci Roma" repeated itself at least a hundred times while I battled to finish graphs, with Solly taking the odd nap till we cracked the paper.

When Dr Renshaw, a home grown Sexologist, returned from the USA and was giving a lecture at the same time as our original SAGES meeting, only three stalwarts gathered to hear us. Solly summed up the situation with his usual aplomb as "Sex beats GI every time".

We were the first to mix different races at our Clinic and to have to defend ourselves to patients who complained about the use of the same equipment for White and Black.

Solly introduced the "Saturday Morning Special", where it was mandatory for Second Year Medical Students to have an intubated Gastric Acid test before they could advance to the third year. Highly illegal, but much invaluable data.

The "Coup de Gras", came when Solly was asked to endoscope the second most expensive racehorse in South Africa: That saga, a story on its own, as this was the first animal to be endoscoped will live on in history or infamy. The only regret was that we did not film the episode as we would have no doubt won the Cannes Film Festival award for best documentary.

As the word spread of our endoscopic expertise, Solly was asked to locate, by helicopter, a missing bolt from the engine of an offshore tanker. The enthusiasm, by both of us for this venture can only be described as underwhelming, but Solly nevertheless undertook this fruitless enterprise.

Medical patient and staff stories of "Sollyisms", range from the ridiculous to the truly sublime, but it is because of his enthusiasm and work ethic that we did more investigations in the 1960's, in one room, in one day (3 acid tests, 2 pancreatic function tests, 2 intestinal biopsies, 3-6 rigid endoscopies, as well as fitting in ward rounds) than most GI units achieved in many weeks.

Hail to the Chief!
Simmy Bank
North Shore/Long Island Jewish Health Systems
Professor of Medicine
Albert Einstein College of Medicine, New York
 
 
Gil Barbezat

The first time I saw Solly was soon after he returned to Cape Town from the USA. He was conspicuous on the roads around the Hospital and Medical School behind the wheel of his Chev convertible, nicknamed "SS Gnormous" by the students. Soon after, as a fourth year medical student, he asked me to assist him to establish intravenous access to a patient having a pancreatic function test in a medical ward. My job was to hold the rubber band tourniquet while he put in the needle. After searching briefly but unsuccessfully for a vein, he looked at me and came out with a typical Solly comment: "You know, the beauty of your method with that tourniquet is that you occlude the arterial supply as well as the vein." The problem was soon corrected. Little did I know that this man would play such an influential role in my future career.
His influence has not diminished with time, and has been shared by so many of us who have been privileged to work with him.

The founder of the Gastroenterology Clinic in Cape Town, and indeed the grandfather of gastroenterology in South Africa, came with a distinguished scientific pedigree. He has made seminal contributions to medical science in his field, and is highly respected internationally. Virtually everyone knows Solly. Significantly, his international profile has been maintained and extended with renewed vigour when the responsibility of the Gastroenterology Clinic fell back on his shoulders after so many of us flew the nest and seeded out to various centres around the world. In this way, his influence was spread through many Gastroenterology units around the world. It was always good to catch up with Solly at international meetings; he is one of the elite few who have attended every World Gastroenterology Congress since their inception.

Solly is remembered as an amazing clinician. Despite the occasional faux pas with some patients, he demonstrated a deep understanding of the human condition, and really cared about the quality of care offered his patients. His amazing placebo healing rate for peptic ulcer healing (often about 80%) bears witness to his artistry as a physician. He worked hard and kept up the difficult balance between clinical practice and academic productivity. It was always worthwhile having Solly review a draft paper. Even if he knew little about a particular study, he had the uncanny ability to put his finger on weak and strong points in any argument. His ability and exploits as a chairman at meetings were legendary. Those of us who had learned to know and appreciate him took his statements on the chin, while although some were offended, they could not escape the message. (eg "You have been standing there with your mouth open for 10 minutes, what were you really trying to say?" Or, "We hope you will submit a paper to the next meeting where you will present data to support your ideas."

Last but not least, there is Solly, not only as a colleague and mentor, but as a friend and father-figure. He and Inge were marvellous hosts; who can forget their hospitality at the many parties held at their home. We really felt part of the team, a gastroenterology family. Solly's advising and counselling, although typically upfront, was always meant sincerely and reflected great wisdom. Solly, thank you for who you are, what you have meant to us, and what you have done for so many of us. It has been greatly appreciated.

Gil Barbezat
University of Otago
Dunedin, New Zealand
 
 
Ben Novis

In January 1970, Carol and I, recently married, arrived in Cape Town to start my fellowship and career in gastroenterology. On my first day at work, I asked Solly and Simmy what my duties would be and they told me my main function would be placing two nasogastric tubes into the poor patients who were to have a pancreatic function test.

This was to be done using the old X-ray screening unit wearing special goggles. I soon settled into this job.
When I questioned the necessity for so many PFTs a week later, Solly shot back: "This isn't sheltered employment here in J1. (That was a favourite phrase we were all to hear many more times over the years.) The first weekend, we were invited for Sunday afternoon tea and the compulsory tour of the famous Protea garden. The star performer was Karin, then about 3 or 4 years old, who knew and could spout off, to the obvious pride of her father, the name of every protea in that enormous, magnificent garden. I'm sure, like almost every other visitor, we were slightly shamed at being shown to be so ignorant in comparison to a small child. Perhaps we were meant to be!

This was the first of numerous wonderful dinners and parties so superbly arranged by Inge in their gracious Constantia home. Whenever an overseas visitor came to Cape Town, it was the duty of one of the junior doctors to fetch them at the airport " and sometimes more. One visiting gentleman, who spoke little English, wore out his welcome at the Marks' guest suite. He exasperated Solly so much that one evening I got a phone call from him. "It's your turn to take him out!" he demanded.

A whole generation of gastroenterologists grew up in the bowels of Groote Schuur hospital J1. The GI clinic became renowned for its clinical excellence and academic productivity. Solly, together with Simmy, was the prime figure in instilling in us a love of gastroenterology, in teaching us how to critically appraise the literature and not to casually accept every new technique. He always warned that the cost benefit to the endoscopist often outweighed the cost-effectiveness to the patient. He believed, as he put it, that one should treat the patient as a whole and not the hole in the patient. This has remained with me throughout my career.

Solly taught me the importance of a relaxed, friendly atmosphere when seeing patients in clinic consultations and for endoscopy. I remember some mornings when Simmy was not available to help him in his Foreshore office, and I was called in. The patient was always offered a cup of coffee and a cigarette (!) after the procedure, and, in this wonderful atmosphere, he proceeded to explain the medical situation in plain, non-medical speech. With dignity, care and empathy he practised both the art and the science of medicine, for the patient's benefit. Solly taught me the importance of the head of the department also being available to all the staff and taking an active part in furthering their careers, as well as being interested in their lives outside the hospital. He was a wonderful mentor, and an example to us all.

After I left Cape Town to set up a gastroenterology department at Meir hospital in Israel, Solly also kept close contact and was helpful in finding a donor for equipment to start the endoscopy service. Letters went back and forth about various patients with possible alpha chain disease and the possibility of short sabbaticals. When many of the senior doctors left for overseas posts, Solly took over the tricky manoeuvre of riding two horses, at the same time hoping he would not end up on his glutei.

When Solly gave up private practice, not an easy decision, he wrote to me that this was not made easier by the knowledge that many of his chronic "metsiahs" would continue to haunt him in his new surroundings as full-time Chief of Gastroenterology. An unforgettable experience was the 25th anniversary of the Gastrointestinal Clinic in 1984. Almost all members of staff, from consultant to registrar, ex and present, attended for a weekend of congresses, partying and wine tasting, in a spirit of camaraderie, nostalgia and scientific endeavour.

The GI clinic that you established Solly, and ran for so many years, was undoubtedly one of the finest in the world. It provided a scientific basis to gastroenterology in Cape Town and South Africa, with basic and patient-oriented research. I feel enormously proud and privileged to have been associated with it. The number of gastroenterologists world-wide who passed through your sharp, critical, but very humane training, is a testament to this.

Ben Novis
Tel Aviv University
Israel
 
 
Jonathan Clain

It is with considerable pleasure and appreciation that I write this short tribute to Professor I.N. (Solly) Marks, father of gastroenterology in South Africa and mentor to a generation of gastroenterologists from around the world.

After training in gastroenterology in the United Kingdom and the United States, Solly returned to South Africa where he established the GI unit at Groote Schuur Hospital in 1959.
In those early days the clinic was run out of one or two rooms in J1 and stories of those times abound. (One of my favourites is about the man who, despite mild protest, was urged to swallow a nasogastric tube for gastric analysis, and only later managed to articulate that he was attending the Dermatology Clinic next door!) Solly Marks and Simmy Bank, then a young full time Fellow, set to work and created a clinical service and laboratory for the investigation of gastrointestinal disorders. Their clinical expertise and reputation at home and abroad soon became known.

I joined the unit as the senior registrar in 1973, and my association continued later as a consultant until 1979. Working with Solly was a unique experience. His clinical acumen and wise counsel were always valuable, and the constant stream of patients from his practice admitted to the gastrointestinal service instructive. Care of the patient and intellectual honesty were paramount. He worked hard, and he expected and received the same from his staff.

Particularly memorable were the long Tuesday afternoon rounds, attended by the entire unit staff and often surgeons and visiting clinicians. This provided a fertile learning experience in which we were all encouraged to participate, even if we, the junior staff, were occasionally admonished by Solly, who, when one made an obvious observation would retort with the comment "And who do you think you are? Christopher Columbus?"

Solly was always generous in many ways to his colleagues, nurses, laboratory technicians and patients. However, his late arrival at Monday afternoon outpatients was routine, at which time he fully expected that the entire support staff would rally around him. Their perennial annoyance was soon dissipated by his sweet talk, but he could never be cajoled to arrive on time! His notes were organized, his script clear, and a cryptic comment such as "apples" written in the margin meant that the patient had an apple orchard and had promised to bring apples at the next visit, the margin note a reminder for Solly to ask for them!

Memories of evenings when we would gather for a unit party around the swimming pools at his gracious home in Constantia live on. He and Inge were wonderful hosts, and made us all feel welcome, down to the most junior staff. There are many more memories and "Solly stories", too many to enumerate. There are not many days that go by when I am not reminded of him by some occurrence in my clinical practice. I think I can speak for all of my colleagues, when I say that Solly's influence has left a lasting mark on all of our professional lives.

Jonathan Clain
Mayo Clinic
United States of America
 

CAPE TOWN &
PRACTICE PERSPECTIVE

 
Andy Girdwood

My first task for Solly was to dig out the Calcifics and help him with a presentation on the first 300 patients with Calcific Pancreatitis for the World Congress in Madrid in 1978. Nel handed me the legendary spreadsheet, which was like the Holy Grail in the GI Clinic, with all the clinical information painstakingly documented by Solly, Simmy, Gib et al. At the time I had no idea of the magnitude of work that had gone into compiling the information but on going through the data with Solly it became clear that he knew all of these patients personally.
We were trying to establish whether the onset of steatorrhoea preceded diabetes in Mr David Swart when Solly said, "I remember that guy; he was in Jannie's ward and ruptured a pseudocyst through his transverse colon " check the bookie, Andy!" Sure enough on checking the bookie " the GI clinic cribsheet of the Groote Schuur Hospital notes " in 1967 in B1 Mr Swart's abdominal mass disappeared and his clinical condition improved after a big bowel action where he passed "membranes". This was the start of many visits to Southern Cross House, and then Dunkeld Lodge, carrying the tray of bookies and the Calcific spreadsheet. Initially this involved collecting the raw data, tabulating it and then the impossible task of "putting pen to paper" and agonising over every sentence into the early hours of the morning with Solly calling the tune and Flip and I falling asleep.

In 1981 I joined Solly in private practice in Medical Centre to find that his practice clientele were like his Calcifics. Each had a card where the presenting complaint in their own words was carefully documented in Solly's neat handwriting. Interestingly enough 20 " 30 years later many functional patients will have exactly the same complaint. It is always said that a good clinician is a good listener and certainly Solly had the ability to put even the humblest patient at ease and allow them to express themselves. He never forgot his Woodstock and Graaff Reinet roots. I think that Solly's great strength, however, was his ability to get patients to listen to him. On the one-to-one consultation, he was devastating.

I still hear patients in their eighties coming out with pure"Markese" from a single consultation in the "60's: "He told me that I funnelled my emotions through my rectum" or "I should keep my mouth closed in the South-Easter". Patients have their initial consultation with Solly imprinted on their brains. One lady in her 50's told me that she saw Solly on her honeymoon in Cape Town from Johannesburg and during the consultation she realised with crystal clarity that she had married the wrong man. She is now happily married to her second husband thanks to Solly's insight, she told me.

Anecdotes with Solly in practice are many. One I remember was with Mrs Budd, his long-standing secretary/receptionist/endoscopy nurse who he inherited from Louis Mirvish in 1960. Mrs Budd came to me and said, "We have a crisis, come quickly". I rushed through to the endoscopy room expecting some endoscopic disaster, to find an elderly, bejewelled dowager, Mrs Levy, stating emphatically, "These are not my teeth!" Solly, Mrs Budd, Mrs Levy and I peered into the waiting room. Solly, I must add, practiced Robin Hood medicine " relieve the rich to subsidise the poor " and there were all walks of life in the crowded waiting room. In the corner sat Mr September, drowsy from his valium, but knocking back a bacon and egg sandwich with ill-fitting dentures, "Don't worry", said Mrs Budd, pulling the dentures out of his mouth, "we will just give them a quick rinse".

Solly left a legacy of old patients who remain eternally grateful of what he did for them and many of them had no idea what he achieved "up the hill" or of his international reputation.

Andy Girdwood
Cape Town
 

SOLLY ‘IN ACTION'

  1. Easy; three things at a time
  2. "Missing nothing........got the nose for it......"
  3. "Penny for your thoughts" with Basil Hirschowitz
  4. "Don't worry, we will finish it tonight"
  5. Taking advise from Judge President George Munnik

  1. Make as if interested"¦"¦
  2. It pays to advertise
  3. "Reaching for statistical significance"
  4. "I'm listening"
  5. "Meneer die Edelagbare"
  6. ".......Not sure about that........"
  7. "Don't be fooled........it's coming"

GI STAFF

Gerry Young
For several decades people from all over the world worked in the GI Laboratory " Chinese, Kenyan, American, Swiss, Dutch, German, Scots and of course South Africans representing the full spectrum of our rainbow nation. There were pancreatic and pepsin pundits, juice extractors, upregulators, acinar cell activists, guinea pigs of the two and four-legged varieties, helicobacter heroes and heroines and nicotine and caffeine addicts (since converted !) To all members of this disparate group Professor Marks (aka The Godfather) was an inspirational guiding force, a severe but fair critic, a dispenser of wisdom and a coiner of phrases. So as not to confuse us with the facts (!!) we had to remember that, whichever way you turn, your tochas is always behind you. Like some peoples' wives, we may not have been the best in the world but we were the best he had. Conversely while he may not have been the best boss in the world he was certainly the best we ever had. Prof - the lab salutes you. Gerry, Nel and Sharon

Helene Negrine
Dear Prof Solly
On behalf of the nursing staff of the GI Clinic, we remember you with fondness and would like to pay tribute to you, our mentor. We thank you for all your wisdom, guidance, moral and loyal support you have given and the respect that you have shown us. Mrs Helene Negrine Chief Professional Nurse GI Clinic 1972 - 1997

Maureen Bloch
Working with Solly was an unforgettable experience. We had our rows during my 25 years in the Clinic, but we had plenty of good times and laughs too. I miss the place very much. We were a real family. Maureen

Wendy Lucke

It was an honour and privilege to work for Solly Marks, charismatic father of GIT Unit. No matter how busy, he was always approachable, giving time which would prove beneficial, enriching and seldom without a joke. Thank you Prof
Love
Wendy
 

GI CLINIC - SNIPPETS OF
SOLLY'S FIEFDOM

  1. The Boss
  2. Maureen Bloch - managing a smile after 25 years with Solly
  3. The Other Boss (Helene Negrine)
  4. Good Queen Bess ( Betty Heselson)
  5. Margaret Levy & Wendy Lucke
  6. Lab in Action
  7. Andy Girdwood - "Relax, only takes 6 hours"
  8. Dis net ‘n "Clain pypie"
  9. Angie - Forever Present

  1. Sharon & Nel having fun
  2. Educating the Surgeons
  3. Simmy Bank (beginning of Fibre optic endoscopy)
  4. Mark Kidd ("Lab Rat")
  5. Always time for a hug (Barbara & Marie)
  6. Francesco Marotta ("Italian Loverboy")
  7. 65th - Not Out !
 

25 YEAR REUNION : GI CLINIC

GASTROINTESTINAL CLINIC
1959 " 1984
Back row: Dr R Tobias, Dr OAA Bock, Prof F Halter, Dr EJS Boyd, Dr JP Wright, Dr JAM Garisch, Dr S Voget
3rd row: Dr PC Bornman, Dr G Münst, Dr SJD O'Keefe, Dr R Roost, Dr ME Denyer, Dr AH Girdwood, Dr M Danilewitz
2nd row: Dr A Neeman, Dr DG Burns, Dr I Kalvaria, Prof JE Clain, Prof C Helman, Dr HS Odes, Dr L Bank, Dr ARW Hatfield
Front: Dr B Lurie, Prof BH Novis, Prof S Bank, Prof IN (Solly) Marks, Prof GO Barbezat, Dr AS Mee, Dr NH Gilinsky
 

MESSAGES FROM COLLEAGUES
ROUND THE GLOBE

 
Selwyn Odes
To Solly, my friend and mentor, one of a few people who helped me formulate my professional career. I owe you so much, Solly. Carry on in health and humour, knowing that your very presence inspires and terrifies your audience.
Selwyn Odes
Israel
Raymond Tobias
I appreciate the opportunity to congratulate you, Solly, on the honour bestowed on you at the SAGES annual meeting. Your exceptional mentoring, work ethic, encouragement, sense of humour and at times "biting sarcasm" are fondly remembered; more so now that I am also involved in teaching residents in the Baptist Health System in the Deep South Bible Belt. Comments like "Nothing short of the Resurrection will cure that patient's abdominal pain" and gently reminding my surgical colleagues that operating in the face of acute pancreatitis is like "sewing moonbeams to flatus", are still frequently quoted by me. Good wishes and warm regards

Raymond Tobias
Birmingham, Alabama, USA
Alexandre Kummer
To Solly, who gave me the opportunity to come to Cape Town fifteen years ago, something which had a tremendous impact on my life. You created an interest in GI which determined my profession. Besides the academic medicine you taught me the human side of medicine in your unique way of seeing the person behind the patient, with a mixture of genuine interest, warmth and humour. Last but not least, you were certainly not uninvolved in Elana and myself meeting. Solly, we wish you an evening to remember and feel privileged to be here with you and Inge tonight.

Alexandre Kummer
Switzerland
Norman Gilinsky
Dear Solly:
While Stephanie and I are unable to join you and Inge in person in recognizing your wonderful achievements, we are certainly with you both in spirit.  Solly, I remain truly grateful for your guidance, advise, imbuing in me a healthy sense of skepticism, and being a world-class mentor during my G.S.H. days. I recall one occasion, late after rounds, you spending hours enthusiastically virtually re-writing a paper I had hurriedly put together. The lessons and pearls I was receiving came to an abrupt end when Inge called, reminding you that it was your wedding anniversary and you were well overdue home! While I appreciated your tutelage on many occasions then, hopefully you have adjusted your priorities now! Solly, be well, enjoy this evening and go from strength to strength.
An ever-appreciative Norman Gilinsky
University of Cincinnati
United States of America
Thomas Lingenfelser
A "medicus" by conviction and orchid lover by passion, Solly Marks succeeds the late Leonhart Fuchs from Tübingen who held the chairs of medicine and botany at its renowned university in the 16th century. He once accepted a young research fellow from Tübingen medical school to his Department in order to relentlessly instigate his interest into gastroenterology. That is why I am privileged to extend my sincere gratitude to "my professor", my archetype of clinical and academic excellence, for pertinaciously teaching me how to take care of patients with gastrointestinal disease.
Thomas Lingenfelser
Germany

Trevor A, Winter
Dear Solly,
Congratulations on all your achievements and contribution to Gastroenterology in South Africa. In particular, I would like to thank you for your penetrating wisdom and guidance over the years I have known you. Wishing you all the best for the future.
Trevor

 

A SAMPLE OF CLASSIC "SOLLYISMS"

"Mundus vult decipe, ergo decipiatur"

"And all the Egyptians were drownded"

"It is more important that a proposition be interesting, than it be true"

"The aim in treating constipation is to get the patient to pass a large banana"

"Knowing when to do a test is more important than knowing how to do it"

"See the patient before the laboratory data"

"Before getting too excited about a statistical result, ask if it really means anything to the patient"

"Nothing short of the Resurrection will cure that patient's abdominal pain"

"Sewing moonbeams to flatus"

"It is only the fish who open their mouths that get caught"

"From the foot of the bed : Neanderthal !"

Concerning anyone who may have a sexually transmitted disease : "Have you asked them about perineal nystagmus ?"

"In my day research was 90% thinking and 10% gadgets; now it's the other way round". (circa 1970's " what is he saying now ?)

A few seconds before withdrawing a semi-rigid gastroscope and manually pumping the patients' stomach full of air: "Metro Goldwyn Meyer presents !"

"Even an autopsy wouldn't tell us what is going on in this patient"

"Nothing but the Resurrection will make this guy/girl better"

Instruction top patient on how to find his rooms for a follow-up visit : "Get off the train at Cape Town station and then follow the crowds"

"We like to learn, but we hate being taught"

Giving an article to read with instructions " "Compulsory toilet reading"

"God is good and Allah is merciful"