biographies

Fowler, Robert (1888 - 1965)

O.B.E., M.D., F.R.C.S. (Eng), F.A.C.S., F.R.A.C.S.

Born
March 5 1888
London, England
Died
May 12 1965
South Yarra, Victoria, Australia
Occupation
Gynaecologist and Medical Practitioner

Details

Transcription of items written by Dr W Ivon Hayes, Dr E.V. Keogh, Dr Carl Wood, Col Rex Hall, Dr H.G. Furnell, Dr. J.N. Buchanan and Air Vice-Marshal E.A. Daley and published in the "The Book of Remembrance", The Royal Women's Hospital, Melbourne, 1965.

ROBERT FOWLER
(1920 – 1924)

The autumnal sunlight of Wednesday afternoon, May 12, 1965, was streaming through the western window of the dignified chapel of Trinity College, University of Melbourne, at the funeral service of one of Trinity’s distinguished sons, Dr Robert Fowler, O.B.E., who had died on May 8. The memorial oration was given by Dr. Colin Macdonald, a close colleague in University affairs for over 30 years, and what follows is an expansion of that memorable address.

Robert Fowler was born an Englishman in the city of London, off Bishopsgate and within a stone’s throw of the Bank of England, in the year 1888. His father, Dr. Walter Fowler, a graduate of Caius College, Cambridge, and a Fellow of the Royal College of Surgeons, came to Australia in 1891 to practice at the riverside town of Echuca, and 10 years later was the medical superintendent of Bendigo Hospital. His grandfather, Dr. Robert Fowler, was a graduate of King’s College, London, and a contemporary of the great Lister.

In 1900, Robert was sent to be a boarder at Caulfield Grammar School under Dr. W.M. Buntine, and at the age of 17 years he entered Trinity College with a resident scholarship, when Dr. W.E. Leeper was the Warden and the other College Heads of the time were John MacFarland of Ormond and Ernest Sugden of Queen’s. Contemporaries with Robert in Trinity were Sir Reginald Leeper, Lord Casey, Sir William Johnston, Dr. Sidney Fancourt McDonald, Lord Baillieu, and Dr. Edward White (Sir Rowden White’s brother), and fellow students in the medical course were Sir William Upjohn, Sir Victor Hurley, Sir Alan Newton and Dr. Richard O’Sullivan, to name only a few in a famous year – 1909 – which has justly been described as an “annus mirabilis”.

After graduation, Robert Fowler spend one year as resident medical officer at the Melbourne Hospital and the next year as Beaney Scholar and Demonstrator in Pathology, and in 1912 he was Assistant Lecturer in Pathology under Professor Harry Allen and gained the degree of M.D. Then, as a well-earned respite from many years of arduous endeavour, he went to England with two objects in view: to visit his relatives and to see medical and surgical work in the important European centres. He returned to Australia in time to become involved at the beginning of the first World War, during which he gave unstinted service and earned well-merited advancement. He rose to be A.D.M.S. of the Australian Mounted Division, and at Damascus in 1918 he had a direct connection with the enigmatic figure of Lawrence of Arabia. Before returning home in 1920, he gained by examination the coveted F.R.C.S. (England); in 1924 he was invited to become a Fellow of the American College of Surgeons; in 1927 he was a Foundation Fellow of the Royal Australasian College of Surgeons. This triple fellowship set the seal on his status in the art and practice of surgery.

He was determined to specialize in surgery, but although he was appointed in 1921 as honorary obstetric surgeon at the Women’s Hospital, where he performed the first Kronig’s lower-segment caesarean section seen at that hospital, he found the acquisition of a surgical clientele so tardy and difficult that he considered moving to Sydney. Fortunately, however, the Alfred Hospital in 1923 decided to appoint their first honorary gynaecologist, and Robert Fowler, though very reluctant to relinquish his appointment at the Women’s Hospital, obtained this position. His financial worries soon ceased, and at the Alfred Hospital, with his team of enthusiastic assistants, he built up a department of international reputation. He retired from the Alfred Hospital in 1948 after 25 years of dedicated service. He was also honorary gynaecologist to the Austin Hospital from 1927 to 1935.

His connection with the Standing Committee of Convocation of the University of Melbourne commenced in 1930 as a representative of the graduates in medicine, and he devoted 35 years to University affairs. He succeeded Dr. S.G. Coppel as Warden of Convocation, and in this office was an outstanding success as a leader and the wisest of counsellors. He succeeded Sir William Johnston on the University Council. Since schooldays Bob had always been greatly interested in English expression, and his clarity of exposition on difficult matters of the University legislation, which each month presents itself to Standing Committee, was a delight to listen to. He dearly loved the music of our language and “the magical spices of words”, and no one better than he could employ the nuances and subtle shades of expression. He was an artist in the “curiosa felicitas” of which the Roman poet Horace wrote. His submissions were invariably carefully prepared, their reliability and accuracy never in question, and as a persuasive speaker with a charming voice he had few peers.

There was a unique atmosphere of personal and professional quality about Robert Fowler – some inbuilt elegance of the later Victorian era, inherited, so it seems, from his father and grandfather, both of whom must have been men of wide scholarship and high ideals. He was indeed a man who brought great lustre to the profession of medicine and to our University of Melbourne.

Scholar, soldier and surgeon, Robert Fowler has a place in our hearts, and by no one who knew him will he be forgotten.
(Dr W Ivon Hayes)


When the Anti Cancer Council of Victoria was established in 1936, Robert Fowler was appointed to both the Council and the Medical and Scientific Committee; but his most valuable and notable achievement, and one that will never be forgotten, was the design, direction and development of the Central Cancer Registry. He initiated this in 1939 and was its indefatigable honorary chief registrar until he retired in 1956. Later he was editor of the Registry’s quarterly bulletin.

It would be impossible to assess just how much the Council owes to Bob. He was always regular in his attendance at committee meetings and took a leading part in discussions. He was always forthright in argument and ready to express his view. When he left the Executive Committee, much of the sparkle went from the meetings. As often as not, his views and mine did not coincide; but however forcibly we differed, we always remained the best of friends.

One of these examples of disagreement was the establishment of an annual travelling fellowship. Bob opposed this tooth and nail, but in the final committee meeting was the sole dissentient. As soon as the motion was carried, I suggested that it be called “the Robert Fowler Travelling Scholarship” because of his great service to the Council. I shall never forget the expression on Bob’s face of mingled surprise and pleasure. He always took a great interest in the choice of the Fellows, and was particularly pleased when they called to see him, as most of them did.

His greatest service, not only to the Anti-Cancer Council but to medicine, was the creation of the Central Cancer Registry. This stemmed from his conviction that no hospital could function properly unless good histories were taken and there was a good record system. Since he found the existing practices inadequate for his own need, particularly in the final assessment of results of treatment of cancer in women, he wanted to create a follow-up centre with statistical facilities. To fit himself for this, he took a course in statistics at the University. It required endless effort on his part to get cooperation in this field from all the teaching hospitals. The Central Cancer Registry now has records, with practically complete follow-up, of some 70,000 cancer patients. There is no similar institution in the southern hemisphere. In this work
Bob was far in advance of his time. The collection of full and accurate data concerning the end-results of treatment and the use of adequate statistical methods for the analyses are now not uncommon in Australia, but Bob was the lone pioneer.

One of his most important papers in this field was “Some Observations on the epidemiology of Lung Cancer”, published in 1955, which reviewed the history of lung cancer in Australia and its association with smoking habits. This remains the most important Australian contribution in this field, and should be compulsory reading for anyone proposing to make public statements on the subject.

He inspired a number of contributions from the Registry but did not wish his name to appear as author or co-author, although his characteristic style made his authorship clear to all who knew him. He was working on a report on endometrial cancer at the time of his death.

Robert Fowler was endowed with great gifts and high ideals, and these he gave freely in service to the Anti-Cancer Council and, through it, to the general community. By his death we have all suffered an irreparable loss.
(Dr E.V. Keogh)

The Alfred Hospital, Melbourne, some forty years ago, decided to develop a gynaecological unit, and Robert Fowler was the first “honorary” appointment. Under his guidance, out-patient and in-patient departments were organized, which soon attracted many patients, and a faithful bank of assistants came forward, who all became devoted to their chief. He had the happy knack of inspiring his assistants and, best of all, encouraged and developed their talents; and were made to feel important members of a flourishing and dynamic unit. The hospital pathologist team met once a week, when macroscopic and microscopic specimens were examined, procedures criticized and helpful suggestions made. These meetings proved of inestimable benefit to all participants. Robert Fowler, a good anatomist, was a superb operator and a model for all to follow.

His outstanding contribution to gynaecology was, I believe, his pioneering work in the treatment of uterine cancer. Radiotherapy was then in its infancy, but its usefulness was eagerly recognized and exploited. Wertheim operations were undertaken, but often proved perilous to the patient, since intravenous therapy (with fluid or blood) was not yet available, nor were antibiotics as yet discovered. With the advent of intravenous therapy and the use of antibiotics, operative and therapeutic treatments fell into their respective spheres, and both methods were utilized. Fowler early insisted on a thorough follow-up of all cancer patients, records being kept to ten-year periods. To assist him in this work, a University examination in statistical method was attempted and passed. His work with the Central Cancer Registry is well known.

In helping pioneer the Wertheim operation in Australia, in the use of radio-therapy, and in the insistence of rigid control in follow-up of all cancer patients lies his very great contribution to gynaecology. In addition, he quickly approved and used the Fothergill-Donald technique for correction of uterine prolapse and recognized the frequency of associated pouch of Douglas hernia. Robert Fowler was a great inspiration to all who worked with him, and we deeply feel our loss.
(Dr. Carl Wood)


As a young captain in the Australian Army Medical Corps, Robert Fowler served in the Citizen Military Forces from 1910, and at the outbreak of war in August, 1914, he joined the First Light Horse Field Ambulance. He left Melbourne in October of that year with the first Expeditionary Force, and after several months’ training in Egypt, he sailed for Gallipoli early in May, 1915. However, with other medical personnel, his services were sorely needed, and he was retained in transporting wounded from the Peninsula to Alexandria. One of his assistants on the transport cum hospital-ship “Scottian” taking 850 wounded on the three-day nightmare journey quotes from his diary: “Captain Fowler, one of six doctors, was tireless in his work, often doing the trip without any sleep whatever.”

After August 6, landing at Suvla, Captain Fowler spent many nights in a forward receiving post just behind “Table Top”, when he would frequently remain awake throughout the night, standing in the “sap” attending to the constant trickle of wounded, both ours and the enemy’s. He would resist his assistant’s effort to make him take a little sleep until sheer exhaustion overcame him. On returning to Egypt after the evacuation, he served throughout the Palestine campaign, when he commanded the Fourth Light Horse Field Ambulance.

Towards the end of the campaign in Palestine, he was A.D.M.S. of the Australian Mounted Division, and had the arduous task of organizing the medical establishments in Damascus after the Turks capitulated. He was, in fact, the senior medial officer who figures in the film “Lawrence of Arabia”. Speaking on the subject recently, Colonel Fowler referred to the “shambles of Damascus”, and said: “It was in these circumstances that I met the enigmatic and fame-enduring T.E. Lawrence.” He made light of his part as portrayed in the film, and added: “Nor did I strike Lawrence in the face [as shown in the film] for his indifference to the misery and suffering of Turkish prisoners in Baramkie Barracks.”

Amongst the honours accorded him, Colonel Fowler was appointed Honorary Surgeon to the Governor-General, and was made an officer of the Most Excellent Order of the British Empire. At the beginning of World War 11, he was senior medical officer to the R.A.A.F. On rejoining the A.A.M.C., he commanded the 117th General Hospital, and later became D.D.M.S. Southern Command.

He will always be remembered by his Service associates for his unfailing and tireless devotion, imperturbable nature and meticulous attention to detail.
(Col Rex Hall)


Robert Fowler was lithe and rangy in build with a lean, aquiline face, fit frame for his keen and active brain. He always gave the impression that he was going somewhere and knew where he was going; but nevertheless he had time to listen to any problem, give it its full consideration and help in any way he could. I am deeply in his debt for help and encouragement in difficult times; I know I had expressed by gratitude to some degree, but I am sure not adequately.

My first contact with him was in 1929, when I had just returned from abroad and joined his clinic at the Alfred Hospital. The most noteworthy feature of his department was that it was alive; it was busy and growing, and “the boss” was never satisfied – he was always eager to improve. Any new idea that seemed worthwhile was given a fair trial – a very stimulating atmosphere for a young man. Many assistants worked in the clinic throughout the years – Doug Aitchison, Carl Wood, Jim Buchanan (who succeeded him), Alf Oldham, John Bennett, Henry Seeley, Vernon Breaton, Leslie Hirshner. We worked hard for him and for him and all remained his loyal friends and admirers.

Robert Fowler played a very important part in improving the standards of gynaecology in Melbourne, and in no aspect was this more marked than in the treatment of gynaecological cancer. His interest in this subject continued, and later in his life he entered the more staid realm of statistics. With typical energy and enthusiasm he became an expert in this field, and rendered great service to the Royal Australasian College of Surgeons and later to the Anti-Cancer Council. I will make no attempt to particularize about his gynaecological work; I hope this will be dealt with in more detail elsewhere.

Robert Fowler served in two wars. In the 1914-1918 War he was in the Middle East and, as would be expected , he served with distinction, being decorated with the O.B.E., and finishing as Colonel A.D.M.S. Australian Mounted Division. In the second World War he commanded the 117th Australian General Hospital and later was D.D.M.S. Southern Command, an appointment he had held from 1933 to 1936.

I was fortunate to be associated with him in another of his activities in which he reached the peak. For many years he served on the Standing Committee of Convocation of the University of Melbourne, becoming Warden in 1959, and relinquishing that dignity on being appointed to the University Council in 1962. I think he greatly enjoyed being Warden, and from his throne-like chair his rolling Burkeian sentences delighted alike audience and author.

Robert Fowler has left a widow, two married daughters and a son, Robert junior, who has already won distinction in surgical research at the Royal Children’s Hospital, Melbourne. To them we offer sincere sympathy, and hope that pride in his achievements will be some solace in their loss.
(Dr H.G. Furnell)


In 1923 the Board of Management of the Alfred Hospital decided to create a special clinic for gynaecological patients. Until that time, the general surgeons of the hospital had attended these women in the course of their duties. The Board were extremely fortunate in obtaining the services of Mr. Robert Fowler as the first chief of the clinic. To a first-class general surgical training, he added a flair for administration and organization which was invaluable in the early days of the clinic.

From small beginnings in annexes of the general wards the efficiency of the clinic rapidly expanded – so much so that in 1939 an entire floor of the “new building” was allotted to the gynaecological clinic. From the beginning, Fowler was ably assisted by Carl Sanford Wood (the father of the present professor at Monash University) in both his planning and his operative work.

Fowler was a magnificent operative technician, his work being marked by meticulous attention to detail. His modification of the Alexander-Adams procedure, using the delivered portion of the round ligament as a living suture, was a classical example of applied technique. Wertheim hysterectomy for carcinoma of the cervix presented no problems to him; but at that period he was distressed by the morbidity which was associated with this procedure in the absence of anti-infective agents and adequate supplies of blood for transfusion. He turned his attention to the radiotherapy of these lesions, and was instrumental in obtaining supplies of radium element on loan from the Commonwealth Government. He practiced the Paris technique of radium application from the outset with highly satisfactory results, so much so that the “Wertheim” was not performed as a routine in the clinic for the next ten years up to the War.

The development of the follow-up system for these cases was a local administrative action, and it was a tribute to his activity with electoral rolls, parish priests and friends or relations that 99% of the patients treated were followed for five years or over. Some of the early patients were seen annually for over 20 years. Quite early, he appreciated the importance of endocrinology, and although this phase of gynaecology was in its infancy, he established a sub-clinic under Carl Wood to explore the possibilities of such preparations as were available at the time. In fact, quite a number of rather crude preparations were developed in conjunction with the Baker Institute.

After the War, his beautiful operative methods blossomed afresh, and those who had the privilege of being associated with him saw gynaecological operations performed by a master.

After 25 years as chief of the clinic, he retired from the hospital in 1948, leaving a record of service and administration greatly appreciated by his admiring colleagues. He continued his activities in the Anti-Cancer Council, and developed a highly successful bureau there for the collation and follow-up of cancer patients from the metropolitan hospitals
(Dr J.N. Buchanan)


Dr Robert Fowler’s immediate professional colleagues and contemporaries can best speak of his personal qualities, medical achievements and war services. But it seems appropriate to refer to a little-known phase of his contribution to Australia’s defence medical services.

At Caulfield Grammar School his name was not infrequently mentioned by masters as an outstanding former pupil there, and one had the privilege later of attending his tutorials in gynaecology during the early 1902’s; but it was in the 1930’s that one saw him firmly demonstrate a keen foresight into military medical problems applicable to Australia in the future, which outstripped the thinking of most of his Citizen and Regular Force medical colleagues. Further, he possessed the enthusiasm and energy to follow up his ideas keenly, and endeavoured to bring them before those who should be interested – and this, in spite of being an extremely busy specialist at a teaching hospital.

At the time when he was D.D.M.S. in Victoria, he began to stress the great potential of “air” as a logical means of transporting casualties and the sick. He gave several illustrated lectures on the subject, and taking the matter into its appropriate “camp” at a combined gathering of A.M.M.C. and R.A.A.F. held at Point Cook, he addressed them with impressive effect on the subject.

In 1935, the R.A.A.F. began to consolidate its Medical Branch policy by exchanges with the R.A.F. service, and the post of D.D.M.S. (Air) became temporarily vacant. Fowler volunteered his services for the period involved. The Air Board accepted, and for some months he made an exceptionally constructive and refreshing contribution to the R.A.A.F. generally. It included improving the range and standard of medical work carried out at bases like Point Cook. Surgeons and other specialists in the C.A.F. were appointed to visit units, with a corresponding increase in the status of medical work done. For personal reasons he found it impossible to complete the two year term, and his secondment with the temporary rank of group captain ceased.

During this period and the ensuing years before World War II, he also repeatedly sounded a note of warning, not only in the medical services, but in the medical profession generally, of the great importance of tropical medicine in any war involving Australia. He encouraged medical officers to think seriously of these problems, and in his article “Arms and Anophelines or the Military Significance of Malaria”, published in the Journal on November 21, 1942, showed how far ahead was his thinking in these various medical service matters. His outlook was to be further highlighted, when war came to Australia, by the sad lack in these very same fields, which for ten years he had stressed.

Thus before the war, along with his professional achievements generally, Robert Fowler made time to contribute in thought and administration to at least two of Australia’s medical services. Alan Walker’s last volume perhaps gives to scant reference to the true significance of his work.
(Air Vice-Marshal E.A. Daley)

Prepared by: Robyn Waymouth

Created: 21 September 2006, Last modified: 26 November 2006