Interview with Bryan Furnass physician and environmentalist

Interview conducted September 2011 at Emeritus Faculty, ANU
Producer, Interviewer and Editor - Peter Stewart
Engineer - Nik Fominas

Biographical note: Stanley Bryan Furnass was born in Manchester, England in 1927, and educated at Manchester Grammar School and Oxford University Medical School, graduating in 1949.  After postgraduate studies at Middlesex Hospital Medical School in London (and meeting his future wife Anne who was nursing there), Bryan spent two years national service in Sierra Leone, working in tropical medicine.  After returning to London, the couple and their twin daughters emigrated to Australia where Bryan became a consulting physician in Goulburn, NSW, in 1960.  A year later Bryan moved to a similar position in Canberra.

Bryan was appointed Foundation Director of the ANU Medical Service in 1966, a position he held until his retirement from ANU in 1991.  Bryan is known for his imaginative approaches to community medicine, emphasising individual responsibility for health care in young adults, and encouraging in them the idea of future ‘health rather than ilth’ through attention to the balance of work and play, and a concern for the environment.  Bryan has written widely about these aspects of community and individual health, and has been an activist in a wide range of forums and prolific contributor to scholarly and popular publications.

Since retirement, Bryan has not let up, particularly in regard to his concerns for environmental sustainability, ranging over modes of human burial to the causes and consequences of global climate change.  He is an active member of the Nature and Science Forum in Canberra, Doctors for the Environment, the Medical Association for Prevention of War, and is a member of the Strategic Council of The Climate Institute of Australia.  In 1994, Bryan was appointed Member of the Order of Australia (AM) for service to health education and promotion.

Synopsis of interview: Stanley Bryan Furnass was born in Manchester, England in 1927, to become a scholar in an enlightened school and university system aimed at educating bright children who would not otherwise have had the family resources to achieve that outcome.  Moreover, to the great benefit of his adopted land, he is also the product of another imaginative experiment in social possibilities – exactly what the “ten pound Pom” was designed to achieve for Australia – hard working and committed immigrants capable of achieving, then contributing, the sort of skills that in considerable part has made Australia what it is today.

Bryan’s parents were both teachers, his father a specialist teacher of the deaf.  The Furnass family sent their son and daughter to the local grammar school, part of Britain’s national selective and free public education system.  As the children’s schooling progressed, the family was tested by the outbreak of World War Two. Living as they did in a major industrial city, the aerial bombardment of the city and its environs caused the family and the deaf school where they lived to move to rural surroundings in an old manor house in Cheshire, about 40km away, for safety. The interior appearance of the house was enhanced by the hanging of paintings transferred for safety from a local art gallery near Manchester. Bryan’s bedroom was a converted hayloft above a cow shed in an adjacent farm. He abandoned rugby football in Manchester in favour of growing vegetables in the neglected  manor house garden, in keeping with Britain’s “dig for victory” campaign, managing at the age of sixteen to win the village silver cup for gardening.

Bryan continued to commute to Manchester Grammar School during the week and returned home to Cheshire at weekends. His most memorable incident in the war was while (foolishly) walking back to his digs from a friend’s house near Manchester during an incendiary raid heard a whistling sound, and as a nearby air-raid warden pushed him to the ground, Bryan held his school bag in front of his face as a (non-explosive) incendiary bomb landed a couple of metres in front of him. In the distance he saw the (empty) dormitory of the deaf school behind the house where the family used to livein flames and being reduced to a burning skeleton. Perhaps inappropriately, this fire engendered a sense of relief, since it would mean his remaining in Cheshire, which he loved, for a few years. Despite these disruptions, Bryan did well at school, with a notable aptitude in and enthusiasm for biology. As his secondary schooling ended, he had to decide between horticulture (a love of which he retains today, as an avid but inconstant gardener), and medicine(and its intellectual and personal challenges).

In 1945, at the end of the war, Bryan received his call-up papers to enrol in the Royal Navy for two years as his national service commitment, but the offer of a county-plus-school scholarship to study medicine at Oxford University, and entry to Merton, Oxford’s oldest college, won the day.Since medicine was a reserved occupation, national service was deferred until he had completed his medical studies. Life in the mediaeval Merton College (founded in 1264) was spartan, since heating and food were still rationed, but it provided a good education for a frugal lifestyle, difficult to achieve, but much needed, in modern affluent societies. The Oxford tradition, which then applied, restricted lectures and labs mainly to mornings, the afternoons being reserved for leisurely or sporting activities (amorous activities were limited by Merton being an all-male college).  Bryan’s choice was for aquatic activities, rowing for the college, swimming for the university , and, best of all, punting lazily along the Cherwell river on sunny summer afternoons, activities which would be unthinkable with today’s crowded curricula. Bryan recalls when cycling to morning lectures or labs being overtaken by Roger Bannister, loping along the footpath in training for his record-breaking four minute mile.

At medical school even, there were ANU connections. Nobel laureates Sir John Eccles (later head of Physiology at JCSMR) worked in Oxford’s School of Physiology, and Sir Howard (later Lord) Florey was the Professor of Pathology, later becoming President of the Royal Society and Chancellor of ANU. For his honours physiology course Bryan was encouraged by his tutor to base his weekly essays on information obtained by reading original papers from the medical school library, rather than textbooks, which was a notable feature of the Oxford system of learning.

Following the Oxford pre-clinical course in 1949, Bryan embarked on his clinical training at the Middlesex Hospital Medical School (in the heart of London) for two years.  On completion of his medical degree, Bryan was appointed house physician in general medicine, cardiology, and neurology at the Middlesex.  A lesson in environmental health was provided while on duty in casualty during the great London smog of 1951, when it was difficult to see across the hospital ward, impossible to see street signs, and over 4000 people died from respiratory failure over a single weekend. The subsequent Clean Air Act, which banned the burning of coal in open fires eventually led to London becoming a ‘clean’ city..

It was in the neurology ward of the Middlesex Hospital that Bryan met his wife, Anne, working there as a nurse. In 1953, he was drafted into national service for two years with the Royal Army Medical Corps, and posted to the army training centre in rural Sierra Leone, West Africa. Anne remained behind to study midwifery in Cambridge, and the couple maintained a correspondence for eighteen months, depending on an unreliable train service which delivered post from Freetown twice weekly. While at the army barracks, Bryan learned something of the culture of West African rural life and gained experience in practising the preventive and management aspects of tropical medicine, particularly malaria and bowel infestations. A surgeon in a local hospital had noted that bladder infestation with Schistosoma haematobium (Bilharzia)was almost universal in children living in the lowlands of Sierra Leone, but not found in the highlands, where goitre (thyroid enlargement ) was prevalent.  The explanation was that highland streams were deficient in iodine, so that snails (the vectors of Bilharzia) could not survive. As Hippocrates had observed  two and a half millennia previously, environmental conditions  must be taken into account when considering the causes of human disease.

On returning to England from Africa in 1955, Bryan was appointed as ahouse physician in the London Chest Hospital, and then as thoracic medical registrar at the West Sussex group of hospitals. He and Anne married in London in the interim. The choice before them was either to enter general practice in the National Health Service, and to train in that direction, or to continue the pursuit of specialist medicine. The choice was made for them when Bryan gained a post as medical registrar and later research assistant in the Professorial Medical Unit at Middlesex Hospital, in 1956. So Anne and he abandoned their pleasant semi-rural lifestyle in Sussex to return to ‘the big smoke’. Anne gave birth to twin daughters at the Middlesex in the following year, and Bryan later gained a higher qualification in medicine, MRCP (later FRCP).

The professor of medicine at the Middlesex was conducting research into the physiological and biochemical aspects of obesity, a project in which Bryan was invited to participate. The key question was how the human body handled the metabolic energy locked in different foodstuffs. Previous observations had shown that patients lost weight less rapidly when fed 1000 calorie carbohydrate diets than when consuming isocaloric (1000 calorie) fat diets. Bryan constructed an apparatus to measure accurately 24 hour oxygen consumption and carbon dioxide production. The results showed that obese patients on carbohydrate retained carbon, despite having similar energy expenditures to the fat diet controls. After a long gestation, while Bryan was working at ANU, these results were successfully submitted for a doctorate of medicine (DM, Oxford, 1978), titled Metabolic Studies in Obesity.  It is of interest that there is now a worldwide epidemic of the so-called metabolic syndrome, comprising obesity, Type 2 diabetes, and associated cardiovascular disorders. The prevailing view that overweight is predominantly due to excess fat intake can now be questioned, since substantial intake of refined carbohydrates, particularly of simple sugars such as fructose, with low satiety value, as well as widely advertised fizzy cola drinks, combined with diminished physical activity, are the more apparent lifestyle changes, not only in affluent societies but also amongst poorer countries and indigenous peoples such as Australian Aborigines. This has important implications for public health policy.

When Bryan’s post at the Middlesex Hospital was due to finish at the end of 1959, the question arose whether to attempt to continue a career in academic medicine, or to try something different. There was a long and very competitive queue for senior registrar and consultant physician appointments, and living in central London did not seem to be an ideal environment in which to bring up toddlers. A chance encounter occurred with a senior general practitioner from a group practice in Goulburn, NSW, seeking a physician and surgeon to join the group, with guaranteed base salaries. So the now well-skilled couple took a deep breath and decided to chance their arm as assisted emigrants to Australia, sailing ‘steerage’ for four weeks on the SS Iberia, with Anne again pregnant. Bryan was appointed consultant physician to  the group clinic in Goulburn, NSW . Departing from England for such a distant destination was not an easy decision for Bryan or Anne, since both had to leave elderly parents and otherfamily and friends behind, and with no contacts in Australia, although Anne’s mother later moved to Canberra to live with them.

Canberra became a natural attraction for the family, now with a third daughter born in Goulburn. Their first impressions of Canberra, little more than the proverbial large bush town with a population of around 40,000, set in a vast sheep run, made it more than tempting.  The attraction was increased by visits to the John Curtin School of Medical Research library, where Bryan encountered two of his old teachers from Oxford -  Sandy Ogston, who was Professor of Physical Biochemistry, and Colin Courtice, in charge of the research Department of Pathology and Immunology at JCSMR.  He also surprisingly met a fellow student and resident house physician from the Middlesex Hospital, Cedric Mims, then working in Frank Fenner’s Department of Microbiology, though later moving to the Chair of Microbiology in Guy’s Hospital, London.

There were then (in 1960)only two consultant physicians in Canberra, and one of them, Marcus Faunce, encouraged Bryan to set up an independent private practice. So another deep breath was taken, and on April Fools’ Day 1961, armed with a new Holden station wagon, an ECG machine, about two hundred pounds in the bank, and a warning from doctors in the Goulburn group practice that they would starve, having no visible means of support, the family took the plunge. They were fortunate to find a three-bedroom ex-government house in Tennyson Crescent, Forrest, backing onto an acre of orchard, with potential for a vegetable garden. The estate agent was George Hohnen, brother of the ANU Secretary Ross Hohnen. (The rent for this prime piece of real estate was ten guineas ($22) per week. Later, after the family moved to a new house, backing onto bushland in Hughes in 1965, this  Forrest house was purchased and re-furbished by Ralph Slatyer, Director of RSBS. then, as is now the fashion, the house was sold for over $2 million, bulldozed and replaced by a much less attractive duplex).

Two other pieces of good luck helped the family survive. First, they found a member of that now almost extinct species, a sympathetic and helpful bank manager. Second, the senior ophthalmic surgeon, John Lodge, lent Bryan his veranda space in Civic Centre as a consulting room, with access to his secretary and phone, pro bono, until another consulting room became available along the corridor. Bryan was appointed visiting medical officer at the then Canberra Community Hospital (later re-named  the Royal Canberra Hospital), where the National Museum of Australia now stands on the lake shore. Bryan ascribes the main reason for their family’s survival to Anne’s capacity for hard work and her extraordinary housekeeping and child caring skills, having raised five children (including twins) under the age of six without family or other outside support. All of Anne’s children were breastfed for nine months, as were her seven grandchildren, none of them requiring any antibiotics during childhood. Daughter Joanna’s two boys were breastfed even longer, over a year, since they were living in a remote area of South Australia, where Joanna and her husband were teaching Aboriginal children, the environment posing a high risk of infectious disease. This reinforced Bryan’s view that breastfeeding whenever possible is the most effective way of boosting the immune system in early life, combined later with good nutrition and adherence to an immunisation program.

Although Anne never resumed her nursing career, when the children had all begun school she studied for a librarianship degree at the Canberra College of Advanced Education (now the University of Canberra), and became librarian at the AME school (of which she subsequently wrote a history, describing  its model of ‘alternative’ education). Despite her busy life she later worked as a volunteer for a number of community organisations. Anne’s love of animals led her to become,  successively, council member, treasurer and eventually president of the ACT RSPCA for six years, in the course of which  she established a veterinary clinic. She also worked as a volunteer for the University of the Third Age (U3A).

In the 1960s, before Medicare (later Medibank ) and pensioner allowances, it was not easy for Bryan to  cover practice and living expenses, since it was traditional not to charge colleagues and their families, nurses, members of the clergy, and pensioners for medical assistance. So pro bono work progressively became an important part of Bryan’s professional life, and remain so for his working future. The dire situation was helped at the end of the first year in Canberra by a refund cheque from the Income Tax Department, since he had netted no taxable income! After that, the trickle of referred patients became a stream, until his fiscal situation became viable.

In his hospital practice, Bryan raised professional eyebrows in his treatment of patients following heart attacks (coronary thromboses). The tradition was to keep them in bed for six weeks, which sometimes resulted in deep vein thrombosis and occasional pulmonary embolism which could be fatal. Provided there were no complications, and the patients’ condition was stable, Bryan would move them out of bed after two days, encourage them to walk slowly around the ward, and subsequently  walk alongside the lake outside, discharging them from hospital after two weeks, with an embargo on smoking and advice to remain active. It is a matter of satisfaction to him that early mobilisation is now standard management of patients following heart attacks, strokes and major surgery. He also recalls gastric-ulcer patients referred by surgeons who planned to remove most of their stomachs. Questioning revealed that they were addicted to APC (Bex) powders, exhorted by advertisers of the product that the solution to many problems was “a cup of tea, a Bex and a good lie down”.  Withdrawal of the aspirin-containing Bex led to disappearance of the ulcers and exasperation for the surgeons, who lost that part of their income! It reinforced Bryan’s (uneconomic) conviction that prevention is better than ‘cure’ . Bryan notes that the majority of non-malignant stomach ulcers are now recognised as being due to infection. To this day Bryan deplores the demise of the general consultant physician, who can assess the patient as a whole, and not through the tunnel vision of the specialist.

In those days, general practitioners had access to hospital beds, providing easy contact with specialists over morning tea, an important direct line of communication which has long since disappeared, being replaced by “grand rounds” at the new Canberra Hospital in Woden, which GPs seldom have the time to attend. In the 1960s, intellectual stimuli and clinical opportunities were provided through regular clinical meetings in the Faunce lecture theatre of Canberra Hospital and by the formation of the Canberra Medical Society (CMS), which hosted monthly lectures in the Florey theatre of the old JCSMR from distinguished overseas visitors to Australia, helping to reduce Canberra’s isolation and medical parochialism. Bryan had the honour of being elected president of the CMS for a couple of years.

By the mid-1960s, Bryan had noted significant changes occurring at the Australian National University, a few hundred metres from his practice at the hospital. In 1960, Canberra University College, until then a teaching arm of Melbourne University, had expanded and merged with ANU (then a research only university).  The new School of General Studies, as the expanded CUC became known, provided the undergraduate teaching functions (as well as its own research capability), and the challenges which Bryan was waiting for.

As well as a range of undergraduate courses at the expanded ANU, student services were proposed which would include a university health service, a counselling service, study skills and employment services, and careers advice.  Bryan was quickly identified as having the range of clinical and social skills needed for the new campus Health Service, suited to students less prone to physical illness but more likely to succumb to the existential and psychological maladies that characterise young adults studying intensively at a high level. Bryan’s skills, honed through both general and specialist practice, and his philosophy of guiding rather than instructing within a rubric of “heal thyself”, struck the university management as likely to provide the sort of health service which would become an effective “health-style” template in the later lives and careers of these ANU students. Bryan was accordingly appointed to head the Health Service, in 1966.

The Service would also provide emergency services for staff, and a wider approach to health promotion on the campus generally.  Importantly, a counselling service, headed by Bryan’s colleague Margaret Evans, was inaugurated about the same time.  The university did well in bringing these two like-minded professionals together. Their impact over some decades has been of great importance.

To Bryan, joining ANU was like becoming part of a new antipodean family.  He found ANU’s  senior managers to be enlightened, and enthusiastic  to support his sometimes unorthodox approach to community health.  Margaret Wallner was appointed part-time assistant physician, and Trish Levick, a physiotherapist, was appointed to meet the burgeoning demands which are inevitably part of university sporting activities.  Pat Sorby was installed as community nurse in Garran Hall, to provide important out-of-hours medical help, and informal guidance, in loco parentis, for students.

The Health Service was initially housed on the third floor of the Copland Building.  It took Bryan some time to persuade the university that such an ‘elevated’ location was not the most practical, particularly since the Health Service was often the first port of call for sports-wracked and accident-prone students.   Bryan argued for the service to be located on the ground floor of purpose-built premises, which it soon was, moving to its current location near the Sullivan’s Creek Bridge, and next to the Counselling Service, which was a further important practical consideration.

With the support of hishealth service colleagues, Bryan developed his new model of community health, one which, as he says, emphasises “health over illth”, to Bryan’s mind a guiding philosophy in general medicine.  Students were encouraged to take greater responsibility for their own health, with the service promoting prevention over cure, and students were asked  to anticipate the consequences of poor life-style choices.  Interestingly, some local officers of the AMA resisted this philosophy. Perhaps choices made by students were seen as potentially uneconomic for the profession!

Bryan took a special interest in occupational health and safety at the university, including the provision of travellers’ clinics for ANU staff and students.  He co-authored a booklet Health in the Tropics, precipitated by the death from malaria of an ANU graduate student, contracted during field work.  He took a close look at student health more generally, and found it to be excellent.  He initiated a Wellness Resource Centre, including facilities for monitored exercise stress testing, located in the old ANU Drill Hall, to evaluate, and anticipate, cardiovascular disease as a major later cause of illness even for otherwise healthy students. A Student Health Survey was conducted, in co-operation with Malcolm Whyte, newly appointed professor of Clinical Science, and Ralph Reader, Director of the National Heart Foundation. Bryan also discussed with students the causes and threats of emotional and psychological stress.  As part of this program, he introduced students to techniques of relaxation and meditation that could be included in the routines of student life, and thus improve the effectiveness of their study and general wellbeing.

A couple of notable occupational health issues for staff emerged during Bryan’s watch. First was the occurrence of so-called repetition strain injury, with pain, stiffness and tingling of hands, arms and shoulder girdle, regarded by some people as psychosomatic, but causing much discomfort for many secretaries. The syndrome coincided with the introduction of computers and heavier typing loads, using different techniques of word processing. As amongst other office workers outside the ANU, the syndrome exhibited the characteristics of an epidemic. The ANU physiotherapist, Trish Levick, played an important role in treating patients, but, more importantly, in education and changing workplace practice, including the introduction of ergonomic chairs, regular breaks for neck and shoulder exercises, and reassurance that the afflicted would recover . Recover they did, and after a few months the ‘epidemic’ died down.

Second, the Health Service started to question whether holding seminars in smoke-filled rooms was in the best interests of the health and intellectual development of participants. On a national basis, the dangers of passive smoking came into focus, eventually leading to a ban on smoking in all closed areas, to the great relief of non-smokers.

In 1970, Vice Chancellor Sir John Crawford asked Bryan to take six weeks leave from his regular duties to survey drug use at ANU and at selected overseas universities. A report was furnished to the University Council entitled “Some Aspects of Drug Consumption in Canada, the United Kingdom, Sweden, Denmark, the United States of America, and Australia”. The Vice Chancellor did not wish the findings to be published, which in retrospect seems a pity. Looking back on that study, and comparing his findings with today’s experience, Bryan’s observations are convincing – exotic drugs were not a major problem for students – alcohol and nicotine were the greater causes of immediate and prospective poor health for university students. Unfortunately in the community at large psychotropic drugs have since also become a significant problem, reaching epidemic proportions, and raising questions as to whether legalisation of the drugs in question rather than punishment of consumers might cut the ground from under drug pushers.

Bryan served as a member of the ANU Council for two years, representing the general staff. After his retirement from the ANU, in 1994, Bryan was appointed Member of the Order of Australia (AM), “for service to health education and promotion”.

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The steady evolution of Bryan’s professional interests from his early years in England and Africa –chest and cardiovascular specialist, then as general physician, and ultimately asking students to practice self-motivated, self-responsible health management, parallels Bryan’s recent  questioning of the care and responsibility practiced by citizens and governments more generally towards their own environment, and of the planet, calling this a metamorphosis from ‘internal medicine’ to ‘external medicine’.  Bryan increasingly became alarmed at what he saw as irresponsible attitudes towards the sustenance of the biological and physical systems that decide the planet’s well-being and thus the health of human populations.  Bryan joined the Nature and Society Forum, founded by his long-time friend Stephen Boyden, to become part of a small but lively group of enthusiasts interested in promoting sustainable ecosystems.  He began inquiring into and writing on the impacts of ‘civilisation’ on the epidemiology of disease, on infectious diseases, nutrition, the interaction between environmental change and human lifestyles generally, on sustainability, and on natural approaches to human burial.

Geologists refer to the present interglacial era as the holocene, dating from the agricultural transition some ten millenia ago. In 2000, following a climate change conference, Paul Crutzen, Nobel laureate in chemistry, declared that so great had been the destructive human impact on the biosphere since the onset of the industrial transition 250 years ago that the present era should be re-named the anthropocene. This suggestion is accepted by many climate scientists and is being officially considered by the Geological Society of London.

 Bryan is a Life Member of the Nature and Society Forum, a Life Member of the Australia & New Zealand Students Services’ Association, and a Life Member of Manning Clark House.  He continues to be an active member of Doctors for the Environment Australia, the Medical Association for the Prevention of War, and is a member of the Strategic Council of the Climate Institute.  He has an enduring but pessimistic interest in global warming and its causes and consequences. In September 2011 he presented a paper to the Friends of the Australian National Botanic Gardens entitled “The Anthropocene and its Discontents”, which is reproduced in ANU Emeritus Faculty’s website, and can be accessed through his biography at his webpage. He thinks he has rather presumptuously invented a neologism – see: www.sustainocene.com , which he plans to present to an Emeritus Faculty meeting in March 2012, entitled “From Anthropocene to Sustainocene – Challenges and Opportunities”.

Bryan is a regular public contributor in support of these social and scientific ideas.  He is an inveterate writer of letters to the Guardian Weekly and Canberra Times, with occasional articles in the latter.

Bryan and Anne continue to live in the house in Hughes, ACT, which they bought in 1965.  Three of their four daughters and their son are now teachers, nurses, activities officers for the aged, or trained carersof the disabled, and one daughter is a retail business manager.  Three of the Furnass daughters have brought forth in turn three daughters and four sons, the basis of much pride,  comfort and hope for Anne and Bryan. Their four oldest grandchildren are at university. The families are now spread across New South Wales, South Australia, and Canberra, with the families coming together regularly.