|5 Mar 2021
|Congratulations and Awards
This is the story of the extraordinary life of Derk Crichton, a distinguished OD who certainly left his mark.
Derk Crichton was born in February 1919. His father, Professor Cuthbert Crichton, a gifted and revered teacher and superb clinician laid the foundations of obstetrics and gynaecology in the Cape Town medical school. At Bishops, Derk played in the 1st XI in his last year. He achieved a First Class matric and left Bishops at the end of 1937. He qualified as a medical doctor at UCT in 1944, earning a first-class in surgery, and, on the sports field, played hockey for Western Province. By 1946 he was a house surgeon at the Peninsula Maternity Hospital. He held the full-time post of registrar at Groote Schuur Hospital and all the maternity units from 1948-1949 when he was succeeded by Dr F Niven Charnock (O, 1934) known as Fred, father of Mark Charnock (O, 1962) also a gynaecologist.
Derk’s academic and clinical achievements were stellar and he rose quickly to the top of his profession. He became a Fellow of the Royal College of Surgeons of Edinburgh in 1953 and a Fellow of the Royal College of Obstetricians and Gynaecologists in 1959. He went on to obtain a D.Phil. from Oxford University in radiological gynaecology and obstetrics in 1953.
In 1955 he became a clinical professor of obstetrics and gynaecology in the then University of Natal in Durban where in 1965, he was also awarded the Blair-Bell Lectureship for outstanding research. In 1967 he won the Hamilton-Maynard medal for the best South African medical publication of the year, an article describing his method of repairing ureteric fistulae. In 1969 he became the external examiner for the Royal College of Obstetricians and Gynaecologists; this was in addition to the English-speaking South African universities and the University of Salisbury in Rhodesia (Zimbabwe). From 1967 until he left South Africa in 1974, he performed all sex-realignment operations (male to female) in Natal.
By 1972 Crichton was managing the gynaecology and obstetrics ward at King Edward VIII Hospital and the university medical school’s teaching hospital, all the while carrying out ground-breaking research and publishing prodigiously. In her book, Canadian academic Susanne Klausen remarks: ‘Crichton was an impressive man, an innovative and talented doctor who was also a workaholic with enormous ambition, the result of having a famous father whom he greatly admired and who expected much of his son’ (Klausen, 2015, p. 109). Looking back on his career in 1991, Crichton recalled his father's powerful character’ and said, ‘[i]t is often frustrating being the son of a great father. Excellence is expected of you and when you achieve it, it is taken for granted.’ (Klausen, 2015, pp. 108-109).
As a highly principled and compassionate doctor, he was also regarded in awe by his students. Said one, “Derk Crichton was like a god to us, we would queue for his lectures which for us were like the Ten Commandments. He was so sure of his medicine that if he told us to treat a patient a certain way, regardless of what the textbooks said, we did it…”. However, he was also infamous for his temper and inability to ‘suffer fools’, and for some he was an intimidating figure. Mark Charnock, a member of the UCT MBChB class of 1968, confirms this impression of Derk, who examined the final year students and ‘terrified the candidates. However, he would apparently give them very generous marks afterwards despite the mauling’.
Chris Winearls (W, 1967), now a retired consultant nephrologist at Oxford says of Crichton, ’I do remember him when I was a UCT medical student. He was a renowned figure in O and G especially as the son of the UCT Professor. He gave some lectures when I was an undergraduate and examined in the UCT Finals. He was known as very hard-working, turning up on the black labour ward at King Edward VIII hospital in Durban to check on how the junior doctors were doing. He was not someone to tolerate bad practice. Some accused him of spending too much time in private practice whilst a university professor. A critic counted the number of hours his car had stood outside the private hospital. He replied by asking whether they had also checked how many hours it had been outside the NPA State hospital‘. (The photo above shows Derk with Chief Gatcha Buthelezi)
Crichton was a liberal, remarkable for his innovations regarding health care and education for blacks. Beginning in 1954, Crichton trained the medical school’s first black doctors; he estimated, that 400 successful graduates had passed through his hands. The contingent of capable gynaecology specialists he trained was a testament to his inspiration. He was deeply admired by medical students. Prof. E. Mokgokong (seen second from the left in the photo to the left) one of Crichton’s former students, was South Africa’s first black gynaecologist and instructor in a medical school, and he recalls Crichton with huge affection, saying ‘he’s like a father to me, he took me up, he made me’. He says Crichton was colour-blind and ‘even-handed’ with his students, meaning he treated his white and black students the same. A nurse remembered Crichton urging black nurses to obtain further training so they could be promoted to higher positions. One ‘took up this educational challenge’ and eventually became a matron (reminiscences in this para. all from Klausen, 2015, pp. 111-112).
.In and of itself, all these achievements and honours amount to a distinguished academic and medical career achieved by the age of 52; but if this were all, Crichton would be remembered only as an eminent academic, teacher and doctor. And that would have been the end of his story. However it is for his acts of moral and political conviction and bravery in the conservative medical world of apartheid South Africa (and indeed the world) in the early 1970s that we salute Crichton. In 2014, his story was covered in Klausen’s journal article The Trial the World is Watching and, in 2015, in her book, Abortion Under Apartheid, but curiously it is a tale that has not yet been celebrated by South Africans.
In 1972 a sensational trial in Durban brought the topic of clandestine abortion to the front pages of the newspapers. Derk Crichton, by then a well-known and celebrated doctor and teacher, loved by his patients and students alike, and James Watt, a self-taught abortionist, were prosecuted for performing illegal abortions. At the time of his arrest in 1972 he was President of the Regional Council of the Royal College of Gynaecologists and Obstetricians in South Africa. Prior to a change of law in 1975 the boundaries of the existing common law were unclear, and the individualism of Crichton led him to challenge both the medical profession and the law. At that time South African law forbade abortion unless necessary to save a woman’s life. To circumvent this harsh law clandestine abortion became an epidemic. White women with means turned to private doctors, but black and poor white women were left to the tender mercies of untrained abortionists who performed highly dangerous procedures to terminate unwanted pregnancy. The fundamentalist Calvinist line of the ruling National Party and the Afrikaner establishment was ultra-conservative and medical abortion was an anathema to the regime, especially if it meant it had to recognise that young white women were falling pregnant outside marriage. The government turned a blind eye to abortions performed on black women, typical of the double standards of apartheid.
In practice ‘criminal’ abortion had been largely tolerated unless it resulted in a woman’s death, at which point the police could no longer look the other way. In his hospital duties, Crichton was constantly confronted by the effects of these backstreet abortions, repeatedly having to treat large numbers of women, mainly black, suffering the consequences. At least one died a month. As a result, he had concluded that the law on abortion was unrealistic and outmoded and became a liberal crusader for women’s rights to decide on and control their reproductive capacity and an outspoken advocate of abortion on demand. Against the background of the prevailing legal uncertainty, Crichton referred teenagers and young women needing abortions to Watts to initiate the termination; the latter was a highly intelligent, skilled and meticulous self-trained ‘criminal’ abortionist. Effectively Crichton exploited a loophole in the law, which permitted an abortion to be completed if a woman arrived at the hospital while miscarrying. The informal abortionist initiated the termination, allowing the doctor to complete the miscarriage safely.
Klausen argues that ‘the purpose of prosecuting Crichton and Watts was to shore up apartheid morality by disciplining, first, a high-profile representative of the liberal wing of the medical profession in order to stop doctors assisting girls to separate sex from marriage, and second, to stop white girls themselves from transgressing the apartheid sex code’ (Klausen,2014, p. 212). This explanation of the purpose of the prosecution may, however, understate the extent to which the investigation was driven by the then conservatism of the medical profession itself. One gynaecologist has observed that Crichton’s abortion practice was not received well in some medical circles, particularly among those members of the profession who were relatively unaware of the predicament of women with unwanted pregnancies. There was no vocal professional lobby promoting access to abortion and attempts to do this would not have received much publicity. That the investigation may have been driven as much by professional conservatism as by political and religious considerations is borne out by the commentary of the son of Mr Justice James, the judge who tried the case in 1972. He observes: ‘I remember my Dad doing the case, and having some sympathy for the maverick Crichton…I recall Crichton stuck his chin out and said do your damnedest. I don’t think it was a ‘politically’ driven prosecution, but more a conservative professional one. Derk was clearly a highly respected doctor, but controversial and very outspoken…’
At the beginning of 1972, the police targeted Crichton for prosecution, and Watts was drawn into this web because of his association with Crichton. A conviction, it was believed, would instil fear into the hearts of other doctors and stem young white women’s access to medical abortionists. The police concentrated their investigation entirely on young white women. The Crichton-Watts trial was ‘aimed at buttressing apartheid culture by disciplining both ‘wayward’ young white women and a liberal member of the medical profession’ (Klausen, 2015, p. 133).
For the duration of the trial, the handsome and supremely confident Crichton never doubted the correctness of what he was doing. The court galleries were packed and the girls who testified were subjected to embarrassing and torrid cross-examination.
In the event, both men were found guilty. The judge sentenced Watts to two years in prison (one conditionally suspended). In contrast the sentence imposed on Crichton was relatively lenient, a fine of R500, as the judge believed Crichton to be a compassionate man who only acted in the best interests of his patients; a criminal conviction would have brought harm to Crichton’s career. In fact the judge described Crichton as ‘a noble man with a history of tremendous service to the community'. (Klausen, 2015, p. 136).
A few months later though, Crichton again stood trial, alongside a medical colleague. Both were found guilty and struck off the medical roll, which barred them from medicine in South Africa. Crichton left for Swaziland with his partner, Susan Pohl, and only returned to South Africa in 1977 following the birth of his elder daughter, Ruth, after his South African license was reinstated. In Durban he resumed private practice and research, and his younger daughter Helen was born in 1984. Derk delivered both his daughters, as they were both medical emergencies. He and Susan married much later, in 2004 in Hermanus. He did resume lecturing at the O & G department and enjoyed the interchange with the students.
Crichton was known in the world of obstetrics because of two contributions to clinical practice. He did important work on the assessment of the progress of labour (published in 1974), and his ‘rule of fifths’ is still used in labour monitoring and the diagnosis of engagement. He also made a significant contribution on the subject of symphysiotomy (published in 1966), a surgical technique to avoid Caesarian section. Although his subsequent career might have been lower key, he continued to contribute to innovation during the 1990s in the field of gender reassignment surgery. Unsuccessfully Crichton advocated equal pay for black doctors. He gave constant advice and support to his former student, Professor Ephraim Mokgokong, who became a pioneer in opening up academic medicine to black doctors in training and practice. Mokgokong headed the Medical University of Southern Africa (Medunsa), which had been founded in 1978 for black students, and subsequently produced a considerable body of black medical graduates. Crichton supported Mokgokong in his endeavours by being an external examiner.
Derk lived with Susan in Hermanus where he later passed away on 14 March 2022. A remarkable man who truly left his mark.
Written by Peter Elliott (W, 1967) and updated after Derk's passing
Crichton, D. :
(1974). ‘A reliable method of establishing the level of the fetal head in Obstetrics’. SAMJ O&G 22 17 April, pp. 784-786.
(1993). ‘Gender reassignment surgery for male primary transsexuals’. SAMJ 83, May, pp. 347-349.
Crichton, D, and Clarke, G.C.M. (1966). ‘Symphiotomy- Indications and contraindications’. S.A. Journal of Obstetrics and Gynaecology, December, pp. 76-79.
Klausen, Susanne. (2014). The Trial the World is Watching ‘The 1972 Prosecution of Derk Crichton and James Watts, Abortion and the Regulation of the Medical Profession in Apartheid South Africa’. Med. Hist. (2014), 58(2), pp.210-229.
Klausen, Susanne. (2015). Abortion Under Apartheid: Nationalism, Sexuality, and Women's Reproductive Rights in South Africa , Chapter 4: ‘The Trial the World is Watching’. The Crichton-Watts Trial, 1972.Oxford Scholarship Online.
Louw, Jan H. (1969). In the shadow of Table Mountain, Part Seven/Chapter Ten, Department of Obstetrics and Gynaecology. Cape Town: Struik.
The Peerage online: http://www.thepeerage.com/p37545.htm#i375447
Peter Elliott and Nicky Bicket (F, 1973) would like to thank Prof. Susanne Klausen for permission to extract from her article and book
Peter and Nicky would also like to thank Derk’s daughter, Ruth Crichton, for the support and encouragement she gave in the researching of this article.
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