A Son’s Tribute to an “Ivory Prince” (Updated)


By Myint Zan


29 June 2010  would have been my father’s 88th   birthday if he were alive. As it was, my father Dr U San Baw, died on 7 December 1984.


As the song goes “all kinds of (different) things” reminds me of my father. A few news items that had appeared some  years back in newspapers in Malaysia   is perhaps worth mentioning as a way of introducing my late father to the readers.


More than 18 years ago there was a partly medical and partly human interest news item which hit the front page of at least one English language newspaper: the New Straits Times of Kuala Lumpur. A toddler Muhammad Azeem lost his little finger at a private medical clinic when the nurse cut the little finger by mistake while bandaging him. (Of course Muhammad Azeem would no longer be a toddler now he would be in his teens). About the same time there were also newspapers reports about a similar misfortune befalling another lady when her thumbs were accidentally cut off. But fortunately they were later “stitched back”


As I understand it, early and prompt microsurgery could have made it possible to “stitch back” little Muhammad’s little finger. Such microsurgery is now within the reach and application of Malaysian surgeons as indicated by a news item that appeared in the New Straits Times of February 17, 1992. A group of Malaysian orthopaedic surgeons, assisted by a Burmese doctor who in fact actually performed the operation had managed to “sew” back the hands of a labourer whose hand was accidentally amputated. Dr Min Lwin whose name was mentioned in the above news item was a former student of my late  father.


My father helped establish the practice of microsurgery at the Rangoon General hospital and its affiliates in 1978. In 1978 alone there were at least 6 recorded cases where completely amputated hands were rejoined by means of microsurgery under my father’s supervision.


But the use and practice of microsurgery was not “invented” or discovered by my father. Perhaps he might (or might not) have been one of the early orthopaedic surgeons in South East Asia to use it.


However there are three areas of orthopaedic surgery where he can be said to be truly a pioneer.


The first one is his development of a new technique for treating congenital or infantile pseudarthrosis of the tibia. Congenital pseudarthrosis of the tibia (extra shin bone beneath the knee if my rough translation is correct) normally requires early treatment during childhood or early youth to be effective. Most of my father’s patients came from the villages. Since their children’s affliction was congenital they have resigned themselves to (what they believe to be) their karma or fate and was not eager for treatment. My father had to do a lot of persuading and in a few cases spent money out of his own pocket for the transportation costs to the hospital for the patient’s treatment and follow-up.


Within a period of about ten years he managed to successfully treat the congenital pseudarthrosis of the tibia of 15 patients. Indeed his new technique came to be informally known among some orthopaedic surgeons as “San Baw’s technique” especially after he published his findings in the Volume 51B of the Journal of Bone and Joint Surgery (British edition) of February 1975, pages 61-68. Professor Subramaniam, formerly Head of the Department of Orthopaedic Surgery at the University Hospital of the University of Malaya in Kuala Lumpur told me that my father performed a few operations on patients with congenital pseudarthrosis using his technique while he was visiting Malaysia on a World Health Organisation’s fellowship in January 1976.


My father also had conducted clinical research in the use of ivory powder instead of cancellous bone to pack bone cavities after tumours had been removed. As of 1976 at least 27 cases were treated using this method.


The most remarkable area where my father made his major contribution to orthopaedic surgery was his use of ivory hip prostheses for fractured neck of femurs. Until my father pioneered the use of ivory in early 1960 on a 83 year old Buddhist nun Daw Punnya, metal was the universal replacement for fractured thigh bones which especially afflicted the elderly.


While studying at the University of Pennsylvania’s Graduate School of Medicine in the United States from 1954 to 1957 it dawned on my father that ivory could beneficially be used for hip replacements instead of the metal that was being used hitherto. He reckoned that in Burma at least ivory would be much cheaper and more easily accessible than metal.


After his return to Burma in 1958 and while posted as Head of the Mandalay General Hospital’s Department of Orthopaedic Surgery he conducted research on the physical, chemical, mechanical and biological properties of ivory for about a year before using it on Daw Punnya. A few weeks after the insertion of the ivory prosthesis, Daw Punnya was able to walk. From 1960 to 1969 over 100 ivory hip prostheses were used by my father to replace the fractured hip bones (ununited fractures of the neck of femur in technical terms) of patients whose ages ranged from 24 to 87. A modest grant by the then Revolutionary government in the mid 1960’s helped kept his research work to continue.


International recognition came in 1969 when my father was invited by the British Orthopaedic Association (BOA) to address its annual conference in London on his use of ivory prostheses. In its invitation letter the BOA wrote that they would like to personally hear about my father’s “unique” method of treatment using ivory. The conference was attended by orthopaedic surgeons from around the world. My father was interviewed by a correspondent from the Voice of America after he addressed the BOA in London. We heard from friends that my father’s interview was broadcast on both the Burmese and English language programmes of the Voice of America in October 1969. The correspondent who interviewed my father said he would send the tapes of the broadcast to my father’s address in Burma; he might well have sent it but we never received it.


There was a stroke of luck though regarding a news item that appeared in an American newspaper. My father received a protest letter from a lady in California who wrote to my father after seeing a news item of my father’s work in the February 1, 1970 issue of San Bernadino County’s Sun newspaper. (Please see a cutting of the paper attached). She thought that my father’s unique method in treating hip fractures would result in the indiscriminate slaughter of elephants. However at least in the 1960’s and 1970’s when my father was using ivory prostheses there was an abundant supply of ivory in the country and there was absolutely no need for or incidents of elephants being slaughtered for my father’s research work. There were about 2000 elephants in captivity. Ivory was sold to the public only after the elephant died a natural death at the end of a useful life carrying and hauling timber.


The lady who wrote that protest letter was kind enough to send the newspaper clipping to my father. After my father’s death, I recall seeing quite a few letters from people in the United States writing to him with some request for assistance with their hips or orthopaedic problems. I also saw copies of letters of reply by my father to the correspondents that ‘at that time [in the early 1970s]’ a visit to the States was not possible’ and he cannot give more concrete or at least face-to-face advice on their orthopaedic problems. He was right. He never visited the United States after he left in late 1957.


In late March 2010 while attending an Association of Asian Studies meeting in Philadelphia I took the chance to visit the University of Pennsylvania Archives. In May 1988 I have sent to the University of Pennsylvania Alumni Office with a resume of my late father and a few published papers about my father’s work with ivory hip prostheses. The Alumni office forwarded the papers to the Editor of Penn Medicine magazine, which is the University of Pennsylvania Medicine magazine  and the then editor of Penn Medicine magazine published a short notice of my father’s death and in his own words ‘ a brief description of his achievements’ in the Fall 1988 issue of the  magazine. The then editor Dr. Marshall Ledger (Ph.D.) in sending me copies of the magazine also in  a handwritten note wrote me  that “in the limited space” he had, he had tried to mention as many of my late father’s achievements as possible though it is not sufficient to describe a life, the Editor wrote, “as creative and as meritorious as his”. I do not have with me now “notice” or obituary of my father that appeared in Penn Medicine  but from my firm memory it reads:




San Baw, M.D, G.M [Graduate School of Medicine, University of Pennsylvania].’58 [Graduated 1958], Mandalay, Burma, December 7, 1984, an orthopaedic surgeon. He pioneered the use of ivory hip prostheses to replace fractured thigh bones and conducted research in the use of ivory powder instead of cancellous bone after tumours had been removed. He also developed a new technique for treating congenital pseudarthrosis of the tibia. He helped established an orthopaedics curriculum in several Burmese medical institutions and served as chief of orthopaedic surgery at Rangoon general hospital.





I realise that the situation regarding the ivory trade both globally and in Burma has changed. Dr Min Lwin who performed the operation as stated in the NST  news item of February 17, 1992 told me that in  nowadays only in exceptional cases and with special permission can ivory be used for hip replacements.


In other cases where metal or simple pulleys and screws would do they are used by Burmese orthopaedic surgeons many of whom were my father’s former students. Hence Professor Ronald Barnes who was the President of the British Orthopaedic Association in 1969 to whom my father presented a model ivory prosthesis after his lecture to the BOA, might well be right when he wrote me in 1989 when he (Barnes) was 82 years old, that my father’s work is of  “historical interest”.  


Perhaps. But as a father’s son I cannot help but feel that my late father’s work is also historic in its own way. After all he was the first person in medical history to pioneer the use of ivory hip prostheses. And in the first 100 cases, as was reported in the Journal of Bone and Joint Surgery  (British Edition) Vol 52B pp. 177-78 there were 88% success where a majority of my late father’s patients were not only able to walk and squat but also played football and cycle. From 1969 to my father’s death in 1984 he had used about 200 additional ivory prostheses. That is why my father was informally and affectionately known as “ivory prince” among some of his friends when my father visited Malaysia, Singapore, Australia and Hong Kong from January to June 1976.


As a further update on my late father’s work I can mention my recent conversations with two Burmese orthopaedic surgeons. In early June 2010 three Burmese orthopaedic surgeons visited Malacca to attend the 50th anniversary of the Malaysian medical association. Two of them (now retired Professors of orthopaedic surgery in Burma) are former students of my late father. One of them Professor Dr. Kyaw Myint Naing told me that he and Mandalay General Hospital still had specimens of ivory hip prostheses and I requested him to kindly “safe keep” them . Dr. Kyaw Myint Naing worked closely with my father from about early 1971 to about my father’s retirement in 1980 and helped my late father’s work. From about the mid-1960s to early 1971 another of his able assistants was Dr. Sein Lwin, M.D, who also devotedly help my father’s research work. In January 1971 Dr. Sein Lwin migrated to the United States and has practised orthopaedic surgery at Fort Lauderdale, Florida since about 1978. Dr. Sein Lwin stated that my father have used at least 100 ivory prostheses till about 1970 but  he was not sure whether the total amount of prostheses used reached 300.  When I met Dr. Kyaw Myint Naing in early June 2010 he told me that though he was not sure of the exact figure the number of ivory prostheses were used on well-over 300 patients throughout my father’s career.


 Dr. Sein Lwin and Dr. Kyaw Myint Naing told me that when the person whose hip fractures have been replaced by ivory prostheses died, both of them had, in quite a few cases, and with the agreement and cooperation of the deceased families, taken the cadavers, surgically removed parts of the neck of femur and put them under microscope for histological studies to observe how the blood, bone and tissues react with the “foreign body” of the ivory.


Dr. Kyaw Myint Naing mentioned to me that though it can be stated as my late father had stated there is “biological bonding” between the ivory and the bones, tissues and blood vessels, , this “bonding” process can also be described as “creeping substitution” in that slowly but surely the ivory “takes over” and substitutes the bone. “Biological bonding” or “creeping substitution”, call it if you will, my late father’s pioneer work, with the able assistance of his younger colleagues in the 1960s and 1970s is, I sincerely believe and claim, a significant medical landmark.


As one who cares (to be frank) about “fame”,  publicity and recognition  about my father I at times wonder how much publicity and recognition my father work had received. When I read a brief obituary of Sir John Charnley in August 1982 in Newsweek magazine, I, perhaps morbidly, wonder whether foreign and local news media would carry the news when my father does passes away. Sir John Charnley, a British Orthopaedic surgeon was in laymen’s terms a pioneer of metal hip prostheses and Newsweek credited him with easing the pain of thousands of orthopaedic patients throughout the world. As it was, my father was dead of lung cancer (secondary brain) in December 1984 – less than 30 months after Sir John Charnley passed away. (I understand that my father might have met Sir John when he delivered his paper at the London orthopaedic conference in 1969.)


My father was a very heavy smoker. I was told that he started smoking at the age of 10 and except for a few months (weeks?) in the mid 1960s where he temporarily managed to smoke “only” about “one cigar a day” (in lieu of the cancer sticks) he never stopped smoking. Smoking was a “sensitive” matter for him too. Both my mother and I had to approach this subject with great care. Dr Wally Unger, (now a retired dentist whom I last met in early 2004, who if still alive would be in his early nineties)  had told me that my father in anger had scolded him about six months before he actually died: “Wally, mark my words: I will never die of lung cancer”. Uncle Wally is a close family friend; he told this story with sorrow and affectionate remembrance of his friend and not with anger. As I type these lines on my computer keyboard my face is flushed.


In a perverse sense, my father was right. He did not die of lung cancer. Due to radiotherapy which left my father’s head hairless within a few weeks after treatment, the cancer in my father’s lung was reduced to a minuscule. But no one could do anything about the metastasis inside my father’s head. When his cancer was discovered by X ray as a result of my father’s complaining of being unable to write properly, the metastasis was already in the head. The technical or immediate cause of his death was complications arising from lung cancer not the lung cancer itself.


But back to the ‘publicity; News items (or almost literally announcements) of breakthroughs in orthopaedic surgery reminds me of my father. AsiaWeek’s  January 27, 1989 issue carried a news item of china (not the country) being used for replacing bone. I wrote back in response about my father’s work with ivory which AsiaWeek published under the title “Another Use for Ivory” in its March 17, 1989 issue. Again in December 1989 AsiaWeek published a Thai orthopaedic surgeon’s pioneering work where he boiled bones that were used in surgery to sterilise them from getting infected.  The article stated that Dr Derek Israngul was to be awarded Thailand’s highest honour by the Thai King.


Alas, my father never received such honours. After reading the article about the Thai orthopaedic surgeon’s achievements I wrote to AsiaWeek  (which have now “closed shop”)  again, describing my father’s use of ivory powder to pack bone cavities and his technique for treating congenital pseudarthrosis of the tibia. But as they say once lucky, twice shy and my letter to AsiaWeek never saw the light of day.


In my unpublished letter to AsiaWeek of December 1989 I mentioned about the first ever San Baw memorial prize awarded to a Burmese physiologist (Dr Phyu Phyu Aung) and three others for their research concerning the effects of “Chronic Respiratory Diseases Arising from Exposure to Tobacco Dust” in the cigarette (I have difficulty spelling “cigarette” and have to respell it three times; perhaps a traumatic “thought block”) factories of Rangoon. Again, taking my father’s “fatal attraction” and exposure to cigarettes it’s ironic, isn’t it?


This another first in Burmese medical history (the first time a private medical research award was being given) was not reported in the  newspapers though they routinely published photographs of middle school kids receiving one award or the other. And of course it never reached the pages of AsiaWeek or any other international publications though Asiaweek had mentioned in its pages (with photographs) of say Datuk Rafidah Aziz,  daughter graduating from the Law Faculty of the University of Malaya (where I once taught) and what Professor Ungku Aziz, did in his spare time after his retirement as the Vice Chancellor of the University of Malaya in the “People’s section” of the magazine.


An account of that little ceremony of the giving away of the first San Baw memorial prize in the Mandalay Upper Burma (Myanmar) Medical Association on Christmas Day 1989  was published in a magazine Mahaythi in its February 1990 edition. Even then this tribute by the veteran Burmese author the late Ludu Daw Amar (1915-2008)  had to take a “back place” in the magazine in terms of format and prominence to such epochal events like a  film artiste return to Burma  from abroad. 


When in about 1993 I submitted a translation of that article by Ludu Daw Amar to one of the English newspapers in Malaysia the Editor told me to write my personal feelings about my father and how it was like to be a son of a “person who had done all these wonderful things”.


I should add that the second San Baw memorial prize was awarded in November 1995 in Mandalay to Dr San San Myint (main author, Dr San San Myint is currently working with the World Health Organization in Zambia) and three others for their research paper on ‘Task Analysis of Midwives’. The Burmese language newspaper Kyemon carried a short news item about my father’s memorial prize being awarded to Dr San San Myint. I understand that the magazine Aarawjan also published an account of the 1995 2nd San Baw memorial prize some time in early 1996.


The 3rd San Baw memorial prize has been awarded some time in early 1997. When the trust fund for my father’s prize was established in 1985 it was supposed to be a yearly event but due to paucity of quality papers this has not been possible.


From about the late 1990s instead of awarding Dr. San Baw memorial prize the Dr. San Baw memorial fund has been used to compile and annotate Master of Medical Science theses that were submitted at Institutes of Medicine in Burma. I understand that there has been some research funding towards the project of compiling medical theses from the United Nations Educational Scientific and Cultural Organization (UNESCO). When I was at the University of Pennsylvania in March 2010 I have after some efforts able to retrieve for inspection a bound copy of my late father’s Masters thesis entitled ‘A Radiographic and Microscopic Correlative Study of Avascular Necrosis in the Femoral Head in Dogs’ submitted around late 1957. One of the librarians of the University very kindly send me a PDF version of my late father’s thesis to me in an e mail attachment but the attachment did not include about ten photos in the thesis. When I was at the University of Pennsylvania library I have photocopied them though the original photos can only be found in my father’s thesis. In this age of the world wide web I discovered the title and basic details of my late father’s Medical thesis. I also download my father’s  full paper on pseudarthroses and the abstract of the ivory prostheses paper that were published in the 1975 and 1970 editions of the Journal of Bone and Joint Surgery. I suppose there might have been, in the past,  an audio tape of my father’s presentation at the British orthopaedic association conference in 1969 and also the interview with the Voice of America but even in this internet age they are almost certainly not retrievable or even traceable now.  


But back to how it is like to personally live with my father who has done “all those wonderful things”. As a matter of fact, I didn’t have much time to spend with my father. When I was about four months old both my parents went abroad for their post graduate medical studies. They came back to the country when I was about four years old. I did have the chance to stay with them fairly continuously till about 16 when I finished High School and have to go to (then) Rangoon University for 5 years of study in law. We resided in Mandalay and at that time only Rangoon Arts and Science University 400 miles down south from Mandalay have a Law Department. So for my five  years at Rangoon University I had had the chance to stay with my parents during the summer holidays which lasted less than three months.


The year I graduated from Rangoon University my father had to transfer to Rangoon from Mandalay. I stayed most of the time in Mandalay and only occasionally I visited my father in Rangoon. When I went to Australia for my post-graduate studies in law my father sent some letters to his friends in Australia. (He made a good number of doctor and non-doctor friends during his three months tour of the hospitals and orthopaedic centres in the major cities of Australia. I am told that it was in Australia that my father was dubbed the “ivory prince” by his colleagues.) It saddened me a lot when I later learnt from one of his friends whom he wrote that my father mentioned in his letter that he did not expect or was not fully confident to see me again.


As it was he was nearly right. He had the chance to see me -his only child-at our house in Mandalay only a few days before he died on December 7, 1984. ( The reasons why I came back to the country  from abroad only a few days before my father’s death is too complicated and  traumatic for me to mention  here and I must relegate it, if at all, to another time.) He did recognise me but was unable to speak except to complain about pain. His illness from cancer lasted barely 6 months and his suffering of pain -at least I hope- did not last too long. But memories of Daddy came back to me time and again and in times of hardship which I had gone through after my father’s death. During those difficult times it was the memory and example of his goodness which had sustained me.


My father was a kind, humane man with empathetic feelings of other’s sufferings and an unpretentious graciousness. Perhaps three random personal examples will suffice. Although he could and was firm with me at times he occasionally praised me as having an “ability to write which is better than both of us (he and my mother)”. Alas, how “infinitesimally little” (to paraphrase the words of Professor Dr. Jalaluddin  Hla Khine at the Department of Anatomy of International Islamic University in Kuantan Malaysia when he wrote about my father in The  Guardian  newspaper in Burma of 18 June 1977) I had achieved, compared to him. He has already established himself as a pioneer of  ivory prostheses when he was my age while yours truly both embarrassingly and unashamedly live in “his shadow” and get sustenance from it.


My father once told me that while he was in Malaysia in January 1976 he had the chance to read the quotations of U Thant, our fellow countryman and distinguished former Secretary-General of the United Nations. Excerpts from U Thant’s speech was apparently inscribed in marble at a certain Malaysian institution whose name I do not recall. He said he was virtually moved to tears by the honour a foreign country had bestowed on a fellow countryman. In fact he actually showed me the messages of U Thant that he had copied in his hand writing from the inscription.


April 1975. The North Vietnamese were about to overrun the South. Radio and newspaper reports chronicled the dying stages of then Indo-China war and the human and other costs of the carnage. I clearly remember my father intensely saying a wish, if you will a prayer. “May the sufferings of the Vietnamese people soon end”.


I now conclude with an “apologia”. On 24 September 1990 when my letter about my father’s work with ivory prostheses was published in the letters column of the New Straits Times (NST) in Malaysia a colleague at work  at the Faculty of Law, University of Malaya mentioned about the letter in front of another colleague who then enquired what it was about that I wrote in the NST.


When I briefly explained to the colleague who had not read my letter that – who had,  I understand had passed away- it was about my father, the first colleague (who had also passed away) teasingly, perhaps just a tiny bit ironically but I am sure or at least I trust without malice said “If it is not the mother, it is the father” (i.e. in relation to my talks and writings about them). Indeed. Isn’t there an ancient exhortation to “honour thy father and thy mother”? I cannot hope to pay full tribute or do justice to my father’s achievements and qualities no matter what my “writing abilities” are and regardless of the (non)limitations of space. But I sure am proud to be the son of such a wonderful father.    




Dr. Myint Zan

Associate Professor

School of Law

Multimedia University

Malacca Malaysia

E mail myintzan@yahoo.com.au          





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