Fresh from the memories of my visit to Washington D.C. for the FIGO 16^th World Congress in Obstetrics and Gynecology from 4 to 9 September 2000, I marveled at the superb collection of books by Thomas Jefferson (1743-1826), held now in the Library of Congress, Washington D.C. Thomas Jefferson was the third President of USA (1801-1809) who was reputed to have read all the English books and works published in the world in his times. I wonder whether I could easily find another person who could indeed have his whole collection of books preserved intact posthumously (without public aid) during this modern era. I needed not look far.

Soon after with much serendipity, during my visit to Manila, Philippines for the 11^th Congress of FAOPS (Federation of Asia-Oceania Perinatal Societies) from 2 to 6 October 2000, I stumble upon such a treasure. This was during a chance private dinner invitation by Congress colleagues to the ancestral home of the late Dr Alejandro R Legarda, an obstetrics and gynecology professor, in the immediate outskirts of the Presidential Palace of Malacanang. I was treated not only to sumptuous fine dining but also to an interesting experience of his rich and varied life, re-living one of Manila's most elegant eras, complete with the heirloom recipes, doting staff, and family collections of china, glassware and silverware and a house filled with priceless works of art, books and memorabilia.

Built in 1937 by Filomena Roces vda de Legarda, the Legarda house was one of the first Art Deco Houses built in Metro Manila. It is located at 315, San Rafael Street, San Miguel, Manila. This neighborhood was once Manila's most elegant district. In this house, Alejandro Legarda (son of Filomena Roces Legarda) lived with his wife Ramona Hernandez (Tita Moning) and also raised four children to practice the noblest profession he knew - Medicine.

Alejandro Legarda Sr., M.D (1902-1993) was a Professor in the Department of Obstetrics and Gynecology, College of Medicine and Surgery at the University of Santo Tomas, Manila (the oldest existing university in Asia, founded in 1611 and probably the largest Catholic university in the world located in one campus).₁ He was a respected OB-Gynecologist, avid photographer, and accomplished Ham Radio Operator. He was a devoted husband, father, and grandfather. He treated soldiers from both the American and Japanese sides during the war. Dr Legarda was a man who has lived though turbulent times in Philippines (under the control of Spanish, American, Japanese, American and then the local Philippines authorities) and he was the president of the Philippines Association of Obstetrics and Gynecology in 1964.

What could be found inside the house was an impressive collection of medical books including books relating to OBGYN for the past century. The books in his library were truly an eye opener and gave an insight to the learned qualities of this man. Besides journals and examination notes, a quick scan in the bookshelf revealed many books in obstetrics and gynecology, some of which are listed in Table 1. There were the Spanish, American and British OBGYN books. It was interesting to note in a receipt that some recent books were acquired by him from a cooperative with a sum of 15 to 25 pesos. His books (with an occasional British one towards the later part of the century) showed the predominant influence on American OBGYN practice on him and Filipino OBGYN practice. This was in contrast to the practice at my hospital - the KK Women's and Children's Hospital, Singapore (formerly the world's busiest maternity hospital in the 1950s to 1970s) where the predominant influence was British, understandably so as Singapore was Britain's former colony (1819 to 1963). The first OBGYN (or O&G in Singaporean lingo) professor in Singapore (1922 to 1948) was Prof JS English (1890-1971) who was an Irish and a past Assistant Master (1919-1921) of Rotunda Hospital (the Dublin Lying-in Hospital). On the other hand, Singapore's second O&G professor (1948 to 1960), Prof BH Sheares (1907-1981) was a local Eurasian Catholic, who although trained in the British school of O&G and personally taught by Prof English, was more inclined towards American school of OBGYN in his later practice.₂

Table 1: Some OBGYN Books & Monographs in Library of Ancestral Home of Dr Alejandro Legarda

1. Tratado de Obstetricia. G Lepage. Madrid 1904.

2. Gynecology. William P Graves AB, MD, FACS. Professor of Gynecology at Harvard. WB Saunders Company. Philadelphia 1924.

3. Apuntes de Obstetricia. Ramon Lopez Flores. Universidad de Santo Tomas. Philippines 1925.

4. Tratado de Obstetricia. A Ribemonte-Dessaingnes. Madrid 1929.

5. Diagnostico y Diagnostico Diferencial de las Afecciones Ginecologicas. Walter Benthin Konigsberg 1932.

6. Gynecology and Obstetrics edited by Carl Henry Davis. Marquette University of Medicine. N.F. Prior Company Inc. Hayestown Maryland 1934.

7. Gynaecological Operations. J Lyle Cameron. Oxford Press. London 1941.

8. Tratado de Ginecologia. Jean Louis Faure and Armand Siredeo. Madrid 1943.

9. The Mechanics of Obstetrics. Noris W Vaux MD and Marto A Castall AB, MD, FACS. Philadelphia 1945.

10. Control of Pain in Childbirth. Cliffort B Lull & Robert A Hingson. JB Lippincott Company, Philadelphia 1948.

11. William Obstetrics. Nicholson J Eastman. 1950.

12. Modern Trends in Obstetrics and Gynaecology. Kennet Bowes Liverpool 1950.

13. Principles and Practice of Obstetrics. Joseph B Deelee. JP Greenhill, London and Philadelphia. 1951.

14. A Textbook of Gynaecological Surgery. Victor Bonney. Cassell & Company Ltd London 1952.

15. Transactions of Fifth American Congress on Obstetrics and Gynecology. Supplement Issue of American Journal of Obstetrics and Gynecology 1952.

16. Clinical Obstetrics. Cliffort B Lull and Robert A Kimbrough. Pennsylvania 1953.

17. An Atlas of Pelvic Operation. Yangdon Parsons MD and Howard Ulfelder MD. WB Saunders Philadelphia 1953.

18. Surgical Treatment of Cancer of Cervix edited by Joe V Meig. Harvard. New York 1954.

19. Year Book of Obstetrics & Gynecology. 1954-55.

20. British Obstetric and Gynecological Practice edited by Sir Eardley Holland MD Lond, FRCP, FRCS, FRCOG and Aleck Boure. William Heinemann Medical Book Ltd London 1955.

21. Forceps Deliveries. Edward H Deuren MD FACS 1955.

22. Examination Note-Book. The Catholic University of the Philippines. University of Santo Tomas 1956.

23. Operaciones Ginecologicas. Heinrich Martius. Barcelona 1964

(Note: this article and this list were compiled from memories and quick note taking while visiting the Library and the spelling of names may not be very exact.)

In one of the library's older book from a Catholic University in USA, (Gynecology and Obstetrics edited by Carl Henry Davis of Marquette University of Medicine, 1934), the chapter on Peritoneoscopy by John Ruddock MD FACP, proved to be noteworthy. “0.016gm of morphine and local infiltration with novocaine” was used for the procedure. It was described that Peritoneoscopy, “the endoscopic method of examining body cavity, has hardly met with a clinical mishap which could serve as a hindrance to its acceptance.” Various names of this procedure had been mentioned: Coelioscopy (Kelling 1901), Ventroscopy (Van Ott 1901), Laparoscopy (Jacobaeus 1911), Organoscopy (Bernheim 1911), Peritoneoscopy (Orndoff 1920, Ruddock 1934), and Abdominoscopy, Celoscopy, Splanchnoscopy (Medical Dictionary, Steiner 1924).

I thought Dr Legarda was a firm believer and facilitator of CME (Continuing Medical Education) as evident from the 1979 ACOG colposcopy course book still being acquired a decade after he retired from active duties in the University Hospital of Santo Tomas (after 41 years of service from 1928 – 1969). Displayed prominently at his clinic desk were 2 important pioneer monographs – “Sonar in Obstetrics & Gynecology” by Ian Donald in Year Book of Obstetric and Gynecology 1967-1968 and “Colposcopy” by Hans Hinselmann with a contribution on Colpophotography by Albreit Schmidt 1954. In this new millennium, Laparoscopy (pioneered by HC Jacobaeus 1911 and popularized by PC Steptoe in 1967) and Colposcopy (pioneered by Hans Hinselmann 1924), has transformed, and Ultrasound (pioneered by Ian Donald 1958) has revolutionized, the practice of Obstetrics and Gynecology worldwide.₃ Dr Legarda was a pioneer in using the ultrasound and doppler machine at University of Santo Tomas Hospital. He had also donated his colposcopy machine to the College of Medicine, Dept of OB-GYN, University of Santo Tomas when he retired from academic practice.

The clinic archives (he ran his clinic at home) were amazing and amazingly intact. There was a full skeleton set hanging which was dug up by himself from the ground, as the custom then was for all medical students to acquire their specimen themselves for study. I came across and felt for the first time several boxed glass specimens of “Vaginal Pipette for the Papanicolaou Stain Technic (Ayre's Modification), an early way to collect cells for Pap smear, pioneered by GN Papanicolaou in 1941.₄ (see Fig 1). Amongst his collection of instruments and gadgets for his practice included the full examining table, various forceps, pathology specimens, radiology practice instruments & charts (including an X-ray machine) and a circumcision set.

Figure 1

Figure 1: Vaginal Pipette for the Papanicolaou Stain Technique (Ayre's Modification)

During the post-dinner tour, the rich life of Dr Legarda became vivid. He was an avid radio-ham operator making friends with people in the early morning those days. He ‘traveled the world' meeting new friends he spoke with on the radio. I wonder how he would have behaved in the world of Internet if he was born half a century later. In any case, it was a poignant reminder for myself, how exciting it was to explore new frontiers during the heydays of early Internet from 1995 to 1998, when I was one of the pioneers who created OBGYN websites and discussion groups.₅

Dr Legarda's granddaughter, Suzette Legarda Montinola, had not only kept faithful until now this obstetrician and gynecologist's last words of “not to sell the house”, but had also left untouched the books in his library, preserving the whole collection for more than a decade now. Dr Legarda's wife, Tita Moning was fond of throwing grandiose parties where her culinary skills and perfection as a hostess became known all over Metro Manila. The Legarda house housed “La Cocina de Tita Moning” since 1999, a special restaurant where one can only dine with reservations and which showcased the family recipes and the past elegant way of life in Manila. The website of the “La Cocina de Tita Moning”, http://www.lacocinadetitamoning.com which included accounts of the Legarda house and family₆ is informative and interesting.

Correspondence to

Dr Kelvin Tan Senior Consultant & Head Perinatal Audit and Epidemiology, Department of Maternal Fetal Medicine Division of Obstetrics & Gynaecology, KK Women's & Children's Hospital 100 Bukit Timah Road, Singapore 229899 Email: kh@tan.net