The Life Story of Dr. Ronald Grant MA MD FRCGP

Born: Carlisle, 30th November 1919
Died: Isle of Arran, 10th July 2007

Written at the suggestion of his younger son, Simon Grant.

© 2002 – 2011


See the index of works and memories.


Index (clickable)


Born 30.11.1919, 4 Wilfred Street Carlisle. (Now a solicitors' office.) First child of Dr George Osmond Grant (24 April 1893) and Dr Jessie Napier Robertson Grant (3 August 1895).

Two early childhood memories; age about 2, being carried from parents bedroom to my own wrapped in an eiderdown (I must have been suffering some minor illness). Age nearer 3; feeling very big and important when given the task of taking my baby brother's bottle and cooling it under the tap in the bathroom. I am also told that, at that age, I knew my way to the railway station to see the chuff-chuffs, and would stand up in my pram at the top of Warwick Road and scream until taken the right way.

Moved to 86 Warwick Road (now a Chinese restaurant) about age 4 to 5 and shortly after started school in the kindergarten department of the Red Gables in Portland Square. This was a girls school which took boys in the kindergarten and first form. Two contemporaries I remember were David Caird, son of a Carlisle surgeon and Pat Semple (subsequently Rickerby), daughter of the local MOH (Medical Officer of Health). Mother being a bit of a snob, I was not allowed to play with any but the carefully selected, so life was a bit lonely with very limited friends. Minor embarrassments at school included trying to tie my shoe laces and going to the loo unaided. Sex education was non-existent, but I think one of our teachers once found us discovering, in all innocence, that some of us had tails where others had a crease.

At Warwick Road I showed an early mathematical interest in that the number of ducks, hens or rabbits on the nursery wallpaper were all counted this must have continued at Red Gables where it became clear that science and maths, which we called "number" were of more interest to me than literature. I still treasure a "Prize for Effort Kindergarten 1925–6" in a special leather binding with the badge of the school in gold lettering. The title was Parables from Nature by Mrs Gatty; I have never read it!

The children of the professionals were nearly all sent off to boarding school in those days, so at the age of 8 I was packed off to a small prep school in Silloth; only 11 pupils, I think, run by a man called Fisher. Insufficient numbers foiled any attempt at the usual ball games and the standard school sport was golf on the quite well renowned course at Silloth. That only lasted two terms when the school closed. All, or nearly all, the boys there went to Seascale Prep School, with much of the furniture, so that particular transformation was not nearly so traumatic as others before and since. My parents were not too sure about it, but went along with the idea when I pushed it.

SEASCALE (1928–30)

Seascale Prep School was, I suppose, similar to many others at the time. I was usually top of the form in maths and a complete duffer at their brand of history, which always started with "chronological order": a list of events on the blackboard which had to be arranged in the correct order and dated; one mark for each correct place and date. Had there been a logical way of working it out I might have done better.

The school was owned and run by one Frank Burnett. I remember his occasional use of the cane and his rather ineffective attempts at sex education, but can't remember why we had a major row one day when I called in my father to tell him where he was wrong. It may have been associated with a major injustice which rankled for ages. Something had been stolen and we were all lined up and it was demanded that the culprit owned up. I was so embarrassed at the idea that anyone should accuse me of stealing that I blushed; this was taken as a sign of guilt and I got beaten for it. This may have started my parents on a hunt for a different school, so at the age of 11 I went to Strathallan School, Forgandenny, Perthshire.

STRATHALLAN (1931-33)

The major advantage, from my point of view, of Strathallan was that it had, by the standards of the time, well equipped Physics and Chemistry labs; science at Seascale having been virtually non-existent. There must have been one or two good teachers too, for I can still remember his definition of "temperature" and have a clear memory of burning a candle in a bell-jar and of Archimedes and his bridge and the consternation of an experiment gone wrong when we found that sealing wax dissolves in methylated spirits. They also had a heated internal swimming pool which would have been more valuable if there had been any instruction.

On the down side there was the agony of learning chunks of "Midsummer Night's Dream" which I was not old enough to appreciate and the music teaching: I had been doing quite well at Seascale, playing simple tunes on the piano, but the teacher at Strathallan got out Czerny book five, which may possibly have been considered good intellectual exercise, but had no catchy tunes nor any pieces I or my parents could appreciate. I dug my heels in and refused to continue. In retrospect it might have been a good idea to introduce me to wood wind or other instruments, but no such offer was made.

Coming to the age of thirteen, my parents must have thought that another change was desirable and I was given exam papers to do without knowing why. They must have had "Oundle School" on the heading, but that had been carefully torn off. Any way the end of the Christmas term I left and was sent off to Oundle in January 1934, i.e. shortly after my 14th birthday.

OUNDLE (1934-38)

Oundle was then typical of public schools at the time. One feature for which I was grateful, was that I was sent to New House under John King, who had been a master in the school since the turn of the century. He had his idiosyncrasies but was in charge of rowing, at which the school was pretty good, as there were always three or more Old Oundelians in the Oxford and Cambridge boats. The difference between New House and the other houses was that we never had any fagging. The internal discipline exercised by the more senior boys on the "new ticks" was tough. How many buttons could be left undone, at what angle you wore your straw hat or cap how you carried your books and whether you were allowed to be seen about with your hands in your pockets were all strictly enforced matters of seniority. John King rarely exercised any direct discipline but could reduce any of us to suitable humility by comment or reprimand at mealtimes. Normal everyday discipline was in the hands of the house prefects with the use of a cane (a corps swagger stick) when necessary although the common punishment was a "house mag", i.e. to produce an article or sketch for the termly house magazine. No-one could honestly say that he enjoyed his first year; I suppose in retrospect that it was a sort of brainwashing, so that one accepted the attitudes and ethic of the school.

Food was pretty awful, but edible, the gaps being filled by a visit to Joe Shutt's chippy, one pennyworth would fill most gaps; you had to be a real trencherman to eat two pennyworth. Incidentally, a penny was always referred to as a "d" and, for example two and a half pence would be called (phonetically) "two dee hay dee". I suffered somewhat from being a much better on the academic side than my age group; Oundle was then really a boarding comprehensive school with some pupils who were incredibly thick. There was quite a variety of voluntary evening pursuits and one could keep a reasonably low profile by, for example, doing gymnastics, at which I became quite proficient as a member of the winning house team on one occasion.

At games I progressed from nobody to being captain of tennis, vice-captain of hockey and of athletics, played rugger for the 2nd fifteen ... the only team that year that the first fifteen couldn't beat! I never could be bothered with cricket and missed the best let out by failing my boat test, which consisted of being dressed in old clothes and thrown into the river; I failed to swim the necessary distance and had to be fished out rather ignominiously. A visit to Germany with the hockey team as guests of the Hitler Youth was interesting and illuminating. While in Germany it was very obvious, in summer 1936, that war was on the way and Jew-baiting was part of their life. We didn't have the background knowledge or experience to know how to react.

On the academic side, I started in a form called C5B2, a lower cert. form, for my first two terms but my obvious proficiency at science (thanks to Strathallan) resulted in being elevated to Science Remove C for my second academic year, this being a higher cert. form and on the ladder to the top forms on the science side. So I never took "School Cert." (the equivalent of the subsequent O-levels and today's GCSEs). Physics Chemistry and Maths were taught at a high level in the next year in Science 6A2 where the physics master (surname) Llowarch was a powerful influence: if one used a formula to solve any problem, one could be challenged to prove it from first principles in front of the whole class, and disgraced if one couldn't. Only "engineers", on whom one was unfortunately taught to look down, used formulae without being able to prove them. Our Chemistry master was the same Palmer after whom the present laboratories are named. The natural progression, the next year, was to the top science form Science 6A1 Alpha 1 where we did quite a lot of research. Among others I made a phenol-formaldehyde resin water-softener which was still being demonstrated several years later at conversazionies and learnt a little glass blowing in order to make my own apparatus to do an experiment on surface tension.

Exams and certificates... One Lower cert and three Higher certs, with a distinction in physics in my second higher cert. (must have been 1936.)

A characteristic of Oundle was the "Workshops Week", a week off academic work every term to work in the foundry, forge (apart from making pokers, one had a go at oxy-acetylene and electric arc welding and shoeing horses), wood workshops or metal workshop. I know that some of my contemporaries found these skills very valuable during the war when vital parts of machinery broke in the jungle and replacements had to be made from available materials.

As head of the house and a School Prefect in my last two terms, I wielded quite a lot of authority, so most members of New House did as they were told. I wielded a stick rarely and never hard, being afraid I might hurt too much. Nevertheless discipline was maintained partly because I had the right to inflict corporal punishment. Beating miscreants is thought by some "modern" educationalists to be degrading to the beater... I say "not so" although sadists have to be watched for and controlled.

And so to Cambridge scholarship exams in the winter term 1937 where I won an Open Exhibition; Might have been a full scholarship if I had not made a bit of a nonsense of one of the practicals. Although I was not sure about going into medicine it was thought wise to get exemption from First MB by passing the appropriate exams; my physics and chemistry were more than adequate but I had not done enough botany and zoology to get exemption from 1st M.B. Had I taken School Cert. in these subjects it would have been enough, so I had the Spring and Summer terms of 1938 to set my own special time-table and get enough into the memory to pass the Higher Certificate in Botany and Zoology.

CAMBRIDGE (1938–40)

Having no previous contacts or reason to pick one college rather than another on historical grounds, we decided to apply for Emmanuel College for the simple reason that the Master, T. Hele was a brother of a Carlisle dentist whom my father knew. On the basis of exam results there was no doubt about being accepted. I went up in October 1938. Neither parent knew anything about life at Cambridge, so finding out was a bit slow and awkward rather than painful. In those days I had no experience of self catering; dining in college was obligatory on at least five days a week and I hated the idea of running up bills; asking for money always produced frowns and knowing the cost of my younger siblings at expensive schools, I made as few demands as possible.

Being still uncertain about career prospects, apart from the fact that science would be the basis, my Tutor thought it wise to register me as a medical student, although not at that time committed to a career in medicine. Organic Chemistry had to be passed to confirm my status as a medical student, but my medical career was only firmly confirmed by the outbreak of war, when our syllabus was determined by the needs of the services. Anatomy and physiology were a hard grind, especially the Anatomy which was just a very tough memory test not amenable to reason, which would have made it more to my taste. There was little time for fun and games, although I did try to keep up with athletics and tennis. One privilege I did enjoy, as an Exhibitioner, was to spend all my time in college rather than in digs and to become a member with all other Emmanuel scientific scholars and exhibitioners of the Thomas Young Club, having regular lectures from distinguished scientists on erudite and obscure scientific subjects.

At the end of my first year I was taken by my father for a holiday with my uncle John and aunt Gwen Gray, he was the minister to what remained of the two parishes, on the island of Fetlar in Shetland. I enjoyed the island life, cutting and bringing in the peat, bird-watching, shooting rabbits (the islanders wouldn't eat them unless they were "hand-groppit") and visiting parishioners with my uncle but it wasn't to last! It was interrupted by the declaration of war and a note from my college to return there before the normal date to start my second year. I was supposed to get there two days after getting the message; obviously not possible, but I got there as soon as I could. My father had been picked up and taken off the islands a few days earlier by one of his special private patients, a Mr. Fairweather, in his private plane, and I had to get back by the normal sea route to Aberdeen. The ship was blacked out and fortunately not spotted by an enemy submarine known to be lurking in the area. I picked up our car, which we had left at Aberdeen, drove back to Carlisle, thence by train to Cambridge.

Arriving at Emmanuel, I found my rooms, in fact the whole of North Court, taken over by the RAF. Many of my contemporaries had been called up, as indeed I would have been if I had not been registered as a medical student. The whole college atmosphere changed enormously; more than half had been called up, food was rationed, so there was henceforward a set charge for all meals, to be taken in hall. The medical subjects were condensed and determined; no question of doing your own thing. The idea was to get qualified as soon as possible to be available for the forces. Qualification seemed an awfully long way ahead and I thought seriously about opting out of medicine into the forces. Had I known that a benevolent government would pay for the rest of my medical education after the war if I joined up, I might well have offered myself for training as a fighter pilot, that being the only option as an alternative to medical studies available at the time; but, in my ignorance, the idea of giving up medicine for good, and parents paying heavily when I got back was too much, so I stuck where I was, nose to the grindstone, until I passed my Tripos Part 1 and qualifying exams to go on to clinical studies at Bart's.

The gap between exams and going up to Bart's was filled partly, as a total change from academic work, by cutting down soft-woods and converting them into pit-props in or near a village outside Cambridge called Linton. Then, in the Long Vac Term, by a very good short introductory course to clinical work under Prof. Ryle, a very sound physician at Addenbrookes Hospital. Came October (1940) and I was off to clinical work proper at Bart's.

ST BARTHOLOMEW'S HOSPITAL (1940-43)

The war had been going for a year and St Bartholomew's Hospital had been divided into three parts for both medical and teaching purposes. The first clinical year was spent at Hill End Hospital, St. Albans, an old asylum from which all mental patients had been evacuated. A huge place on two floors; it took twenty minutes to walk from one end ward to the other extreme; That winter, when we woke up, we were able to see the glow of London burning from the previous night's bombing and later in the day helped to receive the sick and casualties evacuated from the main hospital in London. I particularly remember pushing one of the medical students from the year ahead of me on a stretcher down the corridor to the neurosurgical unit to deal with his nasty head injury. He had come down, involuntarily, from the roof of the West Wing of Bart's when it got a direct hit. Another staggering phenomenon (at the time) was to see a patient, brought in the previous evening with pneumonia, sitting up in bed reading a paper. All staff from consultant to raw student went along to witness the effect of a few doses of sulphonamide.

The second clinical year (October 1941–1942) was spent at the main hospital in the city. By this time the air raids were much diminished, but all students did duty as fire-watchers or as members of first aid teams. Fire watching meant knowing one's way round all the roofs with the idea that we might deal with an incendiary bomb before it did any serious damage. Fortunately I had nothing to do most of the time although I did spend at least one night watching an air raid from the top of the main ward-block. I was at other times attached to a first aid post at Unilever House (next to Blackfriars Bridge) again with nothing to do and being entertained by films in their nice little theatre in the basement. Much of our clinical work was in the casualty department, below ground level, so there were many days when one never saw daylight at all. I have very little recall of work in the wards or out-patients. One character who stood out was Dr Geoffrey Evans, a colourful character who charmed his patients and was thought by many to be a bit of a charlatan! Not so, his flamboyant attitude concealed a very astute brain. Other outstanding consultants/teachers were E.B. Strauss, a psychiatrist who seemed at the time (and also in retrospect) to have a much better ability to diagnose and treat psychological illnesses than many of today's psychiatrists; he was also a pioneer in the use of E.C.T. Sir Harold Gillies was an outstanding consultant, a pioneer plastic surgeon who taught those, including Sir Archibald MacIndoe, who did such valuable work particularly with the terribly burned Air Force pilots and crew. I was one of very few who ever went to his out-patients which were voluntary. One lesson he taught me was from his own personal experience: he was endowed with a very weak chin of which, as a schoolboy, he was ashamed and which he regularly tried to hide by holding one hand over it. This, of course made his contemporaries look to see what he was hiding and he suffered many taunts along the lines of "chinless wonder" &c. &c. It was not until he went to college that he discovered that if he ignored it nobody noticed. A lesson I have tried to pass on to many patients with minor disfigurements.

Our third clinical year (October 1942 – Summer 1943) was spent at another converted "loony-bin" Friern Barnet known to most as "Colney Hatch". (Now in the news as it has been converted into a complex of luxury flats and leisure facilities. I understand that the 600 yard straight corridor still remains!). It was not completely taken over and many of the original patients were still there under conditions which would be totally unacceptable today. Again the teaching was not memorable but must have been reasonably effective. Being miles from anywhere we had to find our own lunch which we usually had at the local "British Restaurant" ... establishments set up to provide cheap meals for the world's workers. Mostly quite tolerable but one chap came out in a rash after eating "beef" ... he was allergic to horse! During this year I had to find digs which I found in Hendon and spent many nights wondering whether to go to an official bomb shelter or just go to bed, block my ears and hope for the best. There were very few bombs in that part of London, the main hazard being the rain of chunks of anti-aircraft shell and the noise of the anti-aircraft guns.

EARLY LIFE AS A QUALIFIED DOCTOR (1943–44)

I spurned the so-called conjoint exam as a qualification and went direct for the Cambridge M.B., B.Chir. which happily I passed first time (July 1943) and went off to my first job as House-surgeon to John Hosford, a brilliant Bart's surgeon, back at Hill End in St. Albans. It was wartime, so one didn't complain about the almost incredibly hard work. Looking after seventy major surgical beds, there were just myself and John Hosford, who came in to do the operating after I had arranged the admissions, checked the diagnoses, arranged the theatre lists, cross-matched any necessary blood, made sure that the patients were fit enough ... &c., the jobs nowadays of four or five people. Then, of course, there was the care of patients after operations... I used to get to bed between one and two o'clock in the morning after night ward rounds, get up and deal with problems in the night and be apparently all bright-eyed and bushy-tailed for ward rounds the next morning. Once or twice I was so tired that I forgot I had been up in the night and asked the nurses to confirm that what I had done or ordered was sensible. There was no time off or any kind of relief at all, the only other house-surgeon was just as busy; We covered for each other for a few hours on two or three occasions, the only times we escaped from the hospital. Pay was at the rate of £120 per year, but I hardly got any chance to spend even that.

LIFE IN THE ARMY (1944–46)

My job came to a sudden end at the beginning of January 1944, three weeks prematurely, with a notice to report for army service. No exemptions or excuses accepted, it was the big call-up, about three times the normal intake, obviously with D-day in mind. A pretty ragged lot of us arrived at the depot in Crookham on Jan 8th 1944 for three weeks of lectures, drill and a few exercises, not nearly enough as it turned out... (see later)... When the next intake arrived we had difficulty in believing that we must have looked so scruffy. We had got used to uniforms and with regular feeding, had put on about a stone in weight. Then off to the Army School of Hygiene for a week, learning to make oil-and-water flash fires, how many loos and how to dig them and how many sheets of loo-paper were required per hundred men (and more for women) &c.

Then we got our postings, to all parts of the world, or so it seemed. Mine was to Northern Command, report to ADMS (Assistant Director of Medical Services) in Edinburgh and get sent on to Northern Ireland. A few weeks doing locums for other MOs in Belfast, then 306059 Lieut. R.N.R. Grant RAMC (Royal Army Medical Corps) was sent to Londonderry. Being an officer, one travelled first class. This privilege was also given to, or paid for by, the WRNS, so there on the train was an ordinary Wren, better equipped with magazines than I was, and who offered me one of her mags and struck up a conversation. I later discovered that a point of common interest was that this Wren's mother had worked in censorship alongside Elizabeth Evans, daughter of Dr Geoffrey Evans, aforementioned. We parted at Londonderry without particular thought of meeting again. My task in Londonderry was to care for the small number of troops in the area, mainly gunners and operators of the early radar, based at a CRS (Camp Reception Station), an old detached house on Limavady Road, called oddly enough "Seymour Lodge", the same name as my grandparents house on Loch Long. Under my command I had, if I remember, one NCO, two privates, two ATS (Auxiliary Territorial Service; girls in the army) drivers and three VADs (Voluntary Aid Detachment; junior nurses not sufficiently qualified to be QAs); a happy bunch with very little work to do. There being no appropriate accommodation, I lived in the Melville Hotel, was collected each morning by my ATS driver, saw the odd patient or two on sick parade, attended to the one or two patients we had in beds at the CRS (Camp Reception Station: a small unit where minor illnesses could be held and treated without being lost to their units) and later drove down to see the rest of my responsibilities at McGilligan Point. A very easy and cushy life!

The Melville was known for its steaks; some naval officers wives lived there and quite a few naval types would bring their girl friends... One evening one of them brought in a girl I had met before!! On a train!! I don't remember how I managed it, but somehow I made contact and arranged a date. We saw quite a bit of each other after that, at the hotel, the officers club, rarely at Maydown, the naval air station where this particular Wren worked. She had to keep a low profile because the naval types thought that going out with a "brown job" was tantamount to mutiny. Her twenty-first birthday party was imminent (June 2nd 1944) and we spent an hour or two in my room at the Melville making birthday cake candles from bits of wick dipped in melted ordinary candle coloured with lipstick. I was to be the honoured guest, but three days before the event, I got my orders to proceed immediately to HQ Second Army Troops at a named house in Horndean, Portsmouth. So I packed my trunk, complete with best service dress and caught the next train/boat/trains.

Normandy (1944)

Arriving at Portsmouth station I went, as was proper, to the RTO (Rail Transport Officer) and asked for transport to the address I had been given... Horror... Horror... SHHHHH... "You don't say that aloud." I have since wondered whether it was part of a deliberate deception; my orders were sent to Northern Ireland under "confidential" cover ... not even "secret", as an attempt to let the many enemy agents there think that there was little doing at that HQ. Anyway the C.O. of my new unit looked with horror at my service dress and baggage and helped me to take immediate steps to send everything home except battle dress and what I could easily carry. The unit was already packed, waterproofed and ready to go. A week later ... 6th June ... D-day ... we knew it must be from the enormous flights of planes and gliders in the early morning, we were marched down to the pier at Southsea and loaded onto an LCI (Landing Craft Infantry). We sailed across the channel in beautiful sunshine, flights of aircraft giving a marvellous display but did not actually land until the morning of June 8th. It was very noisy, quite a lot of metal was flying about at high speed, puffs of sand seemed to rise from the beach for no reason obvious to me ... "shellfire", I was told ... Warships were making a hell of a racket with their big guns... Each Officer had been allocated ten men to guide to an agreed meeting point which was fairly obvious, having seen the map, so down the gangways into hip-deep water and wade ashore. "Let's get off the shore" I said, leading my group of ten on a straight line to the agreed meeting point. They dutifully followed me, and when half way there I looked back to see them all putting their feet EXACTLY where I had put mine ... they were experienced soldiers! I was as green as grass! As we approached the village of Courseulles-sur-mer the advice to watch out for snipers did nothing for my morale. When we eventually arrived at our spot for the night we were advised to dig a trench to sleep in: we had one trenching tool between ten or so and the ground was solid rock two inches down. What a night!! one of the most uncomfortable I have ever spent.

The next day I was taken from end to end of the bit of France we were occupying and saw, for the first time the sort of problems presented in organising the emergency treatment and evacuation of casualties. It was a tough initiation into the blood and death and fear and pain that go with war on that scale. There were two of us, spare medical officers; looking back I can see that our probable destination was to run the first two static MI (Medical Inspection) rooms (i.e. G.P.-type surgeries), one for each of the proposed roadheads where stores would be held for onward distribution. No. 1 Roadhead never developed, as we didn't push the German army far enough back at the Eastern end of the front; there was a bit of a panic about D+4 or 5 when the German advance at the eastern end might have pushed us back into the sea. I don't know where the other spare MO ended up, but my task was to run The MI room for No. 2 Roadhead. So I was parked in a run-down one-room cottage in St. Sulpice with minimum supplies and a cockney window cleaner as my orderly and general factotum, put up the painted notice outside with a bold red cross and the words M.I.ROOM. Supplies of food &c. were very handy, the appropriate supply dump being just across the road. The standard unit was a 14 man/day "compo", the one with the steak and kidney pudding being the most popular, it also contained a tin of fifty cigarettes, the not-so-nice item being "trinity tea", a mixture of tea-leaves, milk powder and sugar. With a bit of sweet talk to the supply officer across the road I managed to get proper tea, sugar and milk; my MI room was soon known as the only place where you could get a decent cup of tea. There was little to do for the first few days, but my responsibilities built up from about 500 to about 10,000 by the end of the month. A van and driver were added to my establishment after the first few days, which made it easier to get supplies in and to take the unfit to a nearby field hospital for evacuation to U.K.

In spite of declaring that I had no language skills, my days consisted of seeing the British first then attending to the needs of the local French, then going to a POW cage nearer Bayeux and conducting a surgery in German. Some local interest arose when the farmer's wife, across the road, went into labour and I was asked to help. As is normal on these occasions, I got a certain amount of credit and a few doses of rather rough Calvados for being there to supervise the birth of a little girl. It was about ten days before an old bath was rigged up in a canvas shelter in the farmer's land; marvellous to be wet all over and properly clean! At about the same time other luxuries appeared in the shape of a radio and the odd bottle of whisky. You don't realise how much music means until deprived of it for a few weeks.

Up to the front

It was fairly clear by the end of the month that we were there to stay and that my job had become too big. So about half a dozen MOs attached to new units arriving in the area took over my duties and I was sent up to the sharp end to join the 179 Field Ambulance attached to the 11th Armoured division. In Army terms, a Field Ambulance was not just a vehicle, it consisted of two large wagons which could be opened out to form treatment centres, several ambulances and sundry other trucks and jeeps; its function being to collect the sick and injured from the battalions, treat as necessary and send them on to other units as appropriate. It was a good unit:- we were always right up at the front, just behind the leading battalion. I lived and travelled in an Austin four-stretcher ambulance converted into an MI room or doctor's surgery, so that first aid or medical assistance was always immediately available while the rest of the unit opened up to receive casualties. And so it remained all the way through the "Bocage" (known to us as the dead-cow country from the number of beasts remaining un-buried after treading on mines), the Falaise Gap, Amiens, Roubaix and, well ahead of the news we could hear on the radio, to Antwerp. It really was a mad dash; not much rest or sleep; one thing gave us satisfaction was cutting off the German troops in the Calais area who were sending their nasty V1s to London.

Anecdotes on the way... A German Officer with one leg shot off below the knee... I approached with a pint of blood... " Is that English blood?" "yes" "Well I don't want it" "You'll die if you don't get it" And he did. And on a lighter note... Approach by a French civilian with an appeal for help for a French girl in a nearby village who had been injured by a mine or a shell; my immediate-aid-ambulance was available and there was little else doing, so off I go with the Frenchman as guide; we passed sappers marking mine-free areas with white tape; then nobody and no tape; Then down a side road to the house with the injured girl ... "funny uniforms they wear here!!" The German soldiers took no notice while we took our casualty back.

I don't remember much about Antwerp, most of which fell with very few casualties. there was still some enemy activity round the railway station but I was not involved and just enjoyed (relatively) the rest. The Eleventh Armoured Division, having done great things from Normandy to Antwerp, then went into less dramatic mode, and guarded the Eastern flank of the push into Holland, we were not involved in the disastrous efforts to take the bridge at Arnhem. From a personal point of view, I was sent up to a battalion to replace immediately an RMO (Regimental Medical Officer) who had been wounded, while they made up their minds who was going to get the permanent job. That had its moments on the way to and in a little village called Veulen, when a farm used as an ammunition dump got a direct hit; A beautiful firework display, had it not been so serious. And another when walking with the Padre to Battalion HQ in the dark. Having played "Who goes there" as silly home games, I was inclined to ignore such a request in the dark until the Padre said loudly "For God's sake stop, you bloody idiot".

Having decided that I was not getting the RMO job (doctor to a battalion, working in his RAP (Regimental Aid Post)) and my place in the Field Ambulance having been filled, I was sent a little further back to the brigade FDS (Field Dressing Station: rather like a CRS but more mobile,) in Helmond. This was in a dance hall with about fifty stretchers on the floor, where we could keep and treat minor illnesses, so that they were not lost to their battalion, as they would have been, if sent further back. Here I learnt the lesson that it is sometimes wise to be economical with the truth: following the official procedure in minor cases of dysentery was more trouble than it was worth, so one treated but didn't report!

Back to LofC (Lines of Communication i.e. away from the sharp end)

Life in the FDS was complicated by my lack of respect for the CO and his second-in command, which became a little too obvious on one occasion. I was sent for a weekend leave in Paris ... very nice, but when I got back I had been posted right back to a rear medical unit near Caen from which I went to run a CRS in Brionne in a nice looking little chateau.

Two more anecdotes... I sent a fairly obvious case of diphtheria to the nearest proper hospital, which was an American one in Rouen, hoping that they would confirm my diagnosis by taking a throat-swab. They must never have seen diphtheria, for enquiry a few days later found my patient still in an open ward; all sorts of tests done, as is the American way, but no throat-swab! Second anecdote... Asked by the local French doctor to see his young daughter with a chest infection, I suggested, as politely as possible, that sulphonamides were much more effective if given by mouth rather than the way the French seem to prefer. As a reward I was treated to a most memorable dinner in the doctor's house; all the Normandy specialities and appropriate wines taking about four hours. Christmas 1944 was pretty cold, but we had among our patients a railway operating group with as much coal as we needed The Christmas dinner was served in the Roman (?Saturnalia) style with the officers waiting on the other ranks.

Return to the sharp end (1945)

I had a short UK leave from Normandy, during which I must have looked up my Wren friend and popped the question. When I got back I found that they reckoned they couldn't do without me at the sharp end of the affair and I was sent up to 43 Div. (January or February 1945). Can't remember where I joined them, it must have been in Holland, probably near Venraij, a bit east of, but not so very far from where I had last been with the 11th Armoured Div.. Our Artillery had been as careful as possible not to do too much damage to Dutch property, so the difference when we crossed the border into Germany was awful; Cleves and Goch were a frightful mess; there must have been people still living there, but they obviously kept out of sight.

Preparations were well under way for the next big step... Crossing the Rhine. We couldn't see much of the first to cross, small boats and swimming tanks! and some very brave chaps building the necessary bridges. We were lined up in a long traffic queue waiting overnight for the first Class 40 bridge to become usable at Wesel. That was another quite unforgettable day. Travelling as usual in my canvas-sided Austin four-stretcher ambulance while practically everyone else was protected by armour plate at the sides, if not the top as well, we came to a sudden halt while I was in the middle of the Rhine on this flimsy pontoon bridge. There was a fine but dangerous firework display at the exit from the bridge, where an ammunition-carrying truck had been hit. Some air-burst shells were going off above our heads: there was nowhere safe to hide in or around my vehicle, but then air-burst is more spectacular than dangerous. A general movement-in-haste – I couldn't really call it panic – ensued as the trucks behind me were backed off the bridge but I was not told until we were safely off that the truck immediately behind me was also full of ammunition.

By this time it was quite obvious that the Germans were losing. Terror tactics were used to hurry them up. If any sniping was seen from any house, a flame-thrower was called up to burn it down. We had had a short lesson in a nearby field where these flame-throwers would rush almost straight at us, spitting out their nasty stuff, over which we walked with impunity immediately after. As ways of burning down houses they were very good, but more frightening than dangerous to troops.

The rest of the war was comparatively dull... There was a minor incident when I was seconded for a fortnight to give medical care to a group of 5.5in. guns and was sent to visit a troop where there was said to be a casualty. My driver missed the road and I found myself, once again, looking at "funny uniforms". After a rapid about turn, we shortly met one of the officers chasing us to try to catch us before we got too far into enemy territory.

Cease fire and after (1945–46)

We were in a wood, somewhere between Bremen and Hamburg, when the cease fire was declared. Oddly enough, I had seen and described the exact location in a dream about three weeks before! but that is quite another story. Back to normal G.P. type work again, there being no further need for coping with battle casualties, I was sent off to be RMO to the 7th Battalion the Hampshire Regiment in Winsen, then with them for a short stint on the bank of the Elbe, while the powers that be were sorting out the boundaries of responsibility of the Russians, the French, the Americans and ourselves. There was one village where I had to take medical charge of about ten thousand assorted German POWs getting orders to send (e.g.) two surgeons to one place or three physicians to another. I got particular satisfaction from sending for very senior German officers and ordering them to dig and use proper latrines! Then to Soltau; this was very near the concentration camp of Belsen where I saw, apart from piles of bodies, quite a number of the emaciated, newly released prisoners, both at the camp and walking about the town in small groups. Help was being organised on a grand scale, and there was clearly nothing useful for me to do in that context.

The war being over, we could employ German civilians to work in the officers mess and elsewhere; in particular, we had a manager from some hotel in Hamburg looking after our food in the mess, which had the advantage of much "liberated" wines and spirits, and very good too; I was impressed with wild boar as good to eat, although I could not easily accept the hunting methods used, chasing with a Bren-carrier! There was an occasion when our German mess-manager asked me to interpret some of the words used by the troops. In our unit the universally applied adjective for all nouns and some verbs was "f-----g"; he wanted to know what it meant. I explained its basic meaning, adding that its main function in an army context was as a general-purpose, more or less meaningless, qualification of nouns and verbs for those of limited vocabulary. We also had a German riding master and an indoor ring and outdoor jumps and quite a few horses to ride. The troops, as one might expect, made friends with the local "talent" and venereal disease soon became a major medical problem. Our way of dealing with this was to send for the military police who took the patient, with his consent, and sometimes a little persuasion, to find the girl and get them both treated with penicillin, which had become freely available for us to use, but which was not available otherwise to treat German civilians. Under those conditions, the German girls were quite happy to get proper treatment and the infections were reasonably contained. The time passed and our next move was to Berlin.

The route to Berlin was through Russian-held territory. We were not very popular with the Russians, who caused quite deliberate snags and delays on the way. Our unit took over Spandau barracks. It was either in the compound or a nearby prison that Rudolph Hess spent his remaining years at vast expense to the British Government. Life in Berlin was more or less one long party. It was the custom for units new to Berlin to throw a major party for those already there, which we did, with free wines and cabaret. The expense was high by any standard, and had to be met by the officers. It was the time when cigarettes were the true currency; they could be bought for five or six marks for twenty, and sold easily, usually via one's batman, for ten marks each. We were told that no questions would be asked as to where the marks came from when we paid our share of the bill for the party ... even the padre sold a few cigarettes to pay his share. That bonanza soon ended when BAFSVs (British Armed Forces Special Vouchers; bank notes for use of the services) were introduced, but it was fun while it lasted. Our officers mess in Spandau had a very fine large carpet, which the previous unit (can't remember who they were) had taken from Hitler's Chancellery. They had laid on a plan with military precision and suitable diversions to get it out under the very noses of the Russians. Medical work there was not arduous, the battle against venereal disease being the main problem; a tin of bully beef or a packet of cigarettes would buy the services of almost any girl around.

In the background, one part of the war being over, one couldn't forget that the Japanese had still to be dealt with and the thought of an invasion of mainland Japan against an enemy who was capable of putting up suicidal resistance was daunting, to say the least. I was, in fact offered an immediate promotion to Major if I volunteered for the Paratroops or the Airborne which I declined. The fact that our unit would be next in line for training for the Japanese theatre was quite enough.

Coming home on leave from Berlin was quite a strain, with a 36-hour train journey, including an alarming slow crossing of the Rhine on a high level bridge, newly constructed, where looking out of the window on either side, all you could see was the river a long way down. I find it difficult to line up events at home with military affairs, but by elimination, this must have been the leave when I got married. August 8th 1945. Two days later we wondered why all the flags were flying and what was meant by newspaper placards with the single announcement A-BOMB. A day or so later the Japanese surrender was announced and all the dread of an invasion of Japan vanished. The atom bombs may have killed an awful lot of Japanese, but I have no doubt that an invasion of mainland Japan would have cost ten times the casualties and I would have been very lucky to escape being one of them.

Back to Berlin, then the unit was broken up and I spent the rest of my military service in the British Military Hospital in Hamburg. Genuine hospital work, a few months running the casualty department treating everything you could think of including one man who was rushed to me having gone blind after drinking reputed anti-freeze liquid. I gave him an immediate dose of apomorphine ... poor chap spent the next while vomiting his insides up ... but the next day his sight gradually came back and all was forgiven. Then I had a spell of several months as assistant to the Orthopaedic Surgeon, ours was the only British orthopaedic unit in Germany, and as we sent all the potential long-term cases back to U.K. as soon as they were fit to go, it was hard work but intellectually and educationally rewarding. Somewhere in the middle of work in Hamburg I managed to get leave and arranged a delayed honeymoon in Switzerland, meeting my new wife in the Gare-du-Nord in Paris and after enjoying the journey and the time in Switzerland, waved her off onto the boat in Calais and made my way back to Hamburg and was eventually de-mobbed in December 1946.

LIVING IN LONDON

There being hundreds of de-mobbed doctors looking for jobs and further training, the government had arranged many posts as supernumerary registrars to most of the specialities. Having developed an interest in dermatology in student days under A.C. Roxburgh, I applied for and got a appointment as supernumerary registrar in dermatology at Bart's, the department then being in charge of R.M.B. McKenna and Brian Russell. Meanwhile, I had to find somewhere to live and invoked the help of Peter and Janet Ewen: Janet Ewen was the younger daughter of David Allen, a cousin of my maternal grandfather, whose flat in London my mother had long envied. The Ewens were very helpful in providing temporary lodgings while I looked around. I had made contact with them previously in my student days when they lived in Reynold's Close and much appreciated their generous hospitality in occasionally giving me a decent meal in a nice stable home as distinct from student life and lodgings. They then lived in Northgate, Regents Park and knew that a Mrs. Scott, widow of the famous editor C.P. Scott of the Guardian, who had a house in Reynold's Close, very near their previous home, had an attic flat in her house available to rent. I was very fortunate to find somewhere to live so quickly and easily and we moved into our first married home soon after. We only had one bed and a camp bed to start with but by begging and borrowing it became quite habitable by standards of the time. We stayed there for most of 1947 but with Adrian on the way a move was needed. Mrs Scott was really very tolerant, but for argument's sake to help us to get housed, she agreed to be referred to as a nasty landlady who insisted that we left. Having no residential qualifications to claim accommodation in any London Borough, we heard that there was a scheme for those who needed re-housing, where both parties had been in the forces; following this up we were granted a lease of rather a nice flat in a converted house in Templewood Avenue, a very up-stage part of Hampstead. Adrian's birth in the Maternity Unit of Bart's (December 1947) can't have been very long after we moved in. There we lived happily with my parents' old Morris Ten while working up my thesis and practising in so many hospitals until Fiona was on the way, when more room was going to be needed. Being already in a council flat, I could easily apply for a move, which we eventually got to Ferncroft Avenue. It was a race between the change of flat and Fiona's arrival (December 1950); Granny Gray had to appear quickly one day to take Adrian to Chester while Fiona was being born in the Royal Northern Hospital and I was moving house. It was a bit of a shambles, but I managed to get it together sufficiently to get wife and new daughter into our new home and later to re-unite Adrian with them.

WORK IN LONDON (1947–51)

Learning dermatology then was quite different from today ... there was no health service, Bart's was a hospital for the sick poor, anyone with more than an artisan's income would be shown a list of specialists and invited to designate which he would agree to see privately; so few patients had a G.P. and most would continue to attend the Out-Patients dept. until they got better. As one of the most junior, along with the house-physician, it was my job to attend to all old patients, male one day and female the next time. New patients became "old patients" on their next visit, so one had an ever increasing number to see until one managed to cure them at a rate comparable to the rate at which they came. It was a tough school; there were no steroid creams to make life easier, the rest of the staff had little sympathy, so one could be at it from the morning session, well into the afternoon. There was no significant science in dermatology (not that there is now, although the present generation think they know better), so one learnt the art of curing skin troubles with general advice, diagnosis and weird and wonderful creams, pastes and lotions. We could, of course, ask our seniors for help and it was also our duty to supply interesting cases for the chief to demonstrate to the undergraduate students; when McKenna was late or otherwise occupied, I occasionally took on the teaching role. Very interesting and satisfying and, though I say so myself, I got quite good at it.

Come the end of my first year, I had to apply for the next step up, so while continuing to work at Bart's as a clinical assistant and holding an unpaid job at St. John's Hospital for Diseases of the Skin, also under R.M.B. McKenna, I was appointed as registrar in Dermatology and Venereal Disease at the Royal Northern Hospital. The dermatologist there was J.R. Owen for whom I also worked at the Hampstead General Hospital (now defunct, it has been taken over and enlarged to become the new Royal Free Hospital); we used to reckon that he charmed the patients to get better, although his expertise was not quite up to Bart's standard. The V.D. was under James Marshall, a sound teacher whose first lesson was that all patients, no matter how rude or scruffy, would be treated as if they were paying full private consultant fees for the privilege. Gonorrhoea and syphilis were rife in 1947 and we would see up to forty new cases of gonorrhoea and two or three new cases of syphilis per evening session, and we did five sessions a week. Very valuable experience! By the time I left, three years later, the supply of new cases had almost dried up and one wondered how anyone starting then really learnt anything.

By this time, I was working hard and doing the equivalent of fifteen half-day sessions a week, and doing locum consultant work for the dermatologists at Wellhouse Hospital Barnet, now the Barnet General Hospital (derived from the old poorhouse, reputedly where Oliver Twist asked for more), the Central Middlesex Hospital, The hospital at Epping and others. With the start of the N.H.S. in August 1948, James Marshall went off to South Africa, and I agreed to act as locum for his job as consultant dermatologist at the Central Middlesex Hospital in Park Royal for the next six months.

With an eye to the future I attended various other clinics to brush up my knowledge of general medicine, so that I would have a chance of becoming M.R.C.P, which although not then obligatory was visibly becoming necessary for a consultant post, and also get started on research with a view to a thesis for an M.D. The former never matured, partly because I didn't have enough experience of general medicine, and partly because of my background in pure science which put me at loggerheads with anyone who defied basic scientific principles. Being a yes-man may have been good for promoting one's chances in the job field, but when I disagreed, it was usually written all over my face, or so I was told. For the latter I decided that the subject of Acne was to be my research field, principally at Bart's, where all cases of acne were immediately referred to me. At the same time an innovation was the appointment of a psychiatrist, Dr Eric Wittkower, to the skin department. He too was interested in Acne. He probably would disapprove of his work being so briefly summarised, but his conclusions, in this context, boiled down to the fact that patients with acne were psycho-sexually immature; oddly tying up with a 16th century observation ... "matrimonium varos curat" not quite accurate in my opinion, but certainly those who are emotionally ready for marriage don't have acne.

My main message was that acne was tied up with hair growth; that the lanugo hair, particularly when moved by the arrectores pilorum, served as a drain for the pilo-sebaceous follicle, and when, for any reason, there was no hair penetrating the mouth of the follicle, the skin scales and grease collected within the follicle and an acne lesion (a comedo) could develop. When writing a thesis, one is expected to give some history, which I did. Finding that much of what had been written in the last century was far from adequately researched, I chased the subject back thoroughly, ending up by quoting from the Ebers Papyrus, further back than which one can hardly go. Copies of my thesis are available in the Cambridge University Library and the Royal Society of Medicine and a shortened version was published in the American Archives of Dermatology (Vol 76 No.2 pp.179–184 August 1957) The history was published separately, after presentation to the Section for History of Medicine of the R.S.M., in the proceedings of that society (August 1951 Vol 44 No.8 pp. 647–652) I was awarded my M.D. on 27th May 1950.

Going back to the start of the National Health Service, pushed into effect by Aneurin Bevan (5th July 1948). Part of the price he paid for the support of the Royal Colleges of Physicians and of Surgeons was to give them total control of all consultant appointments, so my chance of becoming a consultant dermatologist without the M.R.C.P. vanished. I had two goes at it but they didn't like me! Added to which the grand promises of expansion of the consultant services ran into financial difficulties, first they stopped creating new consultant posts, then they cut down heavily on the number of senior registrarships ... the writing was on the wall. With a wife and two children to support and little prospect of a senior post in dermatology I had to look round other fields. I shared a garage with another man in Hampstead and when we happened to coincide putting cars away, I talked to him on the way home about my dilemma and he suggested that I might enjoy working for the same company as employed him ... the Iraq Petroleum Company; an appointment was arranged, prospects discussed and I agreed to go. With hindsight, I was a bit green about the ways of the business world and might have asked more pointed questions, but I doubt if it would have made all that difference. After an interview with their senior medical officer, a powerful and interesting character, Dr Colenzo-Jones, I had about six weeks to organise my affairs, during which the I.P.C. arranged some elementary Arabic lessons at the S.O.A.S.

IRAQ PETROLEUM COMPANY (1951–52)

The Iraq Petroleum Company (I.P.C.) was a large organisation with headquarters at 214 Oxford Street, for which I worked from mid–1951 to mid–1952. Four major oil companies had equal shares in it, B.P., Royal Dutch Shell, and two American companies, the fifth interested party being Mr. (5-per-cent) Gulbenkian. They kept me in the dark about where I was going, having made it clear that you go where you are sent. Any way my first flight in July 1951 was to the Lebanon via Rome where we had a 24-hour stop due to engine failure ... free trip round Rome and free hotel but no money, not having made preparations for such an eventuality. I managed a look round including being duly impressed by the size and grandeur of St. Peters. Then on to Beirut the next day where I met the first evidence of the power of these big companies; I was approached by a Lebanese character as I walked across the tarmac to the reception area of the airport who said simply "I.P.C.?" I nodded. "Give me your baggage" "and your passport". No bother at all, he went behind the barrier, put my passport and landing card in front of the four officials who stamped them immediately and I was through! Others on the flight were having their baggage searched and being submitted to a lot of delay and questioning. I was discovering how one survives in these countries ... the senior customs officer got his annual present from the company on condition that he ensured no trouble! A night in the company house in Beirut, then off to Tripoli by company car. I had two weeks there, work in the medical department on the standard shift of 7 a.m. to 2 p.m. and the rest of the day at the company's beach; No problem!! At some stage it was whispered that I was destined for P.D.Q.&T.C. (Petroleum Development Qatar and Trucial Coast) and so it turned out. I think I had one or two days in Dukhan, HQ of P.D.Q.&T.C, meeting the medics there, before flying off to Jabal Ali on the Trucial Coast, where I was in sole medical charge of the installation there, known as a "wild cat"; a deep exploratory hole being bored.

TRUCIAL COAST

Based at Jabal Ali, we lived in what was virtually a large refrigerator, a prefabricated bungaloid structure which was kept at a constant 70 degrees Fahrenheit, going out was like stepping into an oven. My responsibilities included one American "Tool Pusher" (head driller), four or five other American drillers, Europeans, mostly English administrators, with a French geologist; Indian, Pakistani and a few Arab artisans, one Nigerian (one of my orderlies) and Arab labourers. Once a week I went to deal with medical problems at the site of the last wild-cat near Abu Dhabi. Staggering to think that I had half a day a week to do what is now done by a major hospital and lots of doctors and nurses. I was interested in one man there with no nose, his name was Sittine, which means simply "sixty", an old slave number. It looked a bit like a form of tuberculosis, rare out there, but he explained that the damage had been caused by a knife; his nose had been cut off for not minding his own business.

Being the only qualified doctor on the Trucial Coast, apart from an ex-Indian-army man in Sharja who didn't really count in my opinion, was exciting. I soon discovered that one of the most serious problems was amoebic dysentery; I had a microscope and could diagnose that, but lacked any X-ray facilities to look for tuberculosis. I was also taken aback somewhat when approached by an Arab with a tooth which needed extraction... I found suitable forceps it my kit and, realising that if I didn't take it out, then someone who knew even less about dentistry would have a go, I set about it. After a few bosh shots and a month or two of practice, I got quite good at it. The Arabs there are tough! On one occasion, visiting Abu Dhabi, I was approached by a patient with severe toothache asking to have the tooth removed; I explained to him that I had no local anaesthetic with me... "No matter, carry on" was his message, with which I complied... He didn't even flinch.

Not having anything like a hospital bed, treatment of amoebic dysentery had to be made as good as I could make it with available facilities. Acute abdominal emergencies, major fractures, heart attacks etc. had to be flown out from our local air-strip, a few hundred yards of rolled sand, in a De Havilland "Dove", a nice little twin-engined ten or twelve seater, the company plane, on which I had first call, no matter how high the status of whoever had it at the time.

This was years before the sheikhdoms united to form the U.A.E.: they were all fiercely independent, and in the process of deciding where their borders were, this being very important in deciding who got the royalties from any oil that was found, This was the task of the two political representatives belonging to the company and housed in Dubai; I am still in touch with Ronald Codrai, one of them; the other died a few years ago after a distinguished career, earning himself a major Times obituary. I went with Ronald Codrai once on a formal visit to Sheikh Shakbut of Abu Dhabi; no proper roads, just tracks in the sand to follow, then wait for the tide to go down before crossing the sea-water ford to the ancient castle, built maybe by the Portuguese. There was an old Portuguese watchtower in the middle of the sea-water ford from which we were shot at by one or two of the watchmen with their ancient rifles! "Don't worry" said Ronald Codrai, "they are aiming at us!" He shouted at them in Arabic and they desisted. When we arrived at the castle in the evening, it was like a story book picture, men dressed in their flowing robes, holding lanterns round the iron-studded wooden gate, we were led up precarious steps to the top of the walls and along to an oblong room perched on one corner of the building to share with some of the elders the obligatory Arabic coffee and incense. When we mentioned the incident of being shot at to Shakbut, he considered having those responsible killed, but we thought that a bit too extreme, as we had come to no harm. The offer may well have been true, Shakbut's regime was vicious and despotic; not one of the previous nine rulers of Abu Dhabi had died a natural death.

The only other properly built house there was the company house, the people of Abu Dhabi living in a warren of barasti huts. There was said to be a war on between Dubai and Abu Dhabi, each sheikhdom claiming that its border was just outside the first habitation of the other. Although now a major port, Jabal Ali was then nothing except what the oil company had put there, in between Abu Dhabi and Dubai, slightly nearer the latter. It consistuted the drilling rig, our prefabricated living quarters, accommodation for the Asian and Arab workers and a small distillation plant by the sea as our water supply. The "well" at Jabal Ali was there as a political ploy, as indeed was the previous well at Abu Dhabi, to keep the rulers happy that they were getting something for the rights to drill which they had granted to P.D.Q.&T.C. Detailed instructions came from the U.S.A. as to how the drilling should go, from which it was obvious to anyone with an enquiring mind that they were determined NOT to find oil then and there. There is no doubt that there was plenty of oil down that hole, our drillers had never known the use of such heavy drilling fluid, known as "mud", nor known so many instructions to see that the well-head structure was firmly tied down. Rashid, the heir apparent, knew very well what was going on; he was a very shrewd and wise man, probably mainly responsible for the present economic strength of Dubai. I expect that, one day in the future, his heirs will decide that their own oil will be produced.

I suppose I was part of the political scene, a spreader of goodwill, as I was encouraged to treat all comers, whether employees or not. This included the ruler of Dubai, Sheikh Saied Bin Maktoum, his son and heir Rashid and the male members of their family, the Sheikhs of Ras al Khaima and of Ajman and ... surprise!! ... one day when I arrived at my simple office, there was a semicircle of men, armed with ancient rifles, round the door; The sheikh of Abu Dhabi had come to consult. The armed guard was, although I presume a normal bodyguard, necessary because the boundary dispute referred to above. The ruler of Sharjah never came near, perhaps he felt some loyalty to the ex-I.M.S. doctor who ran the primitive hospital in his territory. There was no nonsense with religious fundamentalism in Dubai; they were good basically honest and kind and we respected each others religious festivals, although they were not too sure about my Nigerian orderly holding religious (Christian) meetings; perhaps he was trying to convert a few. There was one incident on Christmas Day which reminded me that no skill learnt is ever wasted! Part of our local celebrations was to hold a sort of sports meeting. I was held up by some medical problem and arrived late and found them putting the weight ... remember I had been vice-captain of Athletics at school and although I had not come first very often, I was second or third in sprints and in field events such as the pole vault, discus and putting the weight. They were all standing far too near and laughed gently when I suggested moving back a little. Knowing how to do it, I threw the weight about six feet further than anyone else had done ... they scattered fast! But the follow up was an enormous respect from these big tough Americans, the toughest of whom said that if I could throw the weight that far, he would not care to be on the end of my fist in the event of any major personal dispute.

While at Jabal Ali, I was very much on my own from a medical point of view and, in the course of looking after dental problems I noted a lot of mottled teeth, speculation about which was resolved when I managed to attend a day at the BAPCO (Bahrain Petroleum Company) oil-company's hospital in Bahrain for a most interesting demonstration of Fluorosis, and how it affected both bones and teeth. It seemed that most of the population around Dubai drank well-water from particular wells. I thought it would be interesting to try to correlate the state of their teeth to the fluoride content of the well water which they were drinking. There was no facility for analysis short of the companies facilities in Iraq, and possibly not even there, so I put the idea of research to the field manager, through whom all correspondence had to go. When he asked me what fluorine was made of, I knew I was on a loser and abandoned the idea. Incidentally, the levels of fluoride in the water in question was in the 50 to 100 ppm range; as opposed to the 1 ppm that some people in U.K. make a stupid fuss about.

UMM SAID, QATAR (1952) (Mesaieed)

I tried to hold the company to the promise that I could have wife and family with me, and we looked at one or two possible houses in Dubai, but there were only six Europeans resident in Dubai and it was clearly not a practical proposition. There were wives and families in Qatar, so shortly after that I was replaced and transferred to Umm Said, in sole charge of all company medical activity on that side of the Qatar peninsula. When the day came for transfer, shortly after Christmas 1951, the Jabal Ali air-strip was out of use and the journey was made by boat, a whole day-and-night trip enlivened by the astonishing bio-luminescence of the water and the dolphins playing around and about the boat. Thought about Qatar:... This may have been once the island near the Great Pearl Bank, "five days journey in length" mentioned in the fifth voyage of Sindbad the Seaman, (one of the tales in the Book of the Thousand and One Nights) "where grows the Chinese lign-aloes, which is better than the Comorin." (many of the place names on Qatar refer to the trade in incense.) I was allocated one of the six A-class bungalows, that being determined by income!, and was soon to greet wife and two children as they came down through thin dusty mist onto the local rolled salty-sand flat which served as our air-strip in January 1952.

In such a community segregation by income, although some today might consider it politically unfashionable, was almost inevitable. With parties and entertaining on a fairly lavish scale, it was not reasonable or even comfortable to ask, by implication, those on half the salary to try to keep the same standards of entertainment as the better paid. Our Goanese servant "Cutino" was a good cook and quite capable of producing a meal for two extra at the drop of a hat. Shopping lists were sometimes peculiar, but then these cooks and house-boys did quite a lot of borrowing from each other and one had to tolerate the idea that we were feeding them, and their friends, from time to time. Umm Said was the oil terminal into which the tankers came to take on their load of oil. Some were beautiful, clean and smart, and it was a pleasure to be invited on board for a meal. Lunch on a French tanker took at least half a day of good food and drinks, while others were almost unspeakably scruffy; usually Greek owned with a very mixed crew. The company had an ancient steam tug, the Metinda 2, which must have been agony to work on in the summer heat, to guide the tankers into the proper place; the captain of which came from Kilcreggan, quite near my grandparents Summer home. Other visitors included H.M.S. Dalrymple, a naval survey ship, under the command of Rear-Admiral Sir Edmund Irving, known as "the Egg", who personally gave us very warm and enjoyable entertainment.; There was, I seem to remember, one visiting American warship, notable for the lack of alcohol on board, and an occasional cargo boat with a few passengers and a doctor on board... The company also had three Z class sailing boats for our personal enjoyment and on which we learnt the basics of sailing; they had an extra ton of lead on the keel and were virtually uncapsizable. Brownie points went to the boat with the prettiest girl draped across the bow. Pilots went out to the tankers on ex-naval HDMLs (Harbour Defence Motor Launches), which also served for fishing for the pot, not for sport, using a spoon on a tough line to catch chanard, a very good-eating fish which looked half way between a mackerel and a tunny.

Two incidents worthy of recall; Firstly when I was sent for to go to a Dutch tanker shortly before it got to Umm Said. I went off in the HDML to meet the ship but declined the use of a scrambling net to get aboard and made them put down their proper ladder. Apart from its normal male crew, there were two girls on board, the captain's wife and the ship's carpenter's wife, who also served as stewardess. It was the latter who was stricken with acute belly-ache. Preliminary examination suggested appendicitis, demanding therefore more thorough examination: Being a properly brought up young doctor, it would have been normal to have another female present, but the two girls on board were not on speaking terms; my patient said quite simply, "lock the door". I put on my best poker-face when she then stripped completely and I confirmed that her trouble was indeed an acutely inflamed appendix. By this time the ship had reached the terminal and I required that the ship-to-shore telephone be made immediately available so that I could order the company plane... The General Manager was using it up in Basra ... "tomorrow morning?" "No, I want it NOW" and so it was. The surgeon in Bahrain told me later that I had got her to hospital just in time before it burst.

The second incident worthy of mention was when a smallish company boat arrived from Basra, where there was known to be a minor epidemic of Smallpox, with a man with high fever and a rash. He had been vaccinated, he thought, many years ago but I diagnosed modified smallpox, confirmed by the MOH from Doha. I took him into my hospital, where he made a reasonable recovery, but to stop a full blown epidemic, I had a special consignment of vaccine sent out from London and between myself and a Pakistani health assistant, we vaccinated everyone within ten miles. The boat was stood off and isolated ... anyone arriving by plane had to show me evidence of recent successful vaccination or be done again. The place was somewhat paralysed for a fortnight, but we had no more cases. I suffered a few grumbles about the disruption... Had there been fifty cases and ten deaths, I might have got the O.B.E.

My combined surgery and hospital in Umm Said was quite well staffed and furnished and much of the work was routine, with just enough tropical medicine and rare conditions to keep me on my toes with regard to diagnosis and treatment. The administration, on the other hand, was almost too close and I became aware that there was a measure of corruption in the company. Two rackets were evident; the construction and the catering. According to my information, the construction racket had been started some years before in the Lebanon, when five administrators got together and persuaded a Lebanese by the name of Bustani to form a contracting company in which they were the sole directors; these five men gradually worked themselves into positions of influence in the company where they could promote the interests of "CAT Company" and, at the same time make sure that no other contractor could get a fair chance to put in a tender for any of the many building jobs. The effect was that when the big boss in Dukhan got himself a new house, it cost the parent company at least twice what it ought, and he, being one of the five, not only got his new house, but also a substantial share of the profit from building it. The company shops were run by a comparable monopoly. I found that they kept a wary eye on any competition when, appalled at the high cost of Ribena, I sought to get my own supply direct from UK; the price in the company shop suddenly reduced to below what it would cost me to import. I suppose I should have accepted that I had discovered the way most overseas businesses ran, but still retaining some measure of idealism, and knowing that London HQ of the company were unable to find out why everything out there was so expensive, I blew the whistle (gently) to them. That was NOT a good idea. From that moment everything started to go wrong. Equipment from the hospital was suddenly required elsewhere ... when my car broke down no replacement was available ... if I had gone on leave there was no guarantee that the same bungalow would be available when I got back ... and they had a habit of offering a new yearly contract at a lower salary to any awkward employee. I had a good look at my current contract, found an escape clause whereby on giving a month's notice before the eleventh month, I could terminate my contract and be repatriated at their expense. I was reminded that in the event of my resigning, I would be regarded as a malcontent whose word on corruption in the company could be safely ignored. So I put my resignation in writing and went back to U.K. As a matter of interest, I heard that the general manager of the I.P.C. in Qatar was kicked out shortly after I left and went to work in and for CAT Company, so my whistle-blowing did some good for the company if not for me.

General Practice In Cumbria 1952 – 1979

On return to the UK in August 1952, I needed a source of income and some sort of home immediately, so when it was revealed that my father's drug and drink habit had got to the stage that he needed prolonged treatment in a nursing home in Edinburgh, I agreed to go into the family practice in Carlisle and became the junior partner to both father and mother, although from that moment I took over practically the whole of the practice work. Having set my sights on a career in general practice I made contact with the local obstetrician and arranged to attend the maternity hospital with a view to getting recognised as a G.P. Obstetrician, without which getting into single-handed practice as a principal could be difficult. Working in the old family practice was intellectually interesting and rewarding although financially disastrous. Odd how many parents expect their sons to be grateful for a roof over their heads while doing without regular payment and to live and support wives and families on virtually no money at all. Pressing for a formal share of the practice profits, I was offered a little less than a third for doing practically all of the work. When my father came back into the practice, there was obviously no room for three of us, and relationships between wife and mother became very strained, so I approached the Executive Council to find out about vacancies elsewhere in the county and watched the adverts for jobs in the B.M.J. and Lancet. The Executive Council were at that time taking action against Dr H.A.K. Rowland in Workington for fraud in relation to his prescribing habits and although no action was possible until judgement had been given, it was clear that an immediate locum would be required if he was struck off the Council's list and would I hold myself ready to go to Workington? Jobs for principals under Executive Councils were few and far between at the time, so I readily agreed. New cars were virtually rationed, but I had a cast iron case for one at maximum priority, so I bought my first Morris Oxford on the never-never. I also had to find somewhere to live temporarily; being unable to find anywhere in Workington where I could be on call, I ended up in the Globe Hotel in Cockermouth and began work as locum on 23rd September 1953. With quite a big practice to look after I had to work hard finding my way around as well as coping single-handed with all manner of problems, but I had the pleasure of knowing that I was at last almost independent: I still had to get myself appointed as successor to the practice and couldn't take steps to find a permanent house until that was settled. I had one big advantage over the several others who applied for the practice, in that I was a fully trained venereologist; a qualification desired because of the prevalence of these troubles in the seamen visiting the port who were unable to stay long enough to see the hospital Venereologist. It took two months, from early October to early December 1953 to get myself properly appointed to the practice.

I now had to get myself set up with practice premises and somewhere to live and keep up the payments on my car, all on virtually no money! Practice payments came quarterly and I managed a hand to mouth existence money-wise. While moving about the Gulf, my father had guaranteed any overdraft of up to a thousand pounds, which I thought would see me through, but under the influence of my mother, who seemed determined to make life as awkward as possible for me, that promise was withdrawn. The Westminster Bank, who held my account at that time, declined to give me overdraft facilities and I only survived through the kindness and trust of George Weir, manager of the Midland Bank, who allowed me to overdraw, without guarantor, up to £1200, quite a large sum in those days. I understand that those above him allowed him to do it on his personal responsibility. And there were more financial problems... I visited what was to become our future home in a professional capacity to see patients in what was then the upstairs flat. When I came down the stairs, I was met by one of the Wegulins (the owners, on the ground floor) who ushered me into what became the drawing room and asked me if I would like to buy the house: I had noticed this house when I first came to Workington, thought it might be a nice place to live and wondered who lived in it! So I set the buying of it in motion, with an agreed loan from The Clerical, Medical and General Insurance Company; All seemed to be going well until they heard that there were sitting tenants and withdrew their offer ... PANIC ... being committed to buying it, I could be faced with a forced sale which could cost me quite a lot of money that I hadn't got. However with the help of (solicitor) Iain Mendus, who should not have allowed me to get committed in the first place, and the bank manager, the Halifax Building Society agreed to take it on. Having bought the house I moved in with my wife and two children in January 1954.

Lots of hard work for the next two years before the next financial crisis when the Income Tax caught up with me and at the same time George Weir retired and his place was taken by a much harder manager who demanded that my overdraft be repaid. With the help of accountants, Robinson's, a plan as worked out so that my debts could be repaid in time acceptable to both. There was no spare money for ages.

BRITISH MEDICAL ASSOCIATION (1953 to date)

Apart from the importance of keeping aware of job vacancies, membership of the BMA involved being invited to a participation in medico-political activities and I was, naturally, invited to local meetings of the BMA and very soon found myself appointed to the committee of the Cumberland Division and then to be the BMA representative on the County Health Committee. During this time we played our part in the protests which led to the Doctors Charter 1960. As a member of the branches of the BMA in Carlisle and West Cumberland two memories stand out. On one occasion as the representative on the County Heath Committee when they were making a big fuss about teen-age pregnancy I dared to suggest that girls in particular should be made aware of contraceptive practices at school; A lynch mob, headed by a Catholic priest, was very threatening, but at least I got the idea across. On a more constructive note I managed to persuade the West Cumberland Branch to adopt the idea of fluoridation, probably the best thing I ever did for the public in general. In time, I served in turn as Chairman or President of the Cumberland Division, The Border Counties Branch and eventually the Northern Region of the BMA; the latter was rather a strain, as it involved attending meetings Newcastle. Later when the West Cumberland Division became independent I served as the Representative of that division to the Annual Representative Meeting of the BMA until 1982. Few members realised then as now, just how democratic is the policy forming of that body and I certainly had a hand in it until two years after I retired, when I felt that I could not speak with adequate fire if I did not have to live with the results of our deliberations.

MEDICAL CHALLENGES

By the time I got to Workington I had a fair experience of general practice, but it takes a long time to be reasonably confident in coping with the enormously variable troubles with which patients can present. Always something of an idealist, I stuck to two basic principles;

  1. Begin the way you mean to go on.
  2. Never sign anything unless you are prepared to defend that statement in a court of law.

These were hard to apply, but I stuck rigidly to them; Patients got the treatment I honestly thought best as opposed to what they demanded and as they had been getting whatever they asked for the last few years, there were a few battles of will. This applied to certificates perhaps even more than prescriptions and led now and again to ... "if you won't give it to me, I know who will" and as there was an ex partner of the practice actively canvassing my patients, quite a few departed to this Dr. Edwin Brookes. This had the effect of cleaning up the practice, diminishing it from an unmanageable 3200 or so down to between 2600 and 2700 good honest and loyal patients, the trouble-makers having gone with my blessing to the said doctor, who was a drink and drug addict, whose medical competence might be called in doubt, but who had quite a charm and bedside manner. I believe that his life came to an unfortunate end a few years later.

Washing was not very frequent among patients in the early days. A significant proportion of the population could be fairly described as "The Great Unwashed" and examination of feet or bodies of patients had to be done with due notice or by appointment, otherwise one commonly encountered filthy smelly feet or quite disgracefully dirty underwear. Some miners never washed their backs, as they had a built-in idea, probably based on the old humoral theory of medicine, that, if they got their backs wet, and particularly if the water dried on them, "cold" would "strike" and cause them to be laid off with back trouble. For the women, one could almost see the inward eye considering whether the underwear was presentable on suggesting that an abdomen might be examined; if it was "not convenient" an appointment had to be made. A major change of attitude in this direction followed, and was probably initiated by the introduction of compulsory showers after games at school and the inevitable associated comparisons. Teenagers, then as now, can have a powerful influence on the behaviour and attitudes of their parents and siblings, and the change in the next five to ten years to well scrubbed, cleanly dressed patients was, in my opinion, the most important social phenomenon of the decade, although perhaps too personal to be spoken about openly.

Epidemics of measles, mumps, whooping cough, German measles, hepatitis and poliomyelitis were common and an epidemic of polio in my first winter caused a lot of anxiety and the death of one G.P. Tuberculosis was common and beds for treating it scarce. Ellerbeck Hospital was full of patients with tuberculosis of the lungs, and there was a whole ward in the Cumberland Infirmary devoted to tuberculous meningitis in children, mostly without any hope of recovery. It was during my first two years in Workington that antibiotics for tuberculosis were developed and these wards full of seriously ill patients disappeared. New uses had to be found for the wards devoted to tuberculosis. Ellerbeck, once upon a time the old workhouse, was later converted from a tuberculosis unit to a geriatric ward and the associated huts into a convalescent surgical unit. Visiting lists could be long and arduous, specially when an epidemic of flu or measles added to the normal winter troubles.

WOMEN'S VOLUNTARY SERVICES

Considering local amenities for patients, I found that the W.V.S. were not active ... no "meals-on-wheels", no Darby-and-Joan clubs &c. So I got in touch with my distant cousin Janet Ewen (see above under Living in London), known since London student days, who knew Lady Reading, at that time President of the W.V.S. In what seemed no time at all, although it must have been a few months, the female equivalent of a triumvirate was formed to run the W.V.S. in Workington. My wife to run the meals-on-wheels and Barbara Pavey-Smith and Mrs. Bailey (then next door neighbour) to run other aspects of the organisation. The meals-on wheels took off slowly but satisfactorily; I am sure very few, if any, Workingtonians would now remember that it was I who fired the first Hotlock in our cellar with the first twelve meals, provided by the steelworks, to be distributed by my wife to needy citizens nominated by social workers or health visitors, and delivered from the back of her first car, the first mini in the town.

HEALTH VISITORS

A minor irritation in my early days in practice was the action of the Health Visitors appointed by the County Health Service. there was no co-operation with G.P.s and these women used to go round visiting all new mothers, spreading their own ideas on feeding and clothing the new arrivals. I was not pleased to find them promoting bottle rather than breast feeding; telling new mothers to ease their babies' "constipation" with a spoonful of sugar and insisting that they wear that badly named restricting garment called a "liberty bodice". They were officially under the control of the MOH to whom I complained several times. At that time the MOH was a Dr Frazer, who was pretty unhelpful, but the message must have got across to members of his department, for when he was replaced by Dr Leiper, we had a chat at one of the occasional Management / Consultant / G.P. meetings, I was approached with the idea of attaching Health Visitors to individual practices to promote co-operation. This was clearly a good idea, although it would have to be one health visitor to three G.P.s, which was arranged, the two others being at that time Drs Fitzgerald and a Dr Davidson (who had taken over from Dr Brookes). Promoting an agreed policy on matters of previous contention was much better than the previous muddle and seemed to be working well. Attachment of this kind had been tried by Dr Pinsent in Birmingham a year before but had to be abandoned for unstated reasons about the time we started. Our health visitor seemed to be enjoying her new post although having to change her tune slightly according to whose patient she was seeing can't have been easy. But there is always a snag! I used to talk freely to her and my secretary over coffee in the morning about patients and their problems; persistent reports eventually came back to me that these medical confidences were being shared rather too frequently with other patients over their coffee. So ... she had to go.

The next one or two I had were first class; one even turned out to be a first class V.D. contact tracer. All good things come to an end, however, and it happened with the health visitors when they decided to become a T.U.C. affiliated Union, and that henceforward they were not going to be, nor be seen to be, the doctor's handmaidens. Once again they were going to prove that they were independent professionals in their own right, do their own thing, take their instruction or teaching only from their own kind &c. &c. My next attached health visitor, for whom I had provided a properly furnished room, with all necessary equipment, turned out to be a disaster. The patients didn't like her; I tried to teach her to give injections painlessly, but she couldn't do it. I had promoted the idea of experiment and research, but only by previous agreement over details with me; and when I found her issuing prescription-only medicines, in this case steroid creams for sore bottoms in very young babies, I told her she would have to go. At the time I was on the DMT (District Management Team) and took my complaint to the team member responsible. Did she do the right thing? No, she sided with her union colleagues and I was formally denied direct contact with an attached health visitor. There was fortunately one very good health visitor who kept in touch and did valuable work for the practice unobtrusively.

COLLEGE OF GENERAL PRACTITIONERS

The college of G.P.s was being inaugurated in 1952 while I was in practice in Carlisle, by a band of enthusiasts, with the idea that, by getting together, we could share experiences and learn from each other. I thought that it was a very good idea and became a Founder Member of the college. It was an altruistic organisation to start with ... no thought or hope of financial gain or personal glory ... that unfortunate aspect crept in five to ten years later. I encouraged early members of the College of G.P.s to form a small group to promote the basic idea of the College in sharing ideas with the idea of improving our skills in practice.

One early idea, promoted by Drs John and Valerie Graves of Writtle, near Chelmsford, was to get supposed experts to do a lecture on tape and send it round a circuit of twelve members scattered all over the country, who would gather a small local group to listen to it together and add their questions and comments, on the tape, which then went back to the original lecturer for answers. The "answers" tape would come back round the same circuit with the next taped lecture. Needless to say, I was one of the original circuit of twelve. Our local group met in the drawing room, ate mother's cake and made our responses. When it was decided to spread tape lectures internationally, I was one of three chosen to produce a one-hour tape to inaugurate a similar service in New Zealand. I wonder if copies of that tape still exist in some distant archive. It was all great fun for a few months, then it grew so rapidly that returned questions and answers became impractical, but the general idea of getting lectures on tape became an important teaching aid, recognised quite deservedly by the award of the OBE to both John and Valerie. In its turn, these taped lectures became redundant with the development of Post-Graduate Centres and more formal once-a-week teaching in them.

We were officially attached to Newcastle and I was one of the first members of the faculty board, but going to attend meetings in the evening in Newcastle proved too much after the first year or two. We formed a Sub-Faculty in Cumbria and enjoyed the hospitality of Charlotte Nash for occasional meetings at Lorton Hall; She was an ex-G.P., founder member of the college, who ran Lorton Hall as a home/school for severely physically (not mentally) handicapped children. At this time the only postgraduate education available to G.P.s were the monthly meetings of the West Cumberland Medical Society which, for lack of any available suitable NHS venue, were held in one or other of the local hotels, so I tried to organise special teaching ward rounds for members. This was not a success and, regrettably the Lorton Hall meetings soon ceased when Charlotte Nash became ill. I must have been a glutton for punishment, as I took on the hon. sec. job of the medical society and, apart from organising speakers to come, sometimes from a long way away, I had to guess how many would come to any given meeting so that I could book a room of suitable size in a local hotel and order the right amount of coffee. G.P.s have always been slow to make up their minds and I never knew how many were coming until the very last moment.

DISPENSING

For the first ten or twelve years in Workington, I ran a branch surgery in Distington, from which I was obliged to dispense medicines to all those patients who lived more than three miles from the nearest dispensing chemist. As was the normal custom in those days, dispensing was a proper art, in many cases making up bottles of medicine and ointments and lotions from basic ingredients. As time went on more suppliers would make up the mixtures and ointments I wanted, and the DIY aspect of dispensing gradually faded. Tablets were bought wholesale from official wholesalers, where they agreed, or by arrangement from local pharmacists. This caused quite a lot of difficulty to start with, because the price I was being charged by the wholesalers was in many cases more than I was being reimbursed by the Executive Council. Not being prepared to continue dispensing at a loss, I had to develop a hard business head and "shop around". It worked out all right in the end. When I later reorganised the practice, I gave up my branch surgery in Distington but continued to dispense for the more distant patients from my Workington surgery. Patients liked this arrangement, but the local pharmacists had mixed attitudes about it. There was in fact a major war, nation-wide, between the pharmacists backed by their professional organisation, the A.B.P.I., and dispensing doctors. By this time however, I was getting quite business wise and managed to play the game to my financial advantage.

MORBIDITY RESEARCH

It was considered important by the College of G.P.s to assess the work done in general practice, so, as a basis, one hundred practices were selected to keep records, for later analysis, of every consultation and visit for a whole year, from May 1955 to April 1956. Small scale surveys had been done before, but nothing approaching this major exercise. I volunteered for this and was selected as one of the hundred. The results were published by the General Register Office in three volumes under the title of "Studies on Medical and Population Subjects No.14". The first two volumes were practically all tables, while the third was an attempt to extract some meaning, results and conclusions from the figures. I participated in this and wrote the chapter on skin diseases.

GERIATRICS

During the course of this research I built up quite a large data base which I could use for personal research. It was a great pity that what we accept as an ordinary computer today had not yet been invented. I did do one piece of personal research, however, using these figures when I entered for a prize essay on diseases of the elderly, or some such title. So far as I am aware, I have no copy of this work; there will be one somewhere in the archives or library of the R.C.G.P. I asked our Consultant Physician (John Simpson) to have a look at it before I sent it off. No, I didn't get the prize, but when it came to picking someone to run Ellerbeck Hospital as a geriatric unit, John Simpson asked me if I would take it on, which I did. (?1957) Thus the first geriatric unit in West Cumberland was formed, long before consulting geriatricians were thought of in this area or the appropriate wards in the West Cumberland Hospital were built. This was a surprisingly happy unit, specially when compared with massive geriatric units elsewhere. I think the secret was that it was a small unit, run by local nurses who had often known the patients before. No-one was an impersonal body; any nurse who took an impersonal attitude was quickly put right.

One of the big problems with geriatric units is the problem of sore bottoms! This therefore had to be researched! It was apparent that an important factor was the ammonia formed by the decomposition of urea in the urine, which in a wet bed made the skin very soggy and easily eroded when the patient was pulled up the bed into a sitting position. Experience with babies had shown me that a properly applied "Paddi" and "Paddi-pad", that is, with the plastic touching the skin all round the pad, so the wet pad was not exposed to the air, did not smell of ammonia or cause sore bottoms. It appeared, although I never got a chance to prove it, that the organisms in the pad (no! they were not sterile) needed oxygen to convert the urea into ammonia. Putting two and two together I persuaded Robinsons of Chesterfield, the makers of Paddi, to make a similar garment for my geriatric patients. It worked very well, these mega-paddis having the advantage of a smooth plastic outside which slid up the bed with the patient: and of course they made the nursing of doubly incontinent patients very much easier, just as easy as changing a baby's nappy! As to the commercial aspect; when I originally approached Robinsons their R&D was under a Mr. Mann who was sympathetic to the idea that if this idea was developed commercially, there might be some financial advantage for me, as I needed it badly at the time. My hopes in this direction were boosted when I went to lunch with the directors and found there a contemporary member of my old school lodge on the Board of Directors. Having established, over the next two years, the usefulness of my idea I looked round for some slight reward, to find that Mr. Mann had gone, no-one knew where, my director friend had died suddenly, they did not want anything published which suggested that their pads were not sterile and they vigorously denied that any promise of reward had been made to me. I learnt a hard lesson in the ways of big business!!

When the new maternity unit was opened in Workington Infirmary, ward 8 (the old maternity unit) was converted into a geriatric ward and Ellerbeck was closed. I moved down there with the patients, although, by this time, Dr Kaminski was in charge of the new acute geriatric wards at West Cumberland and only long stay and only patients thought to be incurable were transferred to Workington. Even so the challenge I accepted was to get as many as possible back home to prove how wrong the consultant geriatric unit could be. Regrettably, the nursing standards at the West Cumberland Hospital were not very good, nor was the truth always told in the notes about bedsores, so much so that the first thing we did on receiving a patient from them was to examine the back and sometimes take a photo, so that we could fairly complain rather than take the blame for their sometimes shocking condition. It was a happy ward, understaffed as always but we managed to get quite a lot of help from visiting relatives. I thought it important to keep relatives well informed and involved and made a point of doing ward rounds during visiting time, an innovation never heard of before, so that any questions could be answered on the spot. When the question of going home was raised, I usually arranged for the patient to go home for the weekend, not telling anyone that there was a vacant bed, so that I could instantly re-admit in the event of failure. Those were the days when we had real ward sisters who supervised all meals and all activities and were capable of showing the young ones how to do it by rolling up their sleeves and getting on with it when necessary. I developed a way of keeping beds dry and bottoms healthy by getting all but the actually dying up out of bed every day. It took half the day to get them up and the other half to get them back to bed ... the secret of dry bottoms was to take all patients to the loo on the way up and on the way back, whether they wanted to or liked it or not.

Nothing good ever seems to last long and the time came when the authority wanted to close the major fully staffed maternity unit to convert it to a psycho-geriatric unit, for which it was never physically suited, bring the maternity back to ward 8 and transfer the geriatric patients to wards 1, 2 and 3. It seemed to me at the time to be extraordinarily stupid, but I had no say in the arrangements and voiced my displeasure by resigning from my geriatric job. In retrospect, resigning as a protest is always unfruitful, but it did give me time for other activities.

VENEREOLOGY

Venereology continued to be a significant problem while regular shipments of iron ore were being delivered to Workington by boat, the sailors finding a significant number of local girls easy and willing, particularly at the Ancient Mariner, a pub also known as the "honky-tonk". When I started this service it was all done from my John Street surgery, but soon I was invited to start a clinic in the out-patients at Workington Infirmary, where one session a week soon became two. Bringing V.D. under control involved careful contract tracing and here my knowledge as a G.P. was invaluable; I had a very good health visitor for a while (before the days when they got unionised and TUC affiliated and decided to do their own thing independently of G.P.s) and by working out "where did she take you?" ... "was it the house on the corner?" ... "what name did she give you?" &c. I could get a good enough idea of who she was to send my health visitor to find the girl and get her to the clinic. Unfortunately such health visitors are few and far between, but it was good while it lasted.

Contrary to some expectations, working in such a clinic is really quite good fun. Patients knew that I knew why they have come ... there is no need to beat about the bush ... one can ask direct questions like "Who?" Where?" and "When?" without offence and expect straight answers. There is more inoffensive shared laughter in these clinics than any other.

Some years later when Herbert Bell, our visiting Consultant Venereologist, and for whom I had frequently deputised, became too ill to continue, I took over his clinics at Whitehaven Hospital and became responsible for all the venereology in West Cumberland, continuing until I retired, although the numbers attending the clinics diminished as the port got less busy and contact tracing improved. HIV began to be recognised just before I retired.

DERMATOLOGY

My other speciality, Dermatology, was not forgotten. When I first arrived in West Cumberland, Duncan Cameron, a senior ex-G.P. from Carlisle was visiting dermatologist. I am not sure of dates, but he suddenly announced that he wasn't coming any more ... no warning at all ... so the administrators, who knew of my experience in this speciality, asked me at very short notice to take on the extra job of locum consultant dermatologist until the an appointment could be made. This was interesting and enjoyable, taking me back to my years in Barts. Six months later Dr. Mitchell was appointed. I covered his leaves when he went on holiday and when he gave up the appointment some years later I had to take the job on for a further six months. After that the authorities got themselves better organised with a new consultant and a registrar dermatologist at Carlisle who took over his locum duties as required.

MIDWIFERY

As mentioned before, I had made myself acceptable to the Executive Council as a G.P. Obstetrician. In the early days at Workington there were very few obstetric beds. There were not even enough beds to accommodate all first babies and only those with actual or seriously potential problems could be booked for hospital delivery, so most of the work was done in patients' homes; very enjoyable and satisfying if all went well, which naturally happened in the majority of cases if one had provided careful ante-natal care, but could be a bit hairy if complications arose. Most of the domiciliary midwifery was done by our excellent midwives, but I liked to be around to cheer or to cope immediately with any problem arising. The service improved enormously when the new maternity unit opened over the old railway line via the bridge from the main hospital (now a psycho-geriatric unit). There was one occasion when one of my patients was in labour and the midwife decided that I should be called; I was unaware that her husband was sitting outside the ward, fully aware of what was going on and timed me from call to arrival in the ward. When called in emergency, one does not waste time ... it took me four and a half minutes to get from home responsibilities to the ward!!

We could send our pregnant patients to any of the consultants for total care if we wished, but that was not for me or my patients. Normal and polite co-operation with the consultant services was to send the patient up to the consultant of one's choice, with the idea that he might spot any potential abnormality and then carry on oneself with complete care through pregnancy and the post-natal period. I was however a bit ahead of my time in that I could see little point in the routine shaving of the pubic hair (the sight of a single pubic hair in a patient presented to him used to drive one consultant obstetrician into a frenzy) and once I had achieved the confidence to go my own way, I forbade the staff to perpetuate this rite on my patients. Likewise there was an idea that, for bottle-fed new born babies, full cream milk was wrong and they had to suffer half-cream milk loaded with sugar for the first few weeks; this was the opinion of the consultant paediatrician at the time. New-born babies were weighed daily and those under routine hospital care regularly lost several ounces of weight in the first five days. Having read the opinions of others I considered wiser, the babies of my patients (those who could not be persuaded to breast feed) were given full cream milk from the start and thrived on it, putting on weight satisfactorily from the first day. There was also a difference between the way any perineal repair was done by the hospital doctors and my way. Mine all healed better and were much more comfortable to sit on.

I enjoyed midwifery and always made a point of being present at the birth whenever possible; patients liked it too; they felt, as soon as I came into the room that there as someone there on their side in what in some ways felt like a strange and slightly hostile world. I am sure that my presence gave them the confidence which made delivery both easier and safer.

TEACHING GENERAL PRACTICE

Having given up my responsibilities as geriatrician, there was room for new activities so I considered taking on a trainee. I upgraded the surgery by creating a second consulting room upstairs, got approval from the executive council and advertised for a trainee. After rejecting one or two impossibles I agreed to take on Sheila Eynon, daughter of the headmaster of Keswick school. She had two very young children at the time, so the arrangements were modified so that she could attend half time for two years rather than one year whole time. The three year apprenticeship with built-in hospital appointments had not yet been thought of. For the first few weeks she sat in on all my consultations and wrote prescriptions and asked sometimes very searching questions about why one did this or that ... quite a stern discipline for me as well as for her. Soon she was conducting her own surgery, calling me in any time she was stuck or puzzled and taking her share of the visiting list. During the two years, I sent her off to do midwifery to the point when she could be accepted as a G.P. Obstetrician and sent her to attend geriatric sessions with Dr Kaminski.

As Sheila was coming to the end of her time as a trainee, the health service was being re-organised and G.P.s were about to have a say and a seat in management. My colleagues in General Practice, knowing that I was not frightened of raising my voice in promotion of patients' needs in general and general practice in particular decided that I should be their representative on the District Management Team and all the other associated committees, so I took on Sheila Eynon as a junior partner, working just enough hours to get her full practice allowance from the Executive Council, giving me enough time to cope with my new responsibilities (virtually a whole day a week) and giving her enough time to see to her families' needs. I was a fairly easy boss and was always sympathetic to the request for a few hours or a day off if the children needed her.

HEALTH SERVICE MANAGEMENT

In 1972 or 1973, being a member of the Cumberland Executive Council and the Cumberland County Health Committee, and an occasional critic of the Area Health Board's management, the latter made an effort to get me on their side by sending me on a management course at the Northern Region's facility at Ashington. This was a course for junior management and had not previously had a doctor on the course. It was run by the University of Strathclyde's business school. It was an awful experience; the main qualification for lecturing on this course appeared to be the ability to talk non-stop for an hour and a half and not allow any time for questions. I may not have learnt anything about health service management but possibly absorbed some of their jargon. I have sometimes said (only half) jokingly that whereas, before I went on that course I thought some managers were talking nonsense, when I came back I knew they were talking nonsense.

A year or so later the Health Service re-organisation was imminent, I had been nominated as the G.P. representative on the District Management Team and the whole team was sent off to York University for management training. This was an altogether different course from the one at Ashington ... they did know what they were talking about and it was useful to meet and learn alongside those with whom one was going to work when the re-organised service started. I found out which management theories they were going to follow and took the trouble to get and read the associated books.

Sheila Eynon was by then installed in the practice and had to take sole charge on the half (and sometimes whole) days which had to be allocated to the DMT, the Executive Council, the District Medical Committee, the Community Health Council and others occasionally. The DMT was a six person team, consisting of Secretary/Administrator, Principal Nursing Officer, Finance Officer, Public Health Doctor, Consultant Representative and G.P. representative, each of us taking the chair for a six month period in rotation. This 1974 re-organisation worked remarkably well in our district; we took chairmanship in rotation, agreement was always by consensus, that is, each one of us had the right to veto any decision, but we knew that, if we failed to agree on any particular point, the decision would be taken out of our hands and settled at Area level. At first, meetings used to go on for hours but with practice they became more reasonable. It was the first time that General Practice had a voice in management, and I certainly made sure it was exercised and that my colleagues in practice were kept properly informed on issues raised and decisions reached. This was the main reason for my being given the honour of Fellowship of the B.M.A. (This was and still is a very high honour! Potential Fellows have to be strongly recommended by their colleagues in secret. If the intended recipient finds out, that negates the whole procedure.)

In such a context, you never know what you may have to do at a moment's notice. My first surprise was when, as a team, we went to open the new hospital at Millom. All the local dignitaries were there and, while waiting for something to happen, one member of the team whispered in my ear that I was in the chair! I had to make some rapid ad hoc arrangements, introduce speakers in the right order and generally keep one step ahead. On another occasion I found myself chairing a confrontation between management and unions, and only just managed to keep the peace. All good experience, I am sure, but it gets the adrenaline flowing.

Management sometimes involves knowing a lot about what goes on, including the awareness of degrees of corruption in the system and knowing if and when to blow the whistle can require fine judgement. In this context as in the Persian Gulf it is the matter of who gets the contracts and who gets the back-handers which is the most obviously open to corruption. There was, for example, once a matter of a contract for painting the outside of one of our buildings: tenders were asked for from the usual half dozen contractors, and it fell to my lot be one of the two members of the DMT who opened and read the offers. The two lowest tenders were exactly the same, in a contract worth six or seven thousand pounds, to the last penny. It was quite obvious that the contractors had met and agreed on what figures they would put in, and had muddled them up. There was one independent contractor who regularly put in a tender much less than the others, in this case his tender was in the four thousand region, but there always seemed to be some reason for doubting his ability to do the work. Another occasion was when ward 8 was being enlarged and converted back to a labour ward. The tenders received seemed to me to be high, so I took an outline of the plan to a friend who was a top man in the building trade for his private opinion. He gave me three figures according to whether we wanted economic, good or best possible construction standards. His top figure was about half the agreed contract price which we had to accept under the prevailing rules.

The letters which some consultants wrote to the management took some believing! Sometimes rather petty, as, for example one who regularly complained about his car parking space. But later a much more serious problem arose when a group of consultants, members of the T.U.C.-affiliated union called the Hospital Consultants and Specialists Association (HCSA) went on an organised non-co-operation and go slow exercise involving agreeing to see urgent cases only. The object naturally for such types was to coerce the government into giving them more money. This meant that I had to represent the hospital staff as well as my G.P. colleagues at DMT meetings. During this time most of the consultants continued to behave honourably and do their best, as they always had done, but seemed reluctant to be seen to disagree with the militant few. I heard one member of the HCSA at one of his out-patient sessions, where his list had been reduced to four patients, and for which he was being paid his normal fee, complaining loudly to the appointments clerk that one of those cases was NOT an emergency. I was particularly angry that at least two of my patients, whom I had referred for symptoms suggesting early cancer, were considered as not urgent without being seen at all. I still have their notes. The patients later died of their cancers, rather unpleasantly. I could not go public on the subject as it would have caused more and unnecessary suffering to the relatives. But I did comment in the privacy (I hoped) of the DMT that it seemed that we had one or two consultants who were prepared to risk patients lives for money. This comment was taken to the hospital specialists committee and I was then "blacked" by the members of the HCSA and in order to get my patients seen, I had to write a very insincere apology. They also tried very hard to get me off the DMT, but my G.P. colleagues stood shoulder to shoulder and said quite firmly that I was absolutely right. The general atmosphere had been sullied by the whole affair, and it was difficult to accept that my patients were being discriminated against by the members of that particular union. In order to get my patients properly seen, I began to look forward, sadly, to retirement. Being allowed to retire on a pension as soon as I reached the age of sixty, I elected to retire with effect from the last day of December 1979.

A retrospect on some research while in full time practice

Having always been one of those who enjoy pushing out the frontiers of knowledge I was and am nearly always involved in some kind of research. I have already mentioned Acne, the results published in my MD thesis, a paper in the Archives of Dermatology and the history of it in a paper to the History of Medicine Section of the RSM. A side issue of this concerned the cause of pilo-nidal sinus published as a letter to the BMJ. In about 1956 I was one of a hundred GPs who took part in the first Morbidity Survey undertaken by the College of GPs and the General Register Office and wrote the chapter on skin diseases for its publication. Research into sore bottoms and bedsores in Geriatrics while working in Ellerbeck hospital showed how a modification of "Paddi-pads" worked wonders, but that never got published for lack of co-operation of the manufacturers (Robinsons of Chesterfield). The Circulation of the Blood came under my scrutiny as I could not accept the current theories on the passage of viscous fluids through the capillaries on the basis of my previous knowledge of Physics and proved that much of the motive force was provided by the arterial muscles; this has been mentioned in a letter to the BMJ and an explanation privately sent to a few physicians. It would seem that it will take a few more years for my ideas to be proved right to the establishment.

Asthma is another subject, causing much trouble and anxiety at the moment and in my opinion failing in adequate research because too many physicians, not trained in physics and mechanics, believe that a tone can be produced by the squeezing of the bronchi by the smooth muscle in their walls. When they realise that the musical tones are produced by the vibration of thick sticky mucus within the lumen, the tone varying with the width of the tube, we may see some progress; In the meantime they take no notice of my opinion. ("Who does this ex-GP think he is, telling us, the experts, about our specialist subject?")

I have already mentioned the feeding of new-born babies and the undesirability of removing the pubic hair from parturient women. Pioneering work into appointments systems is still not accepted. The attachment of nurses and health visitors to individual practices were going well until they were more or less wrecked by the widespread adoption of TUC principles by health visitors and, regrettably, some doctors and other paramedics.

Retirement From Full Time Practice (from 1980)

Retirement from full time practice in Workington was naturally a very big change; it meant, firstly, deciding what would happen to The Practice, and secondly retiring from all the other local responsibilities. I had had five years as a member of the DMT, of which four years was supposed to be the maximum, and more as a member of the executive council and other associated committees, which had no formal time limit. Retiring from The Practice could have left Sheila Eynon as senior partner, but she didn't want that. Alternatively Sheila could have stayed on and appointed her own senior partner; She didn't fancy that either, so I had the awkward task of inviting her to resign from The Practice, so that I was free to ask the Executive Council to appoint a successor and dispose of the assets. At the time of being made a partner, she had not purchased a share of the assets, so that aspect gave no trouble. After a minimum period of resentment (I don't see what other course I could have taken) Sheila became a partner in a Whitehaven practice and her skills were duly appreciated ... What else? ... She had been properly trained!! Nobody seemed at all keen to take on my DMT job. This latter was changing anyway, by the appointment of a Manager, who could make decisions on his own rather than have to submit to the consensus we had worked, very successfully in our case, but which was failing in other districts. It was tough on the district that the first new administrator was an ex-naval engineer who knew nothing about medicine and little about management. It hurt to see everything we had built up going downhill, but there was no way I could have stopped it even if I had stayed.

I had often advised my patients on the perils of retirement. Facing these problems is made a little easier when you know what to expect, but can be painful nevertheless. The essential difficulty could be called an identity crisis... For the last five or six years I had been a prime mover on all medical committees and in management and received a lot of recognition and respect in a wide circle and the health service in particular. One does not ask for it, but it is there and one gets used to it. It is astonishing how short is the time it takes to change from being apparently "someone" to being frankly "nobody". That is the first important lesson and accepting that one is now "nobody" is the first step to a happy retirement. I put away my daily diary, which had been so necessary to keep appointments with all my committees and commitments and now had lots of time to do some, if not all those non-medical things which had been pending for ages. Getting away for more than a week had been a problem; now I could do it whenever I chose. I decided to keep up with medicine by doing odd locums, but only for isolated single-handed practitioners, for whom I had particular sympathy, and to use my expertise to work in interesting places abroad. It is difficult to remember the dates of these locums; suffice it to say that I gave my name to the Highland Health Board and to the Argyll and Clyde Health Board both of whom were delighted to be able to call on my services at short notice.

ART STUDENT?

As a complete contrast to all that full time medical work, on retirement I ventured into the World of Art by signing on at Carlisle College of Art (now University of Cumbria) in early 1980. The academic year had started the previous October, but I was welcomed at trivial fee and, with the help of the tutors, constructed my own timetable. So it was "Life-Class" on Mondays, pottery on Tuesdays, "complementary studies" on Wednesdays and Sculpture on Thursdays. The results are still occasionally seen round the house although "Thelma", my effort at sculpture, was unfortunately stolen from the garden in February 1999 after gracing the top of the bank for nearly nineteen years. That summer I went for a fortnight's course to the art school at Marlborough College; an interesting but sometimes frustrating exercise with much more positive teaching than at Carlisle.

I had to give up the Art that summer when I began to suffer my first serious illness with the gradual and somewhat painful loss of the use of the muscles of my hands and arms. My local G.P. did not recognise the condition and thought I was either imagining it or spoofing. I discovered myself that the condition responded immediately and dramatically to small doses of steroids, so I changed my doctor and got sent to the hospital (I thought I had better have guidance if I was going to be on long term steroids), where we eventually decided that I was suffering from Polymyalgia Rheumatica. Once I had learnt to control the condition, I could live and work with it and it took 18 months before I could wean myself off the steroids.

 

Here follows the stories of various locum duties in the six years following retirement from full time practice; not necessarily in strict chronological order.

COLONSAY (1980)

The first call for my services as a locum came from the Argyll and Clyde Health Board who required my immediate services on the island of Colonsay. The doctor there had to be evacuated forthwith with a broken jaw; he was said to have walked into a door (!!!) and would I please present myself the following day to catch the 4 o'clock boat from Oban. It was the summer holiday season and other cars on the boat were loaded with everything necessary for a self-catering holiday. Colonsay had, and probably still has, quite a lot of self-catering accommodation and one nice little hotel run by an Kevin Byrne with a charming wife who was also a very good cook. St. Andrews Cross flew constantly on his flagpole and he was also local innkeeper and ran the off-licence. I was happy to be accommodated there. Work was interesting and varied, as the hundred or so permanent residents on the island were greatly outnumbered by the visitors. All sorts of social activities took place in the equivalent of a village hall in the evenings and there were country games on what passed for a sports field. I listened with much pleasure to Gaelic songs and took part in Scottish dancing, my partner being usually a very sweet young girl whose main job at the time was being waitress at the hotel; I heard later that she went into nursing as a career. One of the reasons for my presence being required so urgently was that the Duke of Edinburgh was due to fly in by helicopter from the games at Lowther to join the Queen who had been on a formal visit to Islay and was on the Royal Yacht which anchored just off the pier with its attendant destroyer. We were all granted gawping rights. Other interests on the island were Colonsay House and its gardens, the home of the Lord Strathcona and Mount Royal and his family and the island of Oronsay with its old abbey, reached from Colonsay at low tide across the sand. On the map there is marked an air-strip, but it was said to have so many rabbit holes that landing would be dangerous. Local legend has it that the first wife of Lord Strathcona left him for a Loganair pilot and thereafter they were denied landing rights.

I paid a second visit to Colonsay when the doctor had to go off for further attention to his jaw; by then the season was over, the weather not so good, so the sparkle had, to some extent, gone.

MUSCAT AND OMAN (1980 / 81)

A little more adventurous was a locum to Muscat and Oman, recruited by Allied Medical; This must have been the winter of 1980/81. On the way there I suffered the effects of so-called jet-lag... I suppose the effects of an alcoholic flight with just enough time after dinner on the plane to get to sleep, when the time difference meant that wake up and breakfast came almost immediately. It took a day and a half before I could cope properly. The set-up was that I was officially employed by contractors called Yahya-Costain; the usual Arab arrangement whereby Costains do all the work, but all firms operating have to be mainly Arab, so the outfit has to have a 51% local boss, in this case a Mr Yahya (I think that was how he spelt it). Owing to tricky local politics, I had to play it very low profile because all sorts of difficulties were put in the way of getting an official work permit. The pay was quite good, the local club provided food and drink, including alcohol, at reasonable prices, I had a car and driver to take me on official business and into the town of Muscat, and to the main residential area of Medina Qabus, where most of the European Expats lived, provided that their employing companies paid the extortionate rents and water charges, and where there was a European style mini-supermarket. The other British employees were kind and took me occasionally on their boats to sandy bays for picnics and bathing. So, socially it was interesting but medically it was a bit of a disaster; the doctor for whom I was doing the locum was allowing the chief of his Indian or Pakistani staff to run his own clinic, where drugs, particularly amidopyrine, which is banned in this country, were being frequently used by injection at the patients demand. Anyone who got the aplastic anaemia which this drug occasionally causes was rapidly discharged from the company's employment ... in some cases, undoubtedly to die at home from the effects.

There was one only one other British doctor practising private medicine in the area (in Medina Qabus); His fees were high and he was a bit averse to turning out for emergencies. This I found out when I was asked to go, in the night, to one of the big hotels in Muscat to see a Gulf Air employee, an air hostess with bellyache. There wasn't much wrong and it certainly could have waited until the morning. I am sure they were testing the system before deciding to change their medical adviser.

During my visit to Muscat and Oman, I managed to get a visit to Nizwa, an interesting all-Arab town renowned for its silverwork. I saw some of it but was more impressed by the local castle with its bottle dungeons. My driver was very nearly locked up for passing an Arab motorcyclist on the way there; odd how touchy they can be! It was also reported that there were two Europeans in the gaol there for getting drunk and being rude. Incidentally they had about two miles of dual-carriageway in Muscat and were operating speed traps on it; anyone caught had a compulsory 24 hours in the formidable looking local castle which served as a gaol. I also visited a site further north where copper mining was getting started and the foundations of a copper refinery were laid. There was evidence of ancient copper working at the same site and there was reported to be a considerable amount of silver in the ore. There was good reason to presume much ancient metal working and that this was an important source of copper in the ancient world which may well have been that lived in and worked by the Magan, a tribe often tentatively attributed to the other side of the Strait of Hormuz.

(Some months later I was invited to take medical charge of the company's operations in the copper mining and works, but declined when I found that I would not be in sole charge, but would have to play second fiddle to the man for whom I had been doing the locum.)

John Simpson, a friend and consulting physician who retired from West Cumberland a few years previously was working at that time in Sharjah, so I broke my journey home from Oman by visiting him for a couple of days, which gave me the opportunity to look for the parts of Dubai which I had known on my first visit to the Gulf. Big disappointment, Dubai was now a modern city, like so many others in the newly prosperous Arab world; nothing immediately recognisable from previous knowledge and not enough time or opportunity to explore in detail. Sheikh Rashid was by then the ruler and it would have been interesting to visit him, as I am sure he would have remembered me, but he was away visiting Pakistan.

Meanwhile my wife had arranged a package holiday in Egypt, so we arranged to meet in Cairo and set off on our tour of the sights of ancient Egypt. I don't think I need enlarge on the sights of Egypt, suffice it to say that, in spite of much hype, the remains of ancient Egypt were well up in terms of interest and value.

GRENADA

While I was in Muscat and Oman, one of the other feelers I had put out resulted in a transatlantic call from: Grenada. I had written expressing an interest in introducing "Primary Care", as they call it, to the final year medical students at the "University Medical College of St. George's in Grenada". (Now St Georges University.) This I dealt with on returning home from Egypt. They wanted me to go, but being a little dubious in view of the questionable merit of American offshore medical schools, I thought it wise to have a month of mutual appraisal, to which they agreed. Basically the terms were: either you go alone and get paid or you take your family and get free accommodation but no pay. I opted for the latter and off we went. We were accommodated at first in the Manor House, where for the first few nights the mosquitoes nearly drove me mad, but after that the weather and general conditions were almost ideal. After a week in St. Vincent we returned to stay at "Twelve Degrees North", a group of idyllic flats with private beach, lovely clear water, beautiful coloured fish to feed from the jetty and water at just the right temperature for comfortable bathing. I had free range to explore the medical set-up, including visiting the hospitals, both in Grenada and St. Vincent. There was a lot to be done! For a start there were no proper facilities for the treatment of the staff and students themselves; treatment of the general population was by half a dozen or so independent doctors. The hospital in Granada was run by a U.K. trained surgeon by the name of Ethelstan Friday, who welcomed me and showed me around as did his opposite number in St. Vincent.

I joined the entourage for one or two ward rounds ... two anecdotes may serve to illustrate the problems.

  1. In the hospital in Grenada there was one ward catering for malnourished children; they were not suffering from any recognised disease, just simple starvation. This seemed odd because I had been told that no-one had ever been seriously punished for stealing the odd banana and there were plenty of fish in the sea, easily got by the poorest. I asked the ward sister what happened to these children and was told that were mostly the offspring of very young mothers and that sometimes they could persuade an older relative to adopt them, otherwise a veil was drawn over their fate. Chasing this story to its origin it appeared that to prove his manhood, a young man had to get a girl pregnant. Local medical services were not short of contraceptive pills or other means of contraception, so the lads would steal their pills and prove themselves. Where funds or willing carers were not available to nurture the resulting infants they were sometimes deliberately starved to death. Long term contraceptive injections were still at the experimental stage of development, but popular when available. It was difficult to know where to start!
  2. In the hospital in St. Vincent on a consultant's ward round, the assembled doctors were invited to consider the cause and treatment of a feverish six-year-old child; various ideas were put forward and I was asked to comment. Looked like otitis media to me, so I asked about the appearance of the eardrums. So the consultant sent for the auriscope, then there was a hunt for batteries to make it work, then, for treatment they had to decide whether this was the best case to treat with the two doses of penicillin they had.

I had previously expressed the firm opinion that Primary Care, by which they meant General Practice, could only be taught with real live patients. Looking at the numbers involved, I though that the best way would be to attach two students at a time to each of the G.P.-run clinics on the island, and pull them in once a week for a seminar on what they had done and seen. There would be a little more to it than that and I suggested working from a book "Towards Earlier Diagnosis in Primary Care" by Keith Hodgkin, which was the best available at the time. However a major snag developed... The Island was then under communist rule and the local Ministry of Health refused to allow any students into their clinics! I suspect that this was because they did not want it to become clear that all these clinics were charging their patients, not legally, but known and tolerated as there was no other way in which the doctors could make a living. It may have changed since then, but I understand that such practise was then almost universal in communist countries. This could be the reason why you never hear doctors in these countries overtly criticising the service The net result was that the ground was swept from under my feet and there was nothing left but to go home. In some ways I wished I had signed on for the whole year when it was offered, but academically it would probably have been too frustrating.

PAPA WESTRAY

You can't get much more remote than the smaller Islands of the Orkneys. I agreed to be one of the last few locums on Papa Westray, an island with, then, about a hundred residents I got there by flying from Glasgow to Inverness by British Airways, then by Loganair to Lerwick, where I was met by the local organising medical officer. Mrs. Thatcher arrived about the same time, but not on the same plane and had full use of the main hotel, so that I was accommodated in the slightly lesser establishment near the Highland Park distillery for a couple of nights until my next flight. Time was filled in by trying to remember where I had been when there before in the early days of the war, on the way from Fetlar (Shetland) to Cambridge in 1939. Saw the beautiful little church built and decorated by the Italian prisoners of war, the causeways built between the islands to prevent German U-boats getting in, and was very pleasantly surprised, having been advised to visit the museum and art gallery at Stromness, to find that they had a very fine collection of sculpture by Barbara Hepworth in that tiny converted boathouse. Then off by one of the eight-seater Islander planes run by Loganair to Papa Westray via Westray, the flight from Westray to Papa Westray being the shortest scheduled flight anywhere in the U.K., if not the world. Fantastic small planes which could land almost anywhere even in the howling gales so common in those parts. Met by the island general factotum who introduced me to the ageing Mini with which I got round and who ran the fuel and general, but not food store, cleared the airstrip of cows, and was responsible for keeping it in working order. Although The "hydro-men" were putting up the posts and wires for a proper electricity supply, the only electricity on the island was from individually owned generators, and my first task in the morning was to start up the generator by the surgery and sweep out the surgery. Any necessary drugs and other supplies had to be ordered from Westray to come over on the school boat. There was an infants school on the island, but all senior to that went off and returned daily to Westray. When children reached grammar school age they went off to board at Kirkwall; much the same pattern of education as applied to other island communities elsewhere in Scotland. There was very little work to do, my creature comforts were looked after by a Mrs. Drever, whose house had a sort of granny flat. Any sort of social life on the island was inhibited by the religious beliefs of the inhabitants, half of whom attended the Church of Scotland ... very fierce! all hell and damnation; no mention of love or forgiveness. The other half were "brethren", and as the latter will not sit down to eat with any but their own, and with a total population of about one hundred there was virtually no social life at all. (How different from Colonsay!) Incidentally the only alcoholic drink supply had to be from the hotel on Westray, brought over in charge of the schoolmistress, who was a member of the (non-drinking) brethren. Nevertheless a fair amount of alcohol was consumed: it was not considered proper to pull the curtains when entertaining, but no-one was quite sure what was in those teacups! The birds and the seals and the amazing amount of largely unexplored archaeology, both on Papa Westray and on the neighbouring uninhabited island, Home of Papay, provided daytime interest.

LYBSTER (1983) (1st Aug 1983 to 30th Sept 1983)

This was a practice where the doctor had totally lost control. Patients were being allowed to order their own medicines and certificates. There was no secretarial help for a relatively large and scattered practice with all sorts of patients from frankly irresponsible gypsy types to thoroughly respectable professionals. The outgoing doctor had been persuaded to retire and there was going to be a period of two months or so before the new doctor arrived. I quickly established contact with the incoming doctor, a Dr Peter Joiner, who was working in his multiple practice in Kingussie until he could be released from his contract. In a situation like this one really can do useful work in bringing the patients round to proper medical treatment, in collaboration, of course, with the incoming doctor. (Where one is relieving for a limited few weeks it is no good initiating new treatment if the regular doctor prefers the old). So I asked Peter Joiner what new ideas he would like to introduce with the promise that, if I agreed, I could relieve him of some of the antipathy he might meet when he took over. In Kingussie, the group practice had all agreed to stop prescribing many drugs such as the benzodiazepines, which although popular, had proved to be addictive and potentially dangerous. So ... I did just that, in addition to letting it be known that from then on, patients would get what I thought was best for them ... not necessarily what they thought they ought to have. This went down very well except in two cases which ended in an almost running battle for the sleeping pills to which they had become habituated. The next practice was about ten miles to the south at Dunbeath, close enough to allow covering for half days and part of the weekend. Distances in northern Scotland can be quite considerable, and the first evening I was on for him, I had to do a round trip of about sixty miles to see one of his more remote patients. But it did give me the welcome opportunity to explore the area from the chambered cairns of Camster to the old gold workings upstream from Helmsdale. While there I was accommodated in a small hotel noted for its good food (when I went back ten years later to look, the owners had gone and the good food too.) It was one of the few times that I have ever had to decline anything significant for lunch, otherwise I could not do justice to the dinner. It was the sort of place where local hoteliers came to eat out for special celebrations: on one occasion Barbara Cartland, all in pink, came in for Sunday lunch with her entourage. While I worked there the house was re-decorated for the Joiners, whom I took for a tour, pointing out where trouble could be expected, at the same time taking my wife, who had come up by train, on a brief tour of the area.

WESTER ROSS (1984) (1st Jan 1984 to 12th Feb 1984)

This was another exercise in filling in the gap between one retiring G.P. and the installation of his successor. This time, however, it was winter and a very tough winter too. The outgoing man was clearly deeply religious, holding strong typically Scottish Presbyterian views, not the most extreme, but not far from it. He had arranged for me to be accommodated, living as family, with one of his cronies. That of course was not acceptable to me, but, being the very definitely "off "season, hotel accommodation was sparse and I had to work through two before I found an acceptable arrangement; this even involved having a special telephone line fitted so that I could respond to emergency calls out of hours and especially at night.

The practice was based at Aultbea and covered the whole coast round Loch Ewe and Gruinard Bay, with a branch surgery at Poolewe. Normally delightful country, with many very interesting and charming people from all walks of life. The nearest colleagues were at Ullapool and they covered the eastern side of the area as far as the sides of Little Loch Broom and, to the west there was a practice of two doctors and a trainee at Gairloch. These latter had been providing cover for half days and odd weekends, so I made it my business to look round their practice area in order to continue the arrangement. However they thought it kind not to get me involved with their practice and I felt a little diffident about accepting their help without a quid pro quo, so there was virtually no time off; not that there was anything to do anyway, as the weather was such that any venture out of the practice area might have resulted in being cut off by snow on the high ground at the boundaries of the practice.

Within a few days of my settling in there were some awful gales, 100 m.p.h. plus, and heavy snowfalls, many trees were blown down, including some important ones at Inverewe Gardens; practically every house suffered some damage, the electricity was cut off for several days and I had to make urgent arrangements for heating the surgery. One young girl suffered a nasty cut wrist, severing a nerve, caused by flying glass; getting her to hospital in Inverness might have been impossible if her father had not been the man who operated the snow-clearing bulldozer or grader.

I got in touch with the in-coming doctor in order to do for him much the same as I had done for Peter Joiner in Lybster, but he was not interested... I made friends with many local residents, including R.G. Macfarlane who had just written a book about the discovery of penicillin and thought that much more credit should have gone to Florey rather than Fleming. The BBC sent a television crew up through the snow and ice to record his views, which I later saw on the box. John and Anette Gibson, who looked after the Inverewe Gardens, I also got to know well and took photos of the storm damage to promote their claim for help in restoration. One of the big social problems in such places is the terrible division caused by the various sects of the Church in Scotland: the differences between them seems to be merely whether particular pieces of ritual should be spoken, intoned or sung. So trivial, yet so important to narrow minded parishioners, particularly the elders who make the rules. The ministers were, on the whole, nice people, in spite of the fact that they preach hell fire and damnation rather than love and forgiveness. The one with whom I got on best was the "Wee Free"!. After I left I had some very charming letters from a few of the patients whose lives I had improved by modernising their long-term treatment: a rare pleasure!!

(When I called back some years later, all had changed; the hotel had changed hands, the Gibsons had moved on, the ex-pathologist had died, slight disappointment to be forgotten so quickly ... but that's life!!)

ISLAY

This was summertime again, and I was asked to cover two practices, one after the other. I was accommodated in the local hospital; a G.P.-type organisation where one looked after one's own patients and took one's turn in being on call for emergencies. I was not aware that any specialists ever visited; there was little need for we had an efficient airport with daily service to Glasgow and free availability of emergency planes, run by Loganair. There were three doctors on the island, one in Bowmore, for whom I did my first duty for a month then round the bay to Port Charlotte for a second month. The third doctor was stationed at Port Ellen, a friend and college contemporary of my cousin Laughlan MacPherson. I saw very little of any of the doctors and had plenty of time to explore the island. Things that stand out as different were the seriousness of the hospital work we had to do; thinking of a patient on peritoneal dialysis which went wrong in the middle of a stormy night ... telephone advice from the hospital which initiated the treatment and evacuation by air as soon as the weather cleared sufficiently settled the matter quite efficiently. With the number of distilleries on the island, there were quite a number of problems with alcohol and we had a reasonably well established routine for drying out those who needed it. I had to deal with one serious incident when two men had gone sea bathing on a part of the coast known to be dangerous. I dashed off to cope as soon as I got the call and we managed to pull one of them round. The rescue helicopter came in just after I got the first casualty to the ambulance, but the other we never found in spite of the efforts of the helicopter. A slightly less serious incident occurred soon after I had visited the local museum and saw there a preserved adder in a jar. "Oh yes," I was told, "they are quite common on the island". When, the next morning I heard advice on the radio that anyone bitten by a snake should go to the doctor who would know what to do (!!) I thought I had better find out with all speed. Just as well that I did, for a day or two later I was rung up by a local farmer who declared that he had just been bitten by a "serpent". I had by this time discovered that the most dangerous thing you can do for snake bite is to use anti-viper-venom serum. He had unfortunately destroyed the "serpent", but 24 hours observation showed that he was none the worse.

I managed to attend the odd ceilidh and pay one proper visit to a distillery, that at Bowmore, where I reckon the best malt whisky is made. I also met and covered one day for the doctor on Jura; a small practice, well organised; I formed the impression that patient handling on the island was good and much more sympathetic than the handling in the Glasgow hospitals.

SAUDI ARABIA

I did two separate locums in Saudi Arabia, quite some time apart where I was able to practice or re-learn the little Arabic I had learnt in the Persian Gulf.

The first was at Al Kharj in a military hospital attached to a munitions factory. Al Kharj is a small town some sixty or so miles south of Riyadh. The hospital was a under the same overall management as the Military Hospital in Riyadh. I had a flatlet to myself which was quite comfortable and well equipped, including a cupboard containing the hot water tank: that may sound trivial, but not so!! All the flats were the same and it was in these cupboards that a carefully prepared mixture of grape juice, sugar and yeast was put into suitable containers and allowed to mature for several weeks, after which it became just potable as red or white wine. There were even competitions to see who could make the best brew; it was said that the Scandinavian plumbers/water engineers could knock you up a still in a matter of an hour or two. I wasn't there long enough to develop my own wine or spirit production. So much for a country where alcohol was officially banned! I found a thoroughly hypocritical society with a lot of alcohol being consumed by the Arabs as well as the expatriates. I heard of one ex-pat who took a job there hoping it would help him to overcome his addiction to alcohol. What a Hope! The Arab authorities dare not search the flats as they would then have to send most of the expat staff home and close the hospital. Anyone turning up drunk on duty was, of course, sent home the next day. As well as getting the key to our flats, we were also issued with a key to the swimming pool, where mixed bathing was allowed for Europeans only. It had an eight foot wall round it in an attempt to keep it private, but if one looked round it was normal to see Arab heads peeping over the edge of the roofs of surrounding buildings. It was only a short walk to the hospital which I often took rather than use the bus which went round. One can only speculate on the reasons why no Indian artisan was ever seen to walk, or even take the bus, if he could share a car with his compatriots.

With regard to the medical work, we had reasonably good interpreters, many Filipino nurses, all very tiny but quite sweet and efficient. We were there officially to deal with the employees of the munitions factory, but if they wrote a sufficiently crawling letter to the local Arab boss, they could get free treatment for their families as well, so the net effect was similar to general practice anywhere. Often the whole family would come together and all members would have to have their problems solved before the consultation finished. The women were in an interesting state of semi-emancipation, so one never knew whether they would be examined or not, so an invitation to submit to examination could result in anything from a blank refusal to virtual total nudity. In retrospect I am surprised how little difficulty I had in spotting and coping with some of the rarer tropical diseases. I also remember only too well the frustration when one had to ask a specialist to take over a difficult problem: they were in the process of employing Arabic speaking specialists, especially from Sudan, of, in my opinion, very doubtful competence, but they were in charge and, in those parts, the G.P. is at the bottom of the pile and can't criticise... One unexpected pleasure followed treating one of their religious leaders for a bad back; He was a bit doubtful when I manipulated his back and complained loudly at the time but when he found he was better, I was always given the warmest smiles and greetings for the rest of my stay.

On the social side, there was a local market one day a week, interesting to visit, and on one occasion a locum visiting physiotherapist, a very pretty young blonde wanted to go there; Women were not allowed to leave the hospital compound alone, so I agreed to take her. I had to escort her past the guard at the gate and I am not quite sure what he made of my Arabic, but I think he let us pass on the assumption that she was my wife! Although properly dressed in a long white dress with arms appropriately covered, she obviously caused quite a stir among the market women traders all covered in black. I also managed a few visits to Riyadh, including one around mid-day on a Friday, when after attending the Mosque, there is a kind of market where one could see all sorts of goods including hawks being traded for almost astronomical sums of money. It is also the time and place where miscreants, having been tried in the mosque are led out into the square to have their heads or hands chopped off according to the nature of their crime. Riyadh is the one place in the world where you could stick ten thousand rials in your back pocket and no-one would dare touch it.

My second experience of Saudi Arabia was at Khamis Mushayt. This was surprisingly different from my previous visit to Saudi Arabia. When I first arrived at my bungalow, I wondered about the air conditioning and could see no evidence of it. It soon transpired that, as we were seven thousand feet above sea level, we were more likely to suffer from cold than heat; but that is a trivial detail. The history of this appointment was that the organisation had, until that moment been run by an American firm, Whittakers, whose services did not come cheaply. The Saudis realised that the same or better services might be obtained at less cost and instead of renewing Whittakers contract, had put it out to tender. Allied Medical had taken over the contract at about half the fee that Whittaker had been charging and were now offering contracts to the resident personnel at about half the rate they had been getting under Whittaker. Morale in the organisation was, not surprisingly, low and about half the specialists were about to go, while the others reluctantly accepted the new terms. I was the first person to be recruited by Allied Medical to work there, so they hadn't got their act together at all: no welcome package of food or supplies ... no-one deputed to advise newcomers &c.: that all came later ... I had to fend for myself. With the staff reduced to half, I and those remaining had to work very hard to keep up any sort of standard of medicine. We worked on a shift system, but had to agree to take extra shifts, especially in the evening. Patients behaved in much the same way as at home, turning up at all hours of the night demanding treatment for conditions which should have been seen during the day. It was useless to complain, and in any case, overtime was being paid at the previous "Whittaker" rates, so we were well compensated. Social life was very restricted, food in the canteen was, I think, cheap and cheerful. No alcohol was available on site, but there was plenty of hooch being made, as in Al Kharj. There was a swimming pool which I cheerfully investigated one day ... walked in, no bother, until I was gently reminded that mixed bathing was not allowed and would I please come back on the men's day. Incidentally, swimming at that altitude resulted in getting amazingly short of breath. Trips out to the town and to local beauty spots were arranged and I did a little exploring on my own. I discovered a small hill with the apparent remains of a temple on top of it, and that it was called Jebel Sheba! This part of Saudi Arabia and neighbouring Yemen is thought by many to be the original kingdom of Sheba, but nobody seems to be taking any interest in the archaeology of the area and as my investigations were being looked on with suspicion, I did not pursue that line.

From a medical point of view, the sexes were segregated, that is, we saw only men at the main hospital in the compound and had to go to a different hospital outside to see the women and children. Medical problems were much as at home, with a few exotic diseases to watch out for. they had quite a good library with audio-visual tapes so that one could brush up one's knowledge of the rarer conditions. I recall two peculiarities!! Calling for specialist help was not helpful: they would just ask for the results of tests, would not come out, and advised treatment only on the basis of path lab results. When a patient with the most obvious myxoedema came my way, I stated my opinion boldly and in writing and started her on appropriate treatment... This was NOT the right thing to do, I should have taken a specimen of blood and sent it off to U.K. and waited six weeks or so for the result before starting treatment.

Having the right tests done is all important in American medicine. There was one employee in the department whose only job was to look through the notes to see that all the correct bits of the patient had been examined, the right tests done and the findings recorded otherwise one might be accused of negligence. I found it very difficult to practice medicine while constantly looking over my shoulder.

Before I left, I offered to reorganise their system according to British standards, but that would, I think, have been too much for the remaining specialists, who would suddenly find themselves having to appear on demand and accept the dominant stance of the British G.P.

TOO OLD?

Exploring the Arab world a month or two at a time seemed interesting, so, when I saw an advertisement for a locum doctor to go to San'a in Yemen. From illustrations in magazines and books it looked most interesting and the job was sponsored by a big international company, so I duly went along for interview: ... the interview went more or less like this; I was first asked to describe my experience... "Just what we need!"... " When can you start?" I asked whether next week would do. They reckoned that I was perfectly suited to the job and just wanted a few details for the record. When they got to "When were you born", I answered truthfully ... it was then early 1985; there followed a short silence followed by the dreaded words equivalent to "Don't ring us, we will ring you". It seemed that there was a firm policy in the company not to employ anyone over 65. The same thing happened the next time I tried for an interesting overseas job, so I had to give up that idea.

I only did one locum job after that at the suggestion and by recommendation of Tony Thursz, who was then based at the hospital in Alexandria. This was as locum consultant dermatologist, covering clinics in the Southern General Hospital in Glasgow, the hospital in Alexandria and clinics in Dumbarton, Helensburgh, Dunoon, Lochgilphead and Oban. There was a generous financial allowance for nights spent away from base, of which I took full advantage. I enjoyed that thoroughly, although the ideas as to what constituted proper dermatology had changed out of all recognition since my dermatological days. It seems now that no-one can start on a career in dermatology without the MRCP, so now they are all looking for an opportunity to out-diagnose and out-treat any truly medical problem that comes their way, especially some obscure internal disease presenting with a few skin lesions, cases which, in the old days, we would have chased off to the General Physicians. The sort of skin disease we used to worry about were Acne, Psoriasis, Lupus Vulgaris and the dermatological variety of Lupus Erythematosus, Lichen Planus, Alopecia areata and all the other eczemas and dermatitides which are now more or less ignored. In fact I think progress in their understanding and management has been essentially negative for the last thirty or so years. Confidential feed back from Tony Thursz suggested that my approach was much appreciated by the patients and nursing staff, but not by the dermatological hierarchy, so I was not invited to return for a repeat performance.

Activity In Fields Other Than Medical Following Retirement

The purchase of a flat in London made a big difference to my ability to get about and do research. This was made possible following my mother's death (Born 3 August 1895 died 29 April 1981). She had always been slightly envious of her London relations and would have liked to have a flat in London, so, adding a few thousand to the twenty thousand pounds she left me in her will, it seemed a very proper to use the money to acquire my pad in Russell Court. I could then my pursue my several interests in Art, Antiques including silver in particular, conduct researches with the use of the British Library, the Public Record Office, the British Museum, the V&A &c. without anxiety about the extra expense of a few more days in London when circumstances dictated. To further these ideas I soon joined the British Museum Society, the Friends of the V&A, the Friends of the Tate Gallery, the Friends of the Royal Academy and the N.A.C.F. thus getting free and unrestricted access to all major exhibitions.

VICTORIA AND ALBERT MUSEUM

Soon after joining the Friends of the V&A, it occurred to me to wonder how the funds raised by the Friends was used and who decided where it should be spent. A few pointed questions soon led to the realisation that all the money was disposed of by the Associates of the V&A (in effect two very pompous women) and that the Friends had no say at all. This seemed to me very unsatisfactory and I looked into the constitution of the various committees. Sorting it out seemed a formidable task, but everyone I spoke to on the subject agreed that "something needs to be done", so encouraged by the secretary of the Friends, one Nonie Vincent, I got out the wooden spoon and had a very good stir. We eventually set up a Steering Committee with the blessing of Roy Strong, which became the proper committee of the Friends after about two years. I had in the meantime written a Constitution for the committee and, to ensure that it did not become a self-perpetuating oligarchy like so many others, wrote in the obligation of all committee members to have a compulsory year off after three years, which meant that, of the original six, two would have to retire each year. I accepted the duty of being one of the first two to go after only one year. I also initiated the idea that the Friends would seek to offer practical help in any department of the museum according to individual taste and ability. This was how I found myself in the metalwork department, firstly helping Philippa Glanville with her book on English Silver and later Ronald Lightbown with his book on Medieval Jewellery. It gives me pleasure to see the Friends of the V&A prospering, tinged with slight regret that nobody now in office will have any idea as to how they achieved the status and spending power they now enjoy.

ANTIQUE SILVER: The Silver Society and Silver Study Group

The Silver Society is the most prestigious body of researchers and connoisseurs in the silver world, counting among its members most of the big dealers and manufacturers. I was encouraged to join by Philippa Glanville and regularly attend their meetings, now usually at the Basil Hotel, where we meet about six times a year and listen to papers by members on their research; there is always time allowed at the start of meetings for members to bring out interesting pieces they may have found round the markets. They also arrange two outings a year, one to an interesting venue arranged by the President in his year of office and the other an overseas visit which I have normally considered too expensive.

I presented my own research into frauds in the export and import of silver, mainly flatware, between 1784 and 1845, and the attempts of the Goldsmiths' Company, the government and individual customs officers to catch the guilty. The full work is deposited at Goldsmiths' Hall, and a slightly abbreviated version appeared in the Proceedings of the Silver Society, so I need not include more than a passing reference here except to comment that this research involved many hours over several months at the Public Record Office in Kew, hunting through many huge tomes of hand-written customs and excise records. It is always interesting to find that there are marks on antique silver which no-one has tried to explain, and personally satisfying to attempt a solution. Other research in silver include a tentative explanation of the three-cusped duty mark, published in the "Finial", the finding and retrieval of the "Ireby Cup", published in the "Silver Society Journal", Some facts about the Howard Grace Cup, now in the V&A; Philippa Glanville has written a lot about this famous cup, but didn't know that it had spent some time in the possession of the Dukes of Norfolk when they were at Greystoke. A more recent research into the origin of a spoon in my possession suggesting that it could possibly have been made in Stirling is being passed round the silver 'establishment' but may prove to be a little too far out for the Silver Society although the idea was surprisingly acceptable to the Silver Spoon Club.

The Silver Study Group (SSG) is an organisation run by one Myrtle Ellis, to which many enthusiasts on the subject belong, many ordinary folk belong to both the Silver Society and the SSG, but the top dealers, manufacturers and experts from the best auction houses stick to the Silver Society only. The contrast is amusing to those not too concerned with prestige, for whereas I am given the honour of being considered an expert in the SSG, I take a quiet back seat in the Silver Society. Both organisations run visits to prestigious collections but there is no doubt that Myrtle is the best organiser; she seems to have a well practised way of getting curators to open their cupboards and let us handle the goodies. For the uninitiated, I might add that the appreciation of silver is as much tactile as visual. Some of the addresses to the members of the Silver Society are undoubtedly erudite, but can be boring by being badly presented. The main attraction of many of the meetings of both organisations is that they allow time for us to show each other our most recent finds and to get good opinions on any doubtful features.

FREEMASONRY

The subject of religion in communities and its basic beliefs and its influence as a code of conduct has been a quiet background subject for serious thought and reflection for many years. I have recorded my developing thoughts and ideas in a separate paper which is in my records as "God without Myth" (not yet finished July 2002). While looking around for a basis for a life style and code of conduct, it was while still working in Bart's and other London hospitals that I began to wonder what Freemasonry had to offer and made tentative enquiries about the Old Oundelian Lodge and was initiated into "The Craft" in a Masonic temple at the back of the Talbot Hotel in Oundle a month or two before joining the I.P.C. in the Lebanon and the Persian Gulf. My attendance at meetings had to be suspended while I was overseas, but on my return, I managed to get to London to work my way through the various offices to become Master of the Lodge in 1959. This formed, in my opinion as good a basis for a code of conduct as I was likely to find, especially when a certain amount of nonsense was removed from the ritual some years later to make it clearly available to members of practically all religious beliefs. More recently, as my ideas of the interpretation of "God" developed and I heard of a potential new member of our Lodge thinking that he would be unable to join as, being a scientist, he didn't believe in the usual interpretations of "God", I wrote a short paper entitled "Can God Be Defined" which is available in my records and which I sent to our lodge secretary to be offered to any candidate with similar doubts.

For the record or interest of anyone who wants to know, my status in various degrees are:
Craft freemasonryLondon Grand Rank
ChapterLondon Grand Chapter Rank
Mark MasonryPast Provincial Grand Senior Deacon
Royal ArkProvincial (London) Grand Rank

Envoi

A short retrospect of points important to me as I go into possible years of decline after a life full of interest and much pleasure tempered, of course, by the normal frustrations and anxieties, which always go with those like myself who try to push out the boundaries of knowledge. The snag here is that if you find something new, it upsets those who hold to previous thought, and thus antagonises the "establishment".

Medicine will always be an inexact science; one must bear in mind that good medicine is unspectacular and one may feel some satisfaction for a job well done but rarely get praise for it and may even be blamed for not doing better. On the other hand it is not uncommon to get praise when it is certainly not deserved. Patients rarely know the quality of the treatment they have been given.

On a personal note I have tried to live my life by Masonic line and rule, and follow the principles of brotherly love, relief and truth. Of course I have made mistakes and trust that I may be forgiven for them. Anyone who has to make important decisions can't be absolutely right every time.

I am a little worried by the present trend of working to fixed hours and being paid by the hour. Members of a learned profession should respect honour, duty and responsibility, always doing their best no matter how long it takes; clock-watching is, to me, totally abhorrent.

I am also disturbed by the attempts of the government and others to control the profession, particularly by various types of examination or inspection by ex-doctors and civil servants who can find no way of measuring the qualities of empathy, integrity, honesty, compassion, charity and humility which are so desirable.


final photo

Postscript

Ronald Grant, my father, died on 10th July 2007, in the Arran War Memorial Hospital. He had became very ill in April, and recovered a little but never regained his strength. He was buried on Arran at a small family ceremony on 18th July 2007. We held a memorial celebrating his life on 25th November 2007, in Workington, Cumbria, where my parents lived for 51 years, from 1954 to 2005.

If you have any special memories of or reflections on him, we'd still love to hear them. They can be placed here as separate pages with links from the index. If you would like to write something, please let me know.

Web page prepared and maintained by Simon Grant, September 2002, revisions to October 2011