My Dad was a single-handed country doctor in England. His office (called “Surgery” in English speak) was in our house, so I first encountered patients and a doctor’s life at an early age, indeed just about 80 years ago.
There was no appointment system, so patients arrived at all hours, with an interesting triage arrangement, at least for those who arrived by bus. Reasonably fit patients hurried to the door and were seen first. The ill ones arrived slowly later or were seen in their homes.
I enjoyed accompanying Dad on his house calls to the local farmhouses and cottages. He was also an engineer and built an electric car (honest). during the war. Petrol was not available but we did have diesel to power our home elecriticity egnerator (no mains supply at that time) so could charge the car. Dad’s cars always had pet names, and this one was called “Cowgoose”! Why I know not. It often shot scary green flashes from behind the back seat, like the Aurora borealis.
I watched as he listened, held hands, examined and advised his patients. His only instrument was a stethoscope, which he said was often useful for thinking down as well as listening up. He tended to minor mental and physical wounds, birthed babies and signed death certificates. His few treatments included immunizations, morphine, digitalis, various unguents and cough medicines. There were no antibiotics and infections were often fatal. There was no structured health system.
Things began to change in the 1940s, with the arrival of antibiotics. Penicillin came first, memorable because we had to get a refrigerator to house it. People came from miles around to view this miraculous new invention – the fridge. Mum needed warning before any such viewing, as she had to remove the food that was not supposed to be in with the penicillin.
Streptomycin arrived soon afterwards and was equally memorable for personal reasons. It cured my older sister who had contracted Tuberculosis on a school trip to Spain. Before Streptomycin, the treatment for TB was exposure to fresh air. Those who could afford it spent years in mountain-side villas in Switzerland, exposed to healing cold air. My sister Ann spent two years in a sanitorium on the east coast of England, where the air was certainly fresh, because it was allowed to howl freely through the basic accommodation. I enjoyed visiting Ann there, not because I was particularly fond of her, but because there was a little golf course nearby.
I should perhaps mention surgery which had been revolutionized by the introduction of anti-sepsis and anesthesia about 80 years beforehand. My Dad had taught my brother and I some basics in carpentry and lathe-work. I enjoyed working with my hands, so we thought that I should consider surgical training when I got to medical school in 1960.
Dad suggested that I should study with a former classmate and hotshot surgeon at St Thomas’ Hospital, a Mr. Norman “Pasty” Barrett (surgeons in England are not called “Doctor”, a throwback to their roots as barbers). I was surprised to be the only student at Barrett’s teaching clinic. He ignored me for about 30 minutes and then said: “have you come to learn?”. I mumbled “yes” and he came back with “How tall was Queen Victoria?”. That fact was not in the surgery textbook on my knee. So, after I mumbled again, he said “4ft 11 ½. Don’t ever forget it”. I have not, nor indeed ever questioned it, nor whether he described the condition that is named after him. (He did not).
Dad liked to tell me that he had been taught biochemistry at Cambridge in the late 1920s by a certain Frederick Gowland Hopkins who received a Nobel prize for inventing vitamins. By nice coincidence I was also taught biochemistry at Cambridge (some 30 years later) by a Nobel prize winner, Francis Crick. He struggled with the directions of his DNA helix every Wednesday afternoon…and became my patient many years later.
There was a small room in our house next to Dad’s office where Ballard ,the live-in pharmacist, dispensed the few medicines that then existed. She was called just “Ballard”, in the same way that the farmer’s wife from the village who babysat me was called just “Pitt”. Students of history and Downton Abbey will know that staff “downstairs” in earlier days were called by their surnames (or even the surnames of their masters). As a 5- or 6-year-old, I used to stand on a chair in Ballard’s “dispensary”, and watch her mix “tonics”, apparently random mixtures of colorful liquids in the pretty flagons that you now see in museums. She would add a little of this to a little of that, but always a good measure of the green liquid that she called “worse than cats” because it smelled bad. She must have had a traumatic cat experience to make that connection.
When Dad died prematurely I found stubs of his death certificates showing a roll call of puerperal sepsis, rheumatic fever, TB, pneumonia and other infections, polio, farm accidents etc, scourges that had chnaged very little over the previous 80 years.
Dad had taken a partner, Doug Chandler, in 1950. Although then very young, I well remember when he entered my life. He was a medical officer during the war at the nearby RAF aerodrome. He was a dashing man with red hair and a smart uniform, with stories about the Air Force, Spitfires and Mosquitos. He gave me model airplanes with which to act out my fantasies. He had a significant influence on my life and development through adolescence, always thoughtful, calm and positive. Doug also introduced me to golf. When at home I would join him and the local Vicar at Wormsley or Kington courses on Wednesday afternoons.
He kindly offered to keep the practice place open for me after Dad died prematurely while I got more training, but I eventually decided to eschew general family practice and to specialize. I think I was intimidated by the vast scope of general practice and chose a specialty which (at that time) seemed simpler and easier to handle. But I have not lost my admiration for general practitioners, navigating the massive spectrum of health, illness and their management, and acting as their patient’s friend and counsellor.