Hewading 1Winners of the Sands Cox CHAAY pRIZE
Fifty years or a Lifetime in General Practice
A J Allan M1951
I left King Edward V1 School at New Street from the lower sixth in 1937 to get a job but really wanted to do Medicine. It was intended that I should be a printing engineer. Came “Munich” and I joined the Royal Artillery, Territorial Army.
I had enrolled at the Medical School early in 1939 but on 24th August the T.A. was “embodied”, a delightful word meaning taken into the regular Army, and on 3rd September we were at War.
We started in an antiaircraft role around Warwickshire, were involved in the Coventry Blitz and shortly after found ourselves in the Orkneys defending the Navy in Scapa Flow. Commisioned in 1942, I went out to North Africa with the First Army. Italy followed and after a time defending the port of Naples the Regiment joined the Eight Army and we pushed up the Adriatic Coast with all its contested river crossings. “V.E.” day found us near the border with Austria into which we advanced in an attempt to prevent the Russians taking the country. As a side line the Jugoslavs had to be stopped from taking Corinthia, the Southern Province.
In 1939 I had time to go across to Edgbaston to say I would not be joining the Year on 4th October. I was shown into the Dean, Stanley Barnes. He walked to the car park put his arm round me and said that when I came back there would always be a place for me. Six years later I came home on leave from Austria and was shown into the office of the Sub Dean,
Charlie Smout, an odious man, who informed me that I did not have to join the army and he did not know if there was a place for me. I was in uniform and told him a few home truths. He kicked the wastepaper basket across the room and stamped out. His secretary came in later and said, His secretary came in later and said, “You have upset the Dean”. I replied that he had upset me. I was home on leave and managed to effect my release from the Army. I was Adjutant of my Regiment and for some time thought that I would be posted ‘Absent Without Leave’ but started in First Year in January 1946. It was a mixed year of medics, dentists and engineers with a small number of ex-service men.
The Chemistry Prof would come in to the lecture theatre, not look up and read a chapter of his text book and retire. This was not “on” and some of the engineers made a bomb which was exploded under the knee hole of the counter and half filled the theatre with smoke. The Prof never paused and finished his chapter.
Anatomy and physiology: I had carried Gray’s Anatomy and Samson Wright’s Physiology for six years and in Austria I dissected a snake to show willing. Organic chemistry and biochemistry forever remained a mystery. After second year the lectures were given by what I considered were “academics” and I abandoned them for hands-on learning, except for Prof Webster’s fascinating Forensic lectures,
With surprisingly little difficulty the General Hospital took me in and ultimately I did three unqualified house jobs because the war had produced a shortage of young
housemen. Four of us ran the Casualty Department for a long time. One on Front Door to sort them out, (a posh word now, “triage”) one on Clean Theatre, mostly suturing and the odd sebaceous cyst, one on Dirty Theatre opening all manner of septic lesions and one who anaesthetised and did the x-rays and plastering . We seldom had to trouble the Casualty Houseman.
One night a small boy came in coughing ceaselessly and looking very miserable. I asked his mother how long he had been coughing and she replied “Ever since he swallowed his motorbike”. X-ray revealed it half way down his trachea. We sent for the ENT houseman. “Buzz” Drury (since knighted and President of the RCGP!) who asked Sister for the coin catcher. I gave the anaesthetic and he passed the instrument with aplomb. There was a click, and with a smile he withdrew it. It came out without the business end. He went a little pale and asked Sister to fetch the other instrument from the ENT Theatre. The procedure was repeated and the original “end” was withdrawn followed, after some difficulty, by the motor cycle.
Once while giving a “gas” before opening an abscess the patient shouted out what we thought was the name of a horse. One of us went hurriedly for the Sporting Times but alas we could not find the name. After closing time Casualty became awash with methylated spirit as we washed out stomachs; it was not safe to strike a match.
They were good days; I dressed for Baron Rose and Fawcett- Welsh with Tony Edwards the registrar and Mick Lord the houseman. I clerked for Prof Arthur Peregrine Thomson (!) with Graham Marson, the registrar who taught me a great
deal. There was a short period with Stirk Adams doing ENT. On a ward round, I was asked to give an account of a patient and he replied “Gawd”. I thought I was doing very badly until I realised he was saying “Good”.
I was disappointed not to be doing midder at Loveday Street and got sent to the ‘Marble Halls’. This was the relatively new QE, where after six weeks I had not done one hands-on delivery alone. I complained to Prof Hilda Lloyd, who told me not to worry because I would be signed up. Angry, on the way home, I called at Sorrento, the Municipal Hospital, and asked to see the Matron. A crusty lady said “we don’t
have medical students here” and was about to show me out when I remarked on her Queen Alexander’s Badge and asked her what hospital she had served in. She said the 93rd General, which I knew in N Africa and Italy. I was in and accepted as a pupil midwife. It was Christmas and the girls were all keen on partying so I covered for them and did nearly 40 deliveries in three weeks; one in a taxi, one in a bath, one in the lift and one on the toilet. I helped the resident registrar to do a section; she had done four previously. I never looked back.
I took “Conjoint” and so qualified earlier and married in January 1951, passed the MB and was offered a partnership by Margaret Rowe (who was the sister of Stirk Adams) whose “assistant with view” left suddenly to take a death vacancy in Dundee. The practice was based in an old building in Dorridge, the consulting room having been a shop, with a green curtain on a brass rail across the window. With a patient on the couch, if a bus stopped outside I stood with my coat open as a shield. The office had been the saddle room for a mews with the hooks still on the walls and a hay loft over. The waiting room had a cosy bay window that overlooked the village.
I accompanied Margaret on visits for the first two weeks; I learned a lot. She was of the old school. Entering a bedroom she would walk to the window and say “Mother, we will have the window on another notch; Mother, we will take one blanket off” and in a moment had established confidence and authority.
The office resembled that of “All Creatures Great and Small”. Gloves boiling in one saucepan and glass syringes in another, a Bunsen burner for testing urine for albumin and Fehling’s Solution for glucose. We had little to offer pharmacologically; the sulphonamides; penicillin was new, and tetracycline, which had to be fetched from the Q.E. The only diuretic had to be given intravenously. CCF was treated with “dig.folia” – compressed foxglove leaves. There were two insulins, two anti-histamines, phenobarbitone and morphia, not to mention five different coloured aspirins and rows of bottles of coloured mixtures such as “Red Tuss”, “Morph and Ipecac”, “Pot Brom & Valerian”.
We bought a typewriter and after much hesitation engaged a secretary. We had some 2,300 patients on the list and booked over 100 confinements a year, the majority delivered at home. If forceps were necessary we both went. We used ether in the summer, and in winter chloroform when there was a fire in the bedroom. We had beds in a GP maternity Unit in Solihull and very good back up from the Consultant, Harold Watson. Surgeries were from 9-11am and 6-8pm and 9am on Saturdays.
I saw 12-20 patients at each surgery and rarely did less than 20 visits a day. I did all the night calls and nearly all the maternity work. The Practice covered a semi-urban nucleus and a rural area of probably 70 square miles including five villages with no public transport. If the family had a car, the husband would be at work with it. Some of the farms had oil lamps, no running water or sewage. There were far fewer home telephones so messages would come via the postman, the milkman and so on.
There were branch surgeries three times a week in Hockley Heath and Lapworth, and latterly once a week in Lowsenford. The second two in the front room of a private house. The patients sat in the hall and on the stairs if busy. Often cups of tea would be passed round. I did over 25,000 miles a year.
The Health Service had been in existence for only two years and we had much trouble with families who had been private patients and expected the same attention for free. Margaret Rowe was violently anti the NHS and would have sabotaged it. She prescribed inordinate quantities of dressings for minor injuries. “What shall I do with all this cotton wool doctor?” – “Stuff a cushion!”
Many established GPs suffered considerable financial loss. We received 19 shillings and six pence (old money) per patient per annum for everything. The £15 maternity payment was for an initial examination, monthly to 36 weeks, weekly to term, delivery, two or three postnatal visits and the postnatal examination. The payment for a notifiable disease form was one shilling. Immunisations – smallpox and DPT – an equally derisive payment. Sale of Good Will was an important factor when a GP retired but came to an end with the NHS. My first year’s one third share of the profits was £850 before tax! For which I did two thirds of the work.
The Profession came near to mass resignation and the Government were forced to appoint a Royal Commission under Lord Justice Dankewerts (of hallowed memory). His recommendation of a completely revised and fair system of remuneration was accepted and from then on we were not anxious when we looked at the balance sheet; there was always enough. We became truly independent practitioners, to run our practice as we thought best with no interference.
The administration and payment of general practitioners, dentists, pharmacists and opticians was by the Executive Council with whom we had a happy relationship; subsequently renamed the Family Practice Committee.
About this time Margaret Rowe resigned as her husband was moved to London. Amongst other items I inherited a fearsome set of destructive obstetric instruments, in chamois envelopes. I hoped that they had never been used and gave them to the Medical School Museum. I also inherited two sets of dental forceps (which I did use a few times) and two tonsillectomy guillotines.
My illustrious predecessor, John Hollick, would now and again do two or three tonsillectomies on a Sunday morning in a room over Gillooly’s shoe shop next door but one! He gave the anaesthetic himself and was quick! I don’t think there were any fatalities
I replaced the shop window and turned a loose box into a second consulting room. I bought a second hand ECG in 1952 and had a diathermy machine made by a patient. In the car I carried oxygen, a couple of giving sets and two bottles of plasma substitute; also a jemmy which was useful for old ladies locked in the lavatory.
The only way of increasing the list size was to provide services that the opposition did not. I did an afternoon of minor surgery and a gynae evening. It is hard to imagine now but there were a considerable number of post menopausual patients with vaginal prolapse for whom we changed pessaries three monthly; another evening was antenatal. I tapped hydrocoeles some Saturday mornings after surgery.
Bill Needham, an old friend from the Medical School took the rooms over the surgery and started a dental practice. I did his anaesthetics with a Boyles machine; some 1,700 before he retired. I found accidentally that I could hypnotise patients and did three long weekend courses at Dudley Road Hospital to learn what I was doing. Dental patients are well motivated to “go to sleep”.
The challenge of every day was exciting; a poltergeist was dealt with. Twice I dealt with a confinement on the train, the station being across the road, and once on a canal barge. Twice I pulled a baby back from the toilet by its cord.
There were several homes that were not easy to reach in winter, along the canal or over the fields. Being a family doctor was exactly that. I called many of the patients by their Christian name and they by mine. In one of the Catholic villages I was sometimes addressed as “Father”.
The practice grew and more partners were added. We built a purpose designed surgery. Life was made easier by bleeps and, later, by answering machines. One night I recorded my message that I was not “On call” and gave my partners telephone number.
An old lady appeared in the morning surgery saying “...after a few words with you last night I became sure I would be all right until morning”. Such is the power of the spoken word. Finally, when a girl came to make an ante-natal booking and remarked that I had delivered her mother I thought that it was time to stop.
In not far short of 50 years I had done well over 1,500 deliveries.
Having practiced in the Golden Years I retired from the NHS in 1996 at precisely the right moment having enjoyed it all.The slide began; the five day week, nine to five, no night calls, no weekends on call, almost no visits and no fun? Doctors have lost the duty of total care.