There is a
sociological definition of decision making which goes something like "a
disjointed
non sequential process of incrementalism". I love the rolling flow of
language in this phrase - it does contrast somewhat with medical jargon! With
hindsight, I can identify three events decisive in changing things for me.
Happily, I think this has been for the better. The first was a letter from
Elizabeth Ford, telling me of her father, Donald Black, being honoured with a
fellowship of the RCGP.
Initially,
he agreed to produce something for the Newsletter, but was then overcome with
modesty (letter on this page) I am so glad I bullied him into letting me have a
copy of the document he produced for Paul Brothwell - it makes quite
inspirational reading.
The
second event was a colleague exploding about the whinging negativism that was
beginning to pervade most meetings involving GP's. Whatever the very genuine
frustrations and increasing burdens causing this, the need to ventilate to peers
seemed to have become counter productive, fuelling a very unhappy working
atmosphere. I instantly recognised myself in his criticisms.
The
third event was the visit to our practice of the "clinical governance
police". We organised this as a lunch time meeting, several members of the
Primary Health Care Team, each talking for two or three minutes on a variety of
topics where we felt the practice had performed well and made effective changes.
It was
surprising how long the list turned out to be, and how an hour of non stop
positive praise and thinking enhanced the well being of all those present! The
accumulative effect of these events has been to re-enforce the more positive
aspects of medical life, and it is a recipe I can heartily recommend.
Hilary
Boyle
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A
Letter From Donald Black
Elisabeth
has passed on to me your letter concerning my Fellowship. I am indeed glad to
know that many of the local GPs do know me as it will relieve Elisabeth' s
doubts about it!
I
feel that I should explain how all this came about. It seems that it was decided
to include in the College Golden Anniversary the award of Fellowship to founder
members in recognition (I quote) "of the very considerable debt we owe to
founder members and associates like yourself. It was through your vision and
commitment to excellence in general practice that the College, later the
Royal
College
, became a reality."
Some
time ago John Ball phoned me with this information and asked if hecould nominate
me as a Founder Member, if I had no objection. I found it hard to decline
especially as he felt a particular obligation as he had been one of my trainees
in GP inthe early days, and maintains that he much benefited!
I
am not sure that anything else needs to be explained. I qualified at
Edinburgh
in 1936 so have many memories of Medical Practice in those far away days. My
Father and Grandfather were both medical men.
I
settled down in practice in Stourport in 1949 and was quite an active
M(R)CGP
in the early days of the development of the College especially with a friend and
old University colleague Dr Milligan and his partner in a
Worcester
practice. Eventually, as the practice grew and commitments multiplied I tended
to opt out - especially of meetings and committees which were not really to my
liking.
So,
perhaps I could add a little interest to your task by giving an account of my
non-medical interests and activities aver the years? Please let me know what you
would like. Alas I shall be 90 years of age in October and have been retired for
20 years. Also I regret that my handwriting is abominable.
With
kind regards and best wishes,
Yours
sincerely,
Donald
Black
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Dr
Donald Black being interviewed by Paul Brothwell
Q:
As we are celebrating the 50th year of the NHS we are anxious to know
something of medical practice before then and will be grateful if you can help
us.
A:
I will be glad to recall some of my memories and impressions of those
days from the late 1920's onwards, with examples from my personal experiences.
Q:
Perhaps you can start by telling me about your background in the medical
world?
A:
I came from a medical family as my grandfather and my father were both
medical men, as was a great uncle. My mother was a Sister at the
Charing Cross
Hospital
before joining the Colonial Nursing Service. My wife and our two daughters are
trained nurses.
Q:
What were your early impressions of medical practice?
A:
I got to know something of it as father ran a country practice near
Aylesbury and so, from my student days I would accompany him on his 'rounds'
during the vacations. In those days many GPs worked all their lives
single-handed. A few employed a succession of assistants who were generally
newly-qualified doctors seeking experience. Usually the 'surgery' was in the
doctor's house and consisted of a consulting room, a dispensary and a small
waiting room. I have memories of father's waiting room which was supplied with
ancient copies of 'The Christian Herald' as reading matter for the patients.
There was no National Health Service as we know it now but the working man was
covered by Lloyd George's 'Panel' system which was introduced in 1911. In
addition my father had two branch surgeries in neighbouring villages where
people could be seen, messages left or taken and medicines left for collection.
Father did his 'rounds' in a Model T Ford, but it is interesting to note that
our Rector still visited his parishioners on horseback!
Q:
Did you have any experience of hospital practice in those days?
A:
Yes, in the
Royal
Bucks
Hospital
in Aylesbury which was a small hospital which was staffed by local GPs for in
those times most doctors were "Physicians and Surgeons", as declared
in their brass name-plates.
It is as well to remember that this was all that was allowed to be exhibited –
no qualifications etc and any hint of advertising would result in a severe
reprimand from the General Medical Council, if nothing worse.
The
routine work of the hospital was done by these doctors but, for any difficult
cases, outside specialists were called in. I was fortunate enough to be
introduced to one of them a Mr. Cecil Joll a well-known Harley Street Surgeon.
He visited on a regular basis and would arrive in his chauffeur-driven Rolls
Royce, always very correctly dressed in Morning Coat and topper - grey in
summer, black in winter. He very kindly allowed me to attend at his visits and
operating sessions when I could. When his visit concluded he returned to
London
by the Express Train stopping at Aylesbury Station. Once, when his operating
ran late, he sent me down to the Hall Porter to phone the Station Master with a
request to 'hold the train' until I he arrived! Can you see that happening
nowadays?
He
once kindly invited me to have lunch with him in
Harley Street
. I mention this only because after lunch he took me to two of the London
Hospitals. At one of them (I cannot remember its name) he introduced me to a
Professor Kennaway who, at the time, was experimenting with the carcinogenic
effects of tar applied to the noses of rats.
Q:
What about your student days?
A:
In those days (1931-36) the
Medical
School
at
Edinburgh
taught students on the assumption that most of us would enter General Practice.
One of our medical 'chiefs' on the teaching staff at
Edinburgh
arranged for a GP friend to give us lectures on General Practice as part of the
Curriculum. Also we were allocated to one of the Town Dispensaries where we
gained experience by attending the poor and needy, for in those days there was
much poverty -real poverty – when folk were often without the means for the
bare necessities and, sometimes, struggled to survive at all. They lived in the
back streets and in the notorious tenements of the city in abject poverty and
filth.
I
can recall an instance of poverty when I visited an old man who lived alone in a
garret at the top of one of these tenements. The stairs reeked of human excreta
amongst which children were playing. He lived alone and was old and infirm, and
on examination he seemed to be suffering from Scurvy. He told me that his sole
diet consisted of bread and butter with a little jam on it and tea without milk.
As he did not like the butter (I wonder if it ~ butter) he scraped it off again.
When I returned to the Dispensary I reported the case. He was found to be
suffering from Scurvy.
So
to sum up the situation; doctors were very aware of the dreadful illnesses that
could inflect people, and at the same time realised that there was very little
that could be done about most of them. I can name a few such as Diphtheria;
Tetanus; Tuberculosis; many infections; all forms
of cancer; influenza; and accidents of all kinds not to mention child- birth
which was still hazardous. So good diagnosis was very necessary in order to know
who would survive and who would not. Luckily, and as now, some diseases were
self-limiting. So sometimes the family could be told that 'all will be well' in
the end, whilst in other cases the doctor's melancholy task was to warn
tactfully, to advise and to comfort as best he could. In my fourth year I spent
a month in the
Rotunda
Hospital
in
Dublin
doing my midwifery cases. In the slums of that City poverty seemed at its worst
and wretched women had to give birth in dirty and dingy bug-infested rooms with
only a medical student (whom they tactfully addressed as doctor) with little or
no experience to assist them. Our equipment was elementary for we had no cotton
wool (only 'tow'); no 'dettol' or anything like that; and the poor women were
delivered lying on brown paper or newspaper, with a few bed-bugs crawling about,
and, of course, without the help of an anaesthetic. And yet, when it was all
over, they were so kind and grateful.
To
endure such conditions there had to be a great sense of dedication and
self-sacrifice in the medical world. As students we were warned that most of us
would never achieve riches but, at the same time, we would never be out of a
job. I sometimes wonder if our modern General Practitioners realise how very
fortunate they are in comparison!
Q:
What were things like after you had qualified?
A:
The first thing I realised very soon was that I knew little about
medicine and that further training was very necessary. So I spend two years
doing 'house jobs' in
Northampton General
Hospital
. I soon discovered that hospital practice was relatively sophisticated. Each of
us was attached to one of the Chiefs of the various departments and that was the
full extent of the Medical Team - no Registrars or any other attachments. The
hospital was funded by the County and there was a contributory scheme for the
working man and his family to cover admissions to the hospital. In addition
there was a Lady Almoner who helped in case of financial difficulties. The
hospital also was backed up by a good convalescent home. The Top Medical Staff,
or Chiefs gave their services to the hospital free, and earned their livelihoods
by private practice.
Nevertheless
our work was primitive by modern standards; but nobody was ever refused
admission (if indicated) for extra beds were put up if necessary. As the wards
were constructed in the 'Pavilion' style these extra beds could be put down the
middle of the wards.
On
the surgical side the two Senior Surgeons admitted all emergency cases over
alternate weeks and so, during the 'take in' week the House Surgeon was on duty
continuously dealing with those admissions, calling in his Chief as required.
There were many dreadful road accidents as the old' AI' (or
Watling Street
) was only a few miles away. Most anaesthetics were administered by the house
men; blood transfusion was primitive as there was no 'blood bank' and the
necessary blood had to be obtained from relatives of the patient or from the
occasional 'donor' who might be available. We did our own 'cross matching',
sometimes at the bedside. The Rhesus Factor was unknown and its
'incompatibilities' were attributed to 'Citrate Reactions'!
However
we all seemed to enjoy this life and were contented in the knowledge that this
was a valuable, if not essential apprenticeship – not to be missed. Our pay
was £150 p.a. but with free board and lodging, free laundry and a bottle of
beer a day!
Discipline
was strict in hospital. From the Matron downwards, the Sister, Staff Nurse and
Student Nurses all wore distinctive uniforms (and very nice they were too)
enabling one to know at once with whom one was speaking. Also nobody would think
of entering a ward without paying the courtesy of asking for permission from
Sister or her deputy.
To
me 'Political Correctness' seems to be destroying all the old disciplines and,
at times, it has gone so far as to verge on absurdity!
Q:
What about General Practice?
A:
After hospital I spent a year as an Assistant in a practice in Bury in
Lancashire
. It was a large practice and, not unnaturally, I was expected to undertake much
of the routine work, some of it unpleasant of course. Again I encountered much
poverty. One of my regular duties was to attend daily a small surgery at the
back of the Town Hall to see the 'poor and needy' once again. I can recall a
poor young woman who arrived with her sick baby. She was under-nourished and
looked worn out. Her baby was ill and fractious yet all she could give the baby
was a feeding bottle of cold tea and a bit of bacon to chew.
Another
of my many tasks was to attend at a large Public Assistance Hospital of which my
Principal was Medical Officer in Charge. One day an old 'tramp' was admitted in
a filthy and moribund condition having been found living in a derelict bam.
When, on admission, he was asked about his personal possessions he confessed to
having some money in his jacket. This turned out to be some £200 or so in the
lining of his coat - all in the old 'Bradbury' notes of that time. He died soon
after from neglect and illness yet he had on him the means to live in a good
boarding house.
In
another part of the town was an area of doss-houses, named rather inaptly
Paradise Square
in which the poor and needy lived in squalor. However there was one resident
who remains in my memory to this day as an example of the sort of kindness that
could exist in such surroundings. She was a very large lady named Mrs. Murphy.
If any child in the area fell ill she always took charge of it personally until
it was better again. When war was declared and air raid shelters were built
there was great consternation amongst the residents when it was discovered that
Mrs. Murphy was so large that she was quite unable to pass through the entrance
to the shelter!
Q:
And what then?
A:
Soon afterwards I departed from the practice to join up little knowing at
the time that it would be six years or more before I could think again of a
medical career which would have to be started allover again.
Q:
What was post-war medical practice like?
A:
The NHS was on the verge of starting in 1948. By that time I had decided
to settle in General Practice mainly for the sake of my wife and family. We were
married in 1939 and for the next 6 or 7 years had no real family life at all and
saw very little of each other. At first practice was very much as before and
resembled an extension of the old Panel System. However there was one important
change in that this new 'Panel' included everybody; and this resulted in a big
improvement as there was no financial barrier between me and my patients -
particularly as at that time, most of my patients were' Panel'. Also I had a
regular salary however meagre it was. As a result I had to take on extra work
such as that of Examining Factory Surgeon, Public Vaccinator as well as a post
in the
Lucy
Baldwin
Maternity
Hospital
and some part-time work in the old
Blakebrook
Hospital
in
Kidderminster
- not forgetting a short spell as MO to the Pioneer Corps at Burlish Camp!
The
surgery hours were much the same. There was always a 6 p.m. surgery for the
benefit of working folk who, as a result, did not have to take time off from
work in order to consult the doctor. So it was often 8 p.m. or later before I
got home in the evenings.
I
became a Founder Member of the Royal College of GPs but soon realised that I had
little interest in Medical Politics or had the time to do so. So for a while
matters went on quite smoothly as before until, so it seemed to me, Political
Guile became a problem. I will mention two examples of this:-
1.
The Pool System of paying the GPs which smacked of sharp practice.
2. The setting up of the Review Body on Doctors' pay the recommendations
of which were regularly ignored.
So,
as time went on, our relations with the Government because severely strained and
then quite impossible; so much so that eventually the BMA had to advise us all
to prepare to quit the NHS and the Association devised an alternative Panel
Scheme. Fortunately the Government saw sense in time, but ever since relations
have been far from happy.
So,
looking back over the years it seems to me that the doctor was appreciated not
so much for his medical skills but more so by the I knowledge that whenever he
was wanted he was always there, known personally to his patients as a friend, a
sympathiser and comforter.
Perhaps
this is best expressed by Robert Louis Stevenson when he wrote of 'The
Physician':-
'Generosity
he has, such as is possible to those who practice an art, never to those who
drive a trade; discretion, tested by a hundred secrets; tact, tried in a
thousand embarrassments; and what are more important, Heraclean cheerfulness and
courage. So it is that he brings air and cheer into the sickroom, and often
enough, but not so often as he wishes, brings healing.'
On
the surgical side the two Senior Surgeons admitted all emergency cases over
alternate weeks and so, during the 'take in' week the House Surgeon was on duty
continuously dealing with those admissions, calling in his Chief as required.
There were many dreadful road accidents as the old' AI' (or
Watling Street
) was only a few miles away. Most anaesthetics were administered by the house
men; blood transfusion was primitive as there was no 'blood bank' and the
necessary blood had to be obtained from relatives of the patient or from the
occasional 'donor' who might be available. We did our own 'cross matching',
sometimes at the bedside. The Rhesus Factor was unknown and its
'incompatibilities' were attributed to 'Citrate Reactions'!
However
we all seemed to enjoy this life and were contented in the knowledge that this
was a valuable, if not essential apprenticeship – not to be missed. Our pay
was £150 p.a. but with free board and lodging, free laundry and a bottle of
beer a day!
Discipline
was strict in hospital. From the Matron downwards, the Sister, Staff Nurse and
Student Nurses all wore distinctive uniforms (and very nice they were too)
enabling one to know at once with whom one was speaking. Also nobody would think
of entering a ward without paying the courtesy of asking for permission from
Sister or her deputy.
To
me 'Political Correctness' seems to be destroying all the old disciplines and,
at times, it has gone so far as to verge on absurdity!
Q:
What about General Practice?
A:
After hospital I spent a year as an Assistant in a practice in Bury in
Lancashire
. It was a large practice and, not unnaturally, I was expected to undertake much
of the routine work, some of it unpleasant of course. Again I encountered much
poverty. One of my regular duties was to attend daily a small surgery at the
back of the Town Hall to see the 'poor and needy' once again. I can recall a
poor young woman who arrived with her sick baby. She was under-nourished and
looked worn out. Her baby was ill and fractious yet all she could give the baby
was a feeding bottle of cold tea and a bit of bacon to chew.
Another
of my many tasks was to attend at a large Public Assistance Hospital of which my
Principal was Medical Officer in Charge. One day an old 'tramp' was admitted in
a filthy and moribund condition having been found living in a derelict barn.
When, on admission, he was asked about his personal possessions he confessed to
having some money in his jacket. This turned out to be some £200 or so in the
lining of his coat - all in the old 'Bradbury' notes of that time. He died soon
after from neglect and illness yet he had on him the means to live in a good
boarding house.
In
another part of the town was an area of doss-houses, named rather inaptly
Paradise Square
in which the poor and needy lived in squalor. However there was one resident
who remains in my memory to this day as an example of the sort of kindness that
could exist in such surroundings. She was a very large lady named Mrs. Murphy.
If any child in the area fell ill she always took charge of it personally until
it was better again. When war was declared and air raid shelters were built
there was great consternation amongst the residents when it was discovered that
Mrs. Murphy was so large that she was quite unable to pass through the entrance
to the shelter!
Q:
And what then?
A:
Soon afterwards I departed from the practice to join up little knowing at
the time that it would be six years or more before I could think again of a
medical career which would have to be started all over again.
Q:
What was post-war medical practice like?
A:
The NHS was on the verge of starting in 1948. By that time I had decided
to settle in General Practice mainly for the sake of my wife and family. We were
married in 1939 and for the next 6 or 7 years had no real family life at all and
saw very little of each other. At first practice was very much as before and
resembled an extension of the old Panel System. However there was one important
change in that this new 'Panel' included everybody; and this resulted in a big
improvement as there was no financial barrier between me and my patients -
particularly as at that time, most of my patients were' Panel'. Also I had a
regular salary however meagre it was. As a result I had to take on extra work
such as that of Examining Factory Surgeon, Public Vaccinator as well as a post
in the
Lucy
Baldwin
Maternity
Hospital
and some part-time work in the old
Blakebrook
Hospital
in
Kidderminster
- not forgetting a short spell as MO to the Pioneer Corps at Burlish Camp!
The
surgery hours were much the same. There was always a 6 p.m. surgery for the
benefit of working folk who, as a result, did not have to take time off from
work in order to consult the doctor. So it was often 8 p.m. or later before I
got home in the evenings.
I
became a Founder Member of the Royal College of GPs but soon realised that I had
little interest in Medical Politics or had the time to do so. So for a while
matters went on quite smoothly as before until, so it seemed to me, Political
Guile became a problem. I will mention two examples of this:-
1.
The Pool System of paying the GPs which smacked of sharp practice.
2. The setting up of the Review Body on Doctors' pay the recommendations
of which were regularly ignored.
So,
as time went on, our relations with the Government because severely strained and
then quite impossible; so much so that eventually the BMA had to advise us all
to prepare to quit the NHS and the Association devised an alternative Panel
Scheme. Fortunately the Government saw sense in time, but ever since relations
have been far from happy.
So,
looking back over the years it seems to me that the doctor was appreciated not
so much for his medical skills but more so by the I knowledge that whenever he
was wanted he was always there, known personally to his patients as a friend, a
sympathiser and comforter.
Perhaps
this is best expressed by Robert Louis Stevenson when he wrote of 'The
Physician':-
'Generosity
he has, such as is possible to those who practice an art, never to those who
drive a trade; discretion, tested by a hundred secrets; tact, tried in a
thousand embarrassments; and what are more important, Heraclean cheerfulness and
courage. So it is that he brings air and cheer into the sickroom, and often
enough, but not so often as he wishes, brings healing.'
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Richard Melville Malins
Many
members of the Medical Society will remember Richard who died earlier this year,
having suffered from Alzheimers Disease since the age of 49. He was a first
class GP as well as being a man of great character. He was born at the
Lucy
Baldwin
Hospital
, the son of the late Prof. Malins, his mother was also a doctor. He had two
brothers and three sisters who were brought up at Elmley Lovett, he was educated
at Shrewsbury School, and went on to study medicine at Brasenose College,
Oxford, and then on to finish his medical training at the Birmingham Hospitals.
After
qualification and house jobs, he went to work in S. Africa, in
Zululand
. He became very popular with the Zulus who gave him the name of Mpandla, the
Bald Joe! He had very strong views about Apartheid and was less popular with the
S.A.
secret police. Because of them he had to make a fairly rapid exit from the
country. Back in
England
he worked at the
Birmingham
Maternity
Hospital
where he met and married Barbara, who so caringly looked after him in his last
few years.
Together
they went to
Colorado
, where they and a friend from
South Africa
set up a hospital for Mexican immigrant workers. So dedicated was he that he
learnt Spanish in two weeks so that he could provide better care. After that, he
and Barbara went to
Jamaica
where they worked in the local hospital, where once again he gained a
reputation as a most caring doctor. He came back to this country in the 70s and
came to our practice in Bewdley first of all as a locum. We liked him so much
that when a vacancy occurred for a new partner we got in touch with him and he
joined the practice.
He
was an extremely well qualified doctor who was able to combine his skills and
knowledge with a humanity that expressed itself in the care of his patients, he
considered not only their ailments and health problems, but also their lives and
relationships, their social and economic conditions. He liked to know all about
them, their families and their employment. He always had time for people, and
though I am sure he was no saint, I don't remember him being moody or bad
tempered.
He
had interests outside medicine; he was a flautist in the Wyre Forest Symphony
Orchestra, and sang in the Bewdley Choral Society and was a very keen and active
member of the Rock Footpath Association. He was very keen on keeping fit, and
tended to run rather than walk, and used a bicycle rather than a car as often as
was reasonable.
To
sum up: Richard was a man of many talents, a modest man, who lived a full life
tragically cut short by a dreadful illness He was an extremely good physician,
but more than that, he was a dedicated caring Family Doctor who loved his
patients and was loved by them, he was a devoted husband and father and a loyal
friend and colleague. I am proud to have had him as a partner.
David Sargeant
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