Sixties – from Casualty Officer to Paediatrics

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On return to the UK in late 1959 I still intended to train to be a surgeon. My second six months as a house surgeon with Mr Geoffrey Wooler and Mr. John Alwyn, the thoracic surgeons at the Leeds General Infirmary, had been very enjoyable. Discussing my hopes to do surgery with Geoffrey Wooler, he said it was important I had six months general surgery. So he kindly arranged for me to do 6 months in York with his friend Mr. Jock Hall, an excellent general surgeon there. I was interviewed and Mr Hall offered me the job as his house surgeon only for me to be denied exemption from the National Service call up. So that was a major set back.

However, when I returned to Leeds after 2 years in the RAMC, not deterred from my intention to follow a surgical career, I first obtained a locum Senior House Officer

LPD c1960
LEEDS PUBLIC DISPENSARY IN 1960

Post in the casualty department of the Leeds Public Dispensary (photo).
The Leeds Public Dispensary (1824-1971) was one of the older medical buildings in Leeds. There is an interesting account of many of the these developments by Audrey Kent on the internet.

Apparently from the mid 18C onwards, the Industrial Revolution coupled with widespread population growth, had led to a vast increase in the number of people living in towns. Many of these people were very poor, living and working in appalling conditions. The existing voluntary hospitals were unable to cope with this situation. They treated mainly “in-patients” and in spite of the increasing population they had made little attempt to boost the number of admissions due to the cost of providing food, accommodation and nursing care. Patients were only admitted to hospitals once a week, which didn’t cover emergencies. In addition, numerous categories of patients were excluded from hospital care including children under 7, pregnant women, the confused and insane, those with or suspected of having infectious diseases, consumptives and persons thought to be in a dying condition. Patients inadvertently admitted with any of these conditions were removed immediately. More provision for the sick poor was desperately needed and dispensaries such as Leeds were set up to help meet this need. Audrey Kent’s account is well worth a read.

In 1959 the Leeds Public Dispensary (LPD) was essentially a casualty department which dealt with minor injuries, fractures and eye metallic foreign bodies. I remember amputating the end of a badly damaged finger on the advice of Mr John Fitton, a visiting orthopaedic surgeon – a first for me.

Accident & Emergency at the Leeds General Infirmary. 1960

After a couple of months at the LPD I moved to the Leeds General Infirmary (LGI) casualty as one of three SHOs working with Mr Maurice Ellis, the Accident and Emergency consultant. I was very fortunate to be appointed to this job which provided a vast amount of experience. Mr Ellis (known to his staff as “Father”) had been surgeon in the colonial service in Africa and he ran a very efficient service at the LGI. The department was organised by Mr Edge, a senior nurse of sergeant major efficiency, who controlled the three SHOs and decided which patients should be seen as emergencies, helping with diagnosis and advising at once on emergency situations. It was a good, efficient and happy department; the jobs were much sought after by the junior doctors and “Father Ellis” was held in high regard by his junior staff and colleagues.

Father Ellis had strict routines for all circumstances and conditions and these were encompassed in the Casualty Officer’s Handbook published in 1962 which went into three editions. There were three Senior House Officers in casualty at the LGI and at any time two would be on days and one on nights. In the mornings the new and return patients would move along a bench past Mr Ellis. It would be fair to say that although kindly his manner was brusque, perhaps stemming from his years in Africa. He would inspect the patient’s casualty card, hear of their progress and decide their treatment passing on the card to one of the two SHOs standing behind him. Mr Edge would be hovering around ensuring everyone was sent to the correct cubicle or treatment room. If a man was still wearing his hat Father would look at the hat and say firmly “Take your hat off!”. We SHOs used to wait for this to happen and he always said the same except one day an Asian gentleman appeared in the queue and gradually moved along at the bench as the queue was dealt with. This man was wearing the most amazing turban like hat. Would Father demand this be removed we wondered? Well, when his turn arrived Father look closely at this head gear, pondered for a moment and then asked “What’s the problem?”.

It was a very efficient system. Minor surgery such as breast and other abscesses and orthopaedics such a Colles’ forearm fractures were dealt with efficiently in the casualty department theatre. Obvious serious medical and surgical cases were evaluated and admitted directly to the appropriate ward; for some the appropriate SHO or registrar was requested to come and see them to decide how they should be dealt with – this was the case with paediatric problems. I used to spend much time in the casualty when I was paediatric House Officer. On one occasion I dealt with thirty children in one day. I became known to Mr Ellis during this time in 1956 when I was the paediatric house officer working for Professor Craig and Dr Allibone.

The experience gained with Mr Ellis was quite vast as all admissions came via his department. All presenting symptoms were dealt with on an appropriate form and in a standard way. For strains and sprains a cooling spray was widely used and I suspect this form of acute treatment may have originated in Leeds. The other unusual method of treatment was of breast abscesses which were relatively common problem referred to the department. The abscess would be drained and then rather than inserting a drain letting the cavity gradually shrink and heal, it would be stitched immediately with deep stitches and the patient given an injection of penicillin. This was really against general surgical principles but the majority healed very rapidly.

Mr. Maurice Ellis MRCS 1930; FRCS 1948; BA Cambridge 1929; MB BCh 1944; DTM&H 1933; LRCP 1930.(1905-1977) (usually referred to as “Father Ellis”) was the son of a motor engineer, who founded a milk business which later became Associated Dairies, was educated at Rydal School, Emmanuel College, Cambridge, and Leeds University School of Medicine. After qualifying in 1930 he was appointed to house posts at Leeds General Infirmary and at Barnsley. In 1933 having decided to join the Colonial Medical Service, he took the London University DTM&H and sailed for Nigeria. Ill health caused an early retirement from the Colonial Medical Service in 1945.
In 1948 he took the FRCS and after a surgical post at Dewsbury was transferred back to the LGI. From 1949 he was senior registrar and in 1952 was made consultant in casualty. He retired in 1969. In 1967 Ellis had become founder President of the Casualty Surgeons Association. Hundreds of clinical students and junior doctors referred to him affectionately as “Father Ellis” In 1962 he published his Casualty officers’ handbook, In 1933 he married Irene Thornley, surgical ward sister at the Leeds General Infirmary. They had one son who qualified in medicine. Maurice died on 13 October 1977.

So in 1960 I was enjoying my work in the Casualty Department with Mr Ellis who knew I was interested in surgery and he made a point of showing me interesting physical signs and conditions.

However, one day I received an offer that was to radically change the direction of my career.

A MAJOR CHANGE FROM SURGERY TO PAEDIATRICS

After working with Father Ellis in the LGI Accident and Emergency Department for about four months I was approached by Dr George Lewis, a Lecturer in Paediatrics with Professor Stuart Craig in the University Department of Paediatrics and Child Health. I knew both George and Professor Craig from my time as the Paediatric House Physician in 1956. George suggested we meet for a drink at the Tunbridge, the pub behind the Infirmary frequented by the medical staff, that evening as there was a matter the Professor had asked him to discuss with me. We duly met in the Tunbridge that evening as arranged and George asked if I would be interested in returning to paediatrics.

Lewis George – Version 4
DR GEORGE LEWIS

I had been the paediatric house physician for six months with Prof. Craig and Dr. Allibone at the LGI after I qualified in 1956 and certainly had enjoyed the job. Also I had done the paediatric locum for two periods of two weeks as a medical student. Even so, at this stage, I had no intention of following paediatrics as a career and had never seriously considered the possibility. So this offer was, to put it mildly, a surprise. I told George that I was already set on a career in surgery although, as yet, it must be admitted, I had not progressed very far! In fact I had not even passed the primary FRCS – a very difficult first hurdle for a surgeon and often even failed by doctors who worked as anatomy demonstrators in the medical school. I had taken a correspondence course for the Primary FRCS when I was in the army but such was the life there in Malta that I’m ashamed that most of the papers remained in their packets.

Prof Craig
PROF. STUART CRAIG

George indicated Prof. Craig was impressed by my performance as his house physician and considered I would be suitable for a career in paediatrics. Also there was a vacancy in his department for a Tutor in Paediatrics which there been some difficulty in filling. I was offered the post at the grade of registrar/tutor with the offer of promotion to senior registrar grade when, and if, I obtained the membership of the Royal College of Physicians of Edinburgh in Paediatrics (MRCPE).

This offer was, to put it mildly, a bombshell!  Here I was, a mere surgical SHO, hardly yet started on a surgical career – satisfactory progress in which was by no means certain, being offered a registrar job in the University Department of Paediatrics with the promise of promotion to senior registrar when I obtained the appropriate higher paediatric qualification i.e. the Membership of one of the Royal Colleges of Physicians. I agreed to think this over – which I did over the next 24 hours.

Considered objectively I had always enjoyed working in the paediatric department, first as a student locum on a number of occasions on the ward and after qualification as the paediatric house physician for six months. Also, although keen to do surgery, I had nonetheless failed to do any work on the primary FRCS anatomy  correspondence course during my 2 years National Service in Malta. The road to a surgical career would be long with years of  hard work and the end uncertain. I had discussed the daunting prospect of a specialist career with my commanding officer in Malta, Colonel Richards who also lived in the same St Patrick’s Officers Mess. I had a good working relationship with him and towards the end of my two years National Service in the RAMC there he suggested I should sign on as a regular. If I wished to do surgery the army would pay all the necessary tuition and examination fees whilst providing me with a good salary and allowances as a captain in the Royal Army Medical Corps. I had also given this tempting previous offer considerable thought but did not pursue the possibility. Although I had enjoyed my time in the army I did not wish to be involved with an organisation whose basic purpose was fighting! Also if one did not happen to make it as a specialist and remained a major as a general medical officer, one was retired in one’s early Fifties.

So, after much thought and some doubts, when George and I met again the next day, I agreed to meet with Professor Craig. So I moved to the Leeds University Department of Paediatrics and Child Health at the end of my 6 months with Father Ellis. When I told Father of my decision he was surprised but very supportive. For the rest of my time with him in A & E he moved many of the paediatric cases in my direction to increase my experience! He was a very nice man and it was a very good six months working with him.

“A PAEDIATRICIAN BY CHANCE”

This would have been an appropriate title for this story of my eventual career choice for paediatrics, a choice which eventually turned out to be appropriate. It came about by a series of chance events which eventually were influential in my becoming a paediatrician. It is interesting how one’s eventual destiny is influenced by so many different events and circumstances.

Student locums as paediatric house physician at the LGI

The first incident occurred before I qualified. As I have described earlier,  in 1954, some months after starting clinical studies as a medical student in the Leeds General Infirmary (LGI), whilst walking down the corridor of the LGI past the entrance to the children’s ward, I was approached by the paediatric registrar who asked if I would be willing to do a two week student locum on the paediatric unit with Professor Craig and Dr. Allibone as the regular house physician had taken sick leave. In those days it was common practice at the LGI for a medical student to stand in for a house officer if they were ill or on leave. After I had established exactly what paediatrics entailed (essentially children’s and infant’s medical conditions), I agreed rather hesitantly to do the locum. I was assured there would be registrar support at all times.

Essentially my job was to be on call the whole time except for one half day a week. I would work between the children’s medical ward 8, the Princess Mary Ward for infants and the casualty department where I was called to be the first to see any “medical children”. Once the casualty staff had decided the child had a medical condition the paediatric house physician was called down to see. Take a history from the parent and examine the child to decide what should be done. Either ir was obvious the child should be admitted, the condition was obvious and non-serious in which case the house physician prescribed as appropriate and discharged the patient home often with a follow-up appointment for the following day. If there was doubt the paediatric registrar was called to decide what should be done – either send home or admit.

With regard to ward work the paediatric house physician would admit new patients either, acutes or planned admissions, attend separate ward rounds with the each of the consultants, Prof.Craig and Dr. Allibone and also do a daily round with the registrar. He would also do various practical procedures usually with the help or supervision of the registrar – taking blood from veins or the fontanelle in infants, inserting intravenous drips which often involved cutting down on a vein at the ankle, lumbar punctures, regular aspiration of infant subdural haematomas – we did not realise they were a feature child abuse in those days. A particular, a responsibility was keeping the patients notes up to date and seeing all the X-rays and investigations were available for the consultant’s ward round. For the even all the children would be neat, clean and quiet on their beds.

The two weeks went well and I learned a great deal including some practical procedures including lumbar puncture. Some months later I was asked to do the paediatric locum again which I did, having enjoyed the previous experience. This did not go down too well with Mr Payne the particular irascible orthopaedic surgeon whose firm I was on at the time; he hoped I would not encounter any orthopaedic cases in the finals examinations! Nonetheless I had another very hard but enjoyable two weeks with the peadiatricians.

Pre-registration paediatric house physician for six months

When I qualified in 1956, it was expected that I would apply for and was appointed as the paediatric house physician at the LGI with Prof. Craig and Dr. Allibone. This was a very hard job but very enjoyable as I have broadly outlined above when as a student locum. I had no thoughts at this time of entering paediatrics as a career. In hindsight it would have been more sensible to do six months general medicine. However in those days we did not look too far ahead but tended to do the junior doctor jobs which were available, seemed interesting and where there was a good “social side”. In fact, the next 6 months as house surgeon with Mr Geoffrey Wooler in the Thoracic Surgical Department persuaded me I wanted to be a surgeon! More of this later.

So this is how an aspiring surgeon, already working in an excellent casualty department, became a trainee paediatrican – by chance!

RETURN TO HOSPITAL PAEDIATRICS IN 1960

So here was a major change in direction of my career with which I felt increasingly at ease, albeit somewhat apprehensive. I would be starting as a Tutor Paediatric Registrar after only 6 months experience in hospital paediatrics as a house physician.
The doctors in Prof. Craig’s department were very supportive. Although Prof. was not an easy man to work for, there was a cheerful camaraderie among the staff

Pryce-Jones
DR LIZ PRYCE-JONES

particularly Drs. Liz Pryce-Jones (registrar), George Lewis (lecturer) and Michael Buchanan (Senior lecturer) who provided much support during my first months. They were all really pleasant people who became good friends. I certainly appreciated their support over the first few months for my responsibilities, for which I was ill-equipped, which included 30 of the Professor’s beds in Seacroft Hospital and a registrar role at the Leeds Maternity Hospital Special Care Baby Unit.

I had an office in the University Department of Paediatrics and Child Health housed in an old house behind the LGI in Blundell Street (now demolished). Miss Bond was the Prof’s secretary and another secretary did our letters and correspondence. I went up a steep learning curve over the next few months and worked hard on brushing up on all aspects of paediatrics. I had teaching responsibilities and registrar type clinical work but there was little research in the department. Prof was a very good writer but was more interested in social paediatrics than building a scientific medical research department. So there were few publications from the staff.  However, I was keen to start at least producing one or two case reports and Prof. agreed for me to go ahead.

A love of clinical research , writing and publication started here

parabiotic twins 2
PARABIOTIC SYNDROME

My first paper was a case report of twin to twin transfusion (parabiotic syndrome) as we had an impressive colour photo that the British Medical Journal agreed to publish. (Polycythaemia and anaemia in newborn monozygotic twin girls. BMJ 1963 vol1(5334)pp.857-9.). From that time on I always had one or more publication in preparation and as I became more senior always ensured the junior doctors working with me had at least one publication to their name when they moved on.

`There were one or two embarrassing moments due to my raw state of paediatric knowledge. In one of my early tutorials discussing liver disease a student asked about Gilbert’s disease which, believe it or not, I had not heard of at the time.

Also the first time I was called in the to the Leeds Maternity Hospital to perform an exchange transfusion, Sister Patullo the very senior chief nurse of the Special Care Baby Unit looked at me and said – “What have you come for?”. I said I was the new registrar tutor and had come to perform the exchange transfusion at which she

EXCHANGE TRANS' 2
EXCHANGE TRANSFUSION FOR HAEMOLYTIC DISEASE

sniffed and let me in. Michael Buchanan came a few minutes later and showed me how to do it thank goodness. However, within a few weeks I was doing exchange transfusion on my own. Eventually Sister Pattullo and I were good friends and colleagues. We were fortunate that she was still in charge when Susan our first daughter was born prematurely at 32 weeks and successfully nursed in the Special Baby Unit at the hospital.    Mike Buchanan told me years later that when asked who was the most impressive registrar she had working with her during her time at the LMH she replied – “Jim Littlewood – he was something different”. That was a real compliment from her – anyway I hope it was – I took it as a compliment!

Prof. went round the LMH and LGI most days and Seacroft at least twice a week, where I carried the registrar responsibility for a large paediatric ward. Consultants  had an on going commitment and responsibility for their patients and  didn’t do off duty and weekends.

So I was now a paediatric registrar committed to a career eventually as consultant paediatrician. I needed to obtain the MRCPE in paediatrics as a basic higher qualification to eventually obtain a consultant post or could end up in general practice as had at least two previous paediaitric registrars who had failed the Membership. One could take the Edinburgh membership in general medicine with  paediatrics as a special subject; but the London membership was in general medicine and more difficult, particularly if one’s experience was mostly in paediatrics. Without one or other of the Memberships one would not be able to obtain a consultant post. So here was a challenge! The Edinburgh MRCPE was considered to be easier than the London MRCP as one was opting for a defined subject.  A medical student in our year, David Fluck, eventually went to Edinburgh to take the MRCPE and the examiner asked him why he had come to Edinburgh. “It’s easier than the London Membership sir” he replied! Surprisingly he passed but he was very bright and obtained both Memberships. David’s surname was slightly difficult. On one occasion in surgical outpatients he addressed a particularly irascible consultant surgeon called Mr Henry Shucksmith as Mr Shoesmith. Henry looked carefully at David and slowly said – “ With a name like yours, Fluck, you should be very careful with surnames!”

However, before attempting the MRCPE there was the London Diploma in Child Health (DCH) to obtain. I passed this exam within six months of starting in the paediatric department. It was really a qualification for local authority doctors, school medical officers and the like and didn’t rate very highly, but it was my first post graduate qualification and gave me some confidence. The next hurdle was the MRCPE which, in retrospect, I entered too early and failed and also failed on the second attempt but passed third time in late 1961 – what a relief. My Achilles heel was a lack of practical experience in basic adult general medicine. However, I was delighted to pass and I know Prof. Craig was relieved. To put my failures in perspective Dick Smithells, who subsequently became our Professor of Paediatrics in Leeds, took the London MRCP six times before he passed and subsequently he had a very successful career – in fact he discovered the link between spina bifida and folic acid deficiency during pregnancy.

Work in the University Paediatric Department carried on and I continued to gain experience but I was concerned that I did not possess the London MRCP. So 1961 I approached Prof. and requested a year off to do six months general medicine as an SHO and then six months as an SHO at Great Ormond Street for further paediatric experience. During this year I would attempt the London MRCP. Without enthusiasm he agreed. However, I was soon surprised to find that it was so difficult to obtain a good SHO job in general medicine and had a few disappointments.

ANN NURSE

It was at this time that I met Ann Phillips, my wife-to-be, in the paediatric outpatients at the LGI. Ann looked very attractive in her uniform (photo) and was very efficient helping me with the clinic; so it was not surprising I had already asked her out for a date before the clinic session was over. However, Ann already had been forewarned by the kindly out-patient Sister that it was likely that I would ask her out, which of course I did. The Sister in outpatients predicted that I would take Ann to the Bay Horse Inn near Harrogate, order prawn cocktails and steaks and then offer to take her home! Ann maintains that she only accepted my invitation as a dare from the staff. As it happened, the Bay Horse was full on the evening of our date so we went to the Squinting Cat also outside Harrogate. I had my usual prawn cocktail followed by steak and chips but Ann, to show her independence at this early stage in our relationship, opted for a shrimp cocktail followed by ham and eggs. We both seemed to enjoy the evening and started dating from that time on.

General medicine at Stoke Manville Hospital. 1962/63

In autumn 1962 I eventually I secured an SHO post in General Medicine at Stoke Mandeville Hospital with a very pleasant physician, Dr John Lloyd-Hart. He was a delightful man and so very kind and polite with the patients compared with some adult physicians I had known.
This was a very good 6 months with considerable general medical experience filling a gap of which I was always conscious. The staff were very pleasant, in particular the very mature senior registrar, Bill Armstrong who ultimately wrote John’s obituary of which are the following are extracts. He certainly had had an interesting life.

Vincent Edwards Lloyd-Hart, (1909-1987) known to his many colleagues and friends as ‘John’, was born in Nailsworth, Gloucestershire, the son of a prosperous draper. He excelled at sport and played rugby football and shot for the school, and was a champion boxer. He then went to London to study the basic sciences and gained admission to the London Hospital medical school. He went for a time to drive an ambulance in the Spanish Civil War. Returning to seek locum work whilst considering the future, he was asked by Sir John Parkinson [Munk’s Roll, Vol.VII, p.443], to whom he had been house physician, to act on his behalf as personal medical attendant to Pierrpoint Morgan on his estate in Scotland. The end of World War II and the inauguration of the National Health Service forced a choice between an established general practice and full commitment to the hospital service. He chose the latter. His contribution to medicine in Aylesbury was indeed great.. His own special interests were in cardiology and thyroid disease. He published relatively little of a technical sort, but his reading was avid and wide. His opinion and advice were much sought and respected. His general interests were wide and included European and local history. He wrote two small books, As a man, despite his shyness and a diffidence sometimes resulting in an over elaborate courtesy, and occasional difficulty in choosing words, for which he had a proper respect, he was good company. The most common word used of him by articulate patients, then and now, has been ‘gentleman’. The less articulate called him, in the modern vernacular, ‘a lovely man’. He had no lack of humour, as is illustrated in the selection of anecdotes in the two books he wrote. Throughout his married life he was supported by his wife, with strength and affection. WB Armstrong [Brit.med.J., 1987,

The six months at Stoke Mandeville were good experience in general medicine observing and working for capable experienced general physicians. There was no contact with the paraplegic unit for which the hospital is known. However, it was sad to see so many of their patients in wheel chairs around the hospital. Our work on the general medicine wards was routine but interesting. Both Dr Lloyd-Hart and Bill Armstrong were very pleasant people and so very kind and considerate to their patients. I presume Bill Armstrong took over from Dr Lloyd-hart when the latter retired.

Sadly, later in the Sixties, Stoke Mandeville Hospital achieved notoriety in relation to numerous sexual abuse crimes by Jimmy Saville. Also in 1990, the consultant paediatrician at Stoke Mandeville, Dr. Michael Salmon, was jailed for 3 years for sex crimes against juniors.

Unfortunately, although I had a valuable six months of acute general medicine experience at Stoke Mandeville, I failed to learn sufficient adult general medicine to pass the London MRCP exam. Fortunately this qualification was not essential for my eventual career as a consultant paediatrician as the membership of only one or other of the Royal Colleges was required. I did not make further attempts at the London membership; but many years later I was elected a Fellow of the London College of Physicians (FRCP) on the basis of my professional achievements – MRCP the easy way!

Hospital for Sick Children, Great Ormond Street – May to Nov 1963

GOS staff 63

So after six months at Stoke Mandeville I was successful in obtaining an SHO post at The Hospital for Sick Children, Great Ormond Street in London (GOS). I suspect my success was with the help of Professor Craig who knew many of the consultants there particularly Dr. Philip Evans and Sir Wilfred Sheldon.
Prior to the appointments committee meeting, candidates had to arrange an appointment to meet and introduce themselves to the relevant consultants. I recall only meetings with Phillip Evans and Archie Norman although I did meet other senior members of the staff.
All the SHOs (house physicians) were resident at the hospital. Most had been paediatric registrars elsewhere in paediatric units around the country; most were doing six months at the hospital before returning to their previous units as registrars or senior registrars. This spell at GOS was useful as I met many members of the consultant staff there who were the national leaders in the paediatric field at the time.

Ann and Jim engaged

In this restless time of our lives. Ann and I were engaged in 1962 (1962 photo in lounge at Pat and Doug’s flat, Adel). When I moved to Stoke Mandeville Ann occasionally used to travel from Leeds to visit me on some weekends. Early in 1963, when I moved to Great Ormond Street to work for Dr Phillip Evans, Ann obtained  a Staff Nurse post at the Royal Homeopathic Hospital next door to the GOS where she lived in the Nurses Home. We had dinner in the mess at GOS some nights and went out for a meal on my one half day per week – usually to an Aberdeen Angus Steak House! We had alternate weekends off but they never seemed to coincide.

Version 2

In the months prior to our wedding in November 1963, when we were both working in London, my stepfather, George Skilbeck, became progressively ill with heart failure and died in September some 6 weeks before our wedding. Ann returned to Leeds during George’s terminal illness to help my mother nurse him at home.

The Great Ormond Street “House” May – November 1963.
The Hospital for Sick Children (GOS) was founded on 14 February 1852 after a long campaign by Dr Charles West, It was in an ornate but modestly sized terraced house north of Holborn. Initially home to just 10 beds and two clinical staff, the hospital was both the city and the country’s first specialist medical institution for children. The country’s first hospital providing in-patient beds specifically for children in England.

Phillip Evans (1910-1990) graduated in Manchester and early worked in the New York as a Rockefeller Research Fellow and later as Director of outpatient clinics at

Evans Philip 2
Dr. Philip Evans

John Hopkins. From 1939 -1946 he was assistant physician at Kings College Hospital and then Director of the Dept of Paediatrics at Guys and Physician at GOS. He had a busy clinical practice but was also Hon. Secretary of the British Paediatric Association, censor of the Royal College of Physicians and Director of the British Tay-Sacks Foundation. In 1967-68 he was the Director of the first British medical team in Saigon which was ravaged by war. He had wide interests and was truly a general paediatrician involved in rheumatic fever, pink disease, and congenital disorders. However, he had a very busy clinical practice and it was said “his name came up when a paediatric colleague sought help with his own sick child”. He contributed to numerous publications on paediatrics and published more than 55 articles and 130 reviews and invited articles. (based on http://adc.bmj.com).

There is an interesting anecdote concerning Dr. Evans from “Medicine’s Strangest Cases’ by Michael O’Donnell – In the 1970s, Dr Philip Evans was one of the most respected paediatricians in the UK. A consultant at London’s Guy’s Hospital and at the Hospital for Sick Children in Great Ormond Street, he also, from 1972 to 1976, looked after Prince Charles and Princess Anne in his official role a physician-paediatrician to the Queen. He was an erudite and kindly man who was popular with his juniors as he was with his patients. Indeed in the 1960s he sometimes stayed on duty for extra hours at Guys covering for one of his juniors, James Appleyard, when he was out making political speeches about the way senior doctors exploited their juniors.
In 1973 Evans was invited to act as an external examiner at a Middle Eastern medical school. The invitation offered an opportunity for exotic travel and he was delighted to accept it, particularly when he learned that, during the exams, he and a second external examiner, another distinguished British physician, would be lodged in a hotel renewed for its luxury.
On the evening before the viva voce exams, Evans was visited in his room by a rich and distinguished local potentate who, in the course of a delicately constructed conversation, revealed that his nephew would be confronting the examiners the following day. Then, merely as a token of his esteem for Philips’ great wisdom, he offered him ‘a little gift’ – a gold cigarette case encrusted with precious stones.
Philip exercising the diplomatic skill you would expect from someone who had to deal with royal children declined the gift politely. Yet, scrupulous man that he was, he began to worry that, if the nephew did appear before him next morning, he might be biased against him because of his uncle’s attempted briber, alternatively might be too generous for fear of being prejudiced.
Luckily he never saw the nephew; and the following evening was able to relax alongside his fellow examiner in the first class cabin of the plane back to London. As the attendant brought them their drinks, his colleague turned to him and said:” I can’t remember Philip, do you smoke?’ And from his pocket he produced a gold cigarette case encrusted with precious stones.

There is no doubt Dr. Evans was one of the most respected clinicians in GOS when I worked there in 1963, in addition to being a very kind person. He was very busy and in great demand for consultations. I realised how busy he was when I asked on one occasion if he would be driving to Guys Hospital – he said he had not the time to drive between hospitals in the London traffic so usually went by the Underground.

As Dr. Evans’s SHO I was directly responsible to him for the care of his patients, although I could seek the opinion of our senior registrar – a very pleasant able man Dr. Hughes-Davies. The registrars at the hospital were employed in the outpatients and not directly involved in the care of ward inpatients.

I recall on one occasion we had a child admitted to our ward during the evening with cerebral symptoms and signs. After thorough examinations and investigation it was apparent the child was becoming generally paralysed. For the one and only time I rang Dr. Evans at home during the night. There was no hesitation in his reply – “I will come in and see him – but it could be an hour”. He arrived and after through examination diagnosed a mid brain tumour which was the exact diagnosis which soon proved fatal. He was always warm with praise at any contribution or furthering a diagnosis by his junior staff.

The work on the ward was essentially general paediatrics although there was a tendency for the consultants to specialise to some extent. We were busy but the work was interesting and the staff very pleasant and helpful. I tried to do some simple research looking at anaemia and eczema but it never materialised.

There were a number of meetings and we could attend other consultants’ teaching ward rounds. One memorable weekly meeting was on Wednesday afternoons – “The Circus!”. The Circus consisted of a series of case presentations by the resident SHOs with discussion by the members of the staff including some of the consultants. We put a great deal of effort into these presentations and approached the meeting with some trepidation.

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18 TRISOMY

I recall the chromosomes were fashionable and trisomy 18 was a relatively recent discovery. I presented the case of a baby with 18-trisomy a condition which subsequently was identified as affecting in 1.5000 babies. The syndrome was described in 1960 by John Hilton Edwards. The features are described in the figure. A particular feature was the excess of arches on the finger prints.

This case was very sad but at times there was some humour at the Circus. A very pleasant doctor from Newcastle or Gateshead was also an SHO at the time. She presented a child with Laurence-Moon-Biedl Syndrome characterised by retinitis pigmentosa, spastic paraplegia, learning difficulties and extra digits. For some time before her presentation we asked her what she was presenting – has the child Boodle Mean syndrome or Loodle Bean syndrome and so it was until she was thoroughly confused by the time her presentation was due! However, fortunately she managed the correct title. I suppose the nature of these presentations reflected one of the features of paediatric practice at the time of observing syndromes and supporting families and children with abnormalities – so different from the positive, invasive, interventional paediatrics of today.

Clayton Dame Barbara

The permanent consultant staff at GOS were very pleasant, distinguished and supportive. A good example was Dr. (later Dame) Barbara Clayton (1922-2011) the chemical pathologist (photo). She was a very pleasant lady who frequently came on ward rounds. On one occasion we had a child who was reported to have a positive occult faecal blood test. During the discussion I suggested that many children had positive tests which surprised her. She said nothing at the time but some weeks later said to me – “You were right. Many children do have positive faecal occult blood tests by the method we use. We are looking into the method which is obviously too sensitive.” I will always remember that a distinguished pathologist was willing to listen to an SHO – not only listen to but investigate his suggestion and change practice. I was very pleased to see that, after she moved to Southampton, she became Dame Barbara. Many years later in the dining room of the Royal Society of Medicine I saw her at breakfast and had a few words recalling old times. A very distinguished and pleasant person.

1963 Return to Leeds, married life and Professor Craig’s University Department of Paediatrics and Child Health

Ann and I were married on November 2nd 1963 at St John’s Church in Moortown, Leeds – two days after I finished work at Great Ormond Street. Our wedding reception was at the Parkway Hotel in Bramhope, near Leeds.

wedding Nov63
Marriage at St John’s, Moortown Leeds
Edinburgh honeymoon

After the reception we went to Scotland for our honeymoon. We stopped at The Bridge Hotel at Walshford for something to eat as we’d missed out at the reception with talking so much! After we drove to the Percy Arms at Otterburn where we stayed.

We chose Scotland in November as shortage of funds precluded a more exotic holiday. It was not a wise choice; the weather was bad and it rained every day. Apparently my mother was unhappy about our going too far in view of recently loosing her husband George. However, we went as far north as Inverness where there was little to do in the evenings except a cinema showing black and white films.

ourwedding1

Park view crescent roundhay

So now we were married and moved into a top floor flat above my mother and Auntie Rose’s flat tin their house at 7 Park View Crescent, Roundhay, Leeds

From the career aspect, the good news was that I had been promoted to Lecturer in Paediatrics by Prof. Craig when I returned to work in the University Department of Pedaitrics and Child health which was housed in an old building in Blundell Street behind the General Infirmary. I had day to day responsibility for Prof. Craig’s patient at Seacroft Hospital and was also registrar at the neonatal unit at the Leeds Maternity Hospital. Ann returned to work as a Staff Nurse on D Floor, Brotherton Wing of the LGI.

This was a busy time for both of us; I spent a great deal of time reading medical books, learning new techniques, preparing lectures, teaching medical students, nurses and midwives.    My boss, Professor Craig was a hard taskmaster but I came to realise the strict discipline in note-taking, evaluating investigations and general clinical thoroughness was very good training (despite the absence of the modern obsession – evidence based medicine!). However, it must be admitted he was not an easy person to work for also I was now familiar with his foibles – for example he would not tolerate the use of the word “kids” when referring to children nor would he allow informal dress on his junior colleagues on ward rounds – sandals and open necks were definitely forbidden.

[The full obituaries outlining the careers of Prof. Craig and Dr. Allibone are in the Pre-registration House Officer” section]

I don’t believe Prof. was ever really happy in Leeds even though he was born in Yorkshire and the son of a general practitioner. He certainly would have preferred to work in Scotland. There were only a few consultant colleagues in Leeds with whom he had good relationships and whom he trusted – admittedly they were some of the more helpful and pleasant consultants. He had high principles and I never heard him speak ill of any colleague unlike Dr. Allibone his NHS consultant colleague. Dr Eric Allibone always resented the fact that Prof. had been preferred to him for the chair, as he was the experienced successful local candidate.

The hospital paediatrics in the city was divided between the university consultants, Prof. Craig and his Senior Lecturer Michael Buchanan, and the NHS Dr. Eric Allibone and his NHS registrar. The University Department were responsible for half the paediatric beds at the LGI, St James’s and Seacroft and neonatal care at the Leeds Maternity Hospital, Hyde Terrace (2500 deliveries pa) and St Mary’s Maternity Hospital, Bramley (3000pa). Dr. Allibone had responsibility for half the paediatric facilities but neonatal care at the smaller unit at St James’s Hospital (not designated as a “University Hospital until Seventies).