A souvenir – “a thing that is kept as a reminder of a person, place or event”

These souvenirs collected over the years are not described in any chronological order as they evoke different memories – in some vivid very pleasant recollections of a person or event, in other cases the association is long forgotten and, frankly, in some the souvenir was so ghastly I just couldn’t resist adding them to my shelf to shock relatives observers of my shelves.

Contemplating the hundreds of souvenirs on the shelves in my study both in Bardsey and in the last five years in Radcliffe-on-Trent, I reflected on the thousands of memories – mostly pleasant – that these objects recall.  So I decided to take a few of these souvenirs and write a few words about the events which occurred around the time of their acquisition.

 

  LIST OF CONTENTS

–  MALTA CIGARETTE LIGHTER

– NODDY – A PRIVATE PRACTICE COMPANION

– TWO THRIFY BEARS FROM HAMBURG

– BLUE RIDGE MOUNTAIN BEAR

– NUNZILLA FROM NAPPA VALLEY

– SWISS COW LIGHTER FROM BASLE

– ANNA’S ‘BOSS GERM’ BADGE

– CUFF LINKS FROM MECCA

 – TWO ROLEX WATCHES MALTA

– REPLICA OF SNOWDEN TRIANGULATION STATION

– BALL POINT FROM INVERCARGILL

– HARRY RAMSDEN’S FISH AND CHIPS

– SALT FROM LUNEBURG

– A CANDELABRA

– THE CUTTY SARK MODEL

– THE ROSSI MEDAL

– AN ARTICLE IN POLISH

–  KENTUCKY FRIED CHICKEN LOGO

 

A MALTA CIGARETTE LIGHTER

One of the oldest souvenirs from the Fifties is Corporal Vella’s gift of a souvenir cigarette lighter at the end of my time in Malta with the Royal Army Medical Corps (RAMC) from 1957-1959.

When I left Malta in 1959 after two years National Service as a doctor in the Royal Army Medical Corps, Corporal Vella of the Royal Malta Artillery, presented me with a small souvenir cigarette lighter as a memory of my time in Malta. Corporal Vella was in charge of St Patrick’s Medical Centre for which I was responsible and where I worked for my time in the island.

Looking back I believe this was one the first of the hundreds of souvenirs that adorned the shelves in my study in Bardsey and since 2016 in Radcliffe on Trent. Since 1959, when I was given this lighter by Corporal Vella,  Ann and I have travelled quite extensively both on holidays and as part of my cystic fibrosis work. So I have acquired many shelves full of souvenirs – not always  in the best of taste I would add!

My work in Malta was essentially as a families medical officer for the UK service families and the families of the Royal Malta Artillery troops most of whom had very large families. In my clinic at the St Patrick’s medical centre I also saw many of the wives of the marines of 40 Commandos and 3 HQ Commandos who were based nearby in St Patrick’s barracks or rented property. I worked in one half of St Patrick’s Medical Centre, the other half was used by the Royal Navy doctor (Lieutenant Commander Guy Bradford).

The commando medical set up was under the direction of Petty Officer Knobs.   My half of the centre was organised by Corporal Vella and Gunner Camilleri – regular soldiers of the Royal Malta Artillery. Corporal Vella and I worked together and had a very good working relationship for the 2 years I was in Malta.

There  were naval nursing sisters attached who were excellent.  Queen Alexandra’s Royal Naval Nursing Service (QARNNS) is the nursing branch of the British Royal Navy. The Service unit works alongside the Royal Navy Medical Branch. They took the wives’ and family clinics with me and also did home visits. We would have a clinic daily after which I would do visits with my Maltese driver in the Land Rover to English or Maltese military families anywhere on the island. After 2 years of this work I knew most of the towns and villages and their streets on the island – in fact, sometimes I had to direct the drivers to a particular street in the smaller less visited villages!

Our hospital support was provided by the Royal Naval Hospital, Imtafa in the north of the island where there were a full range of RAMC consultants.
On 1 March 1951, the designation of the hospital had changed to The David Bruce Military Hospital, after the discoverer of the root cause of brucellosis in 1887 (later traced to goats’ milk in 1905 by Sir Themistocles Zammit). 

I had very little contact with the hospital except for occasional cocktail parties and professional contact regarding patients whom I had referred there. However, the staff were always very helpful with regard to giving a specialist opinion or arranging an admission. I recall receiving great support from the army consultant physician for a colonel’s wife who had the most terrible asthma, for which she was eventually invalided home to the UK.

Corporal Vella was a bustling, efficient nervous man who smoked numerous Flag cigarettes. He also smelt heavily of garlic in the mornings. He had a large family  – 10 children – whom I visited when they all developed flu during the 1957 influenza epidemic. He was a regular soldier in the Royal Malta Artillery but essentially functioned as the full time manager of the  St Patrick’s Medical Centre. It was very similar to a family doctor’s surgery but without old people. Sadly I have no photos of Corporal Vella.

When Lt-Cmdr Guy Bradford was off on exercises with the commandos (as occurred frequently), I would do his clinics and see the Marines with the help the Petty Officer. This was useful on occasion when there were problems outside my limited experience. For example, one morning I was standing in for Guy Bradford doing the Marines sick parade. A young soldier came in complaining of some irritation “down below”. I had a look and suggested there could be some allergic problem.  The Petty Officer learned over whispered in my ear “If you look carefully Sir I think you’ll see that allergy is moving”  I did – and it was.  There were numerous crab lice causing the man’s itching. The PO ordered him to “Report back here with your razor and clean clothes  for treatment”.  So I had much to learn about the problems of soldiers which I had not encountered in my preregistration house jobs in paediatrics and thoracic surgery!

I deal in more detail with my time in Malta in “1957-1959 Royal Army Medical Corps” section of this website.

 NODDY – A PRIVATE PRACTICE COMPANION                                                 

We acquired Noddy in the late Sixties for our own children and around the time I became a National Health Service consultant paediatrician. From 1968 we did private practice for one afternoon a week and Noddy seems to have been involved from  the early years.   My wife Ann, a trained nurse, would organise the clinics, very efficiently weigh and measure the children, perform respiratory function tests, test the  urine specimens and set up a slide specimen for microscopy.                 To occupy the children she would also bring a few toys and books which from the early days included Noddy

Enid Blyton’s Noddy, about a little wooden boy from Toyland, first appeared in the Sunday Graphic on 5 June 1949, and in November that year Noddy Goes to Toyland, the first of at least two dozen books in the series, was published. The idea was conceived by one of Blyton’s publishers, Sampson, Low, Marston and Company, who in 1949 arranged a meeting between Blyton and the Dutch illustrator Harmsen van der Beek. Despite having to communicate via an interpreter, he provided some initial sketches of how Toyland and its characters would be represented. Four days after the meeting Blyton sent the text of the first two Noddy books to her publisher, to be forwarded to van der Beek. The Noddy books became one of her most successful and best-known series, and were hugely popular in the 1950s. 

The history of Enid Blyton’s Noddy books over the years is fascinating.   From around 1950 onwards her work was treated more critically, especially the ‘Noddy’ series, and faced accusations of being elitist, sexist and racist and the books were banned from public libraries! Nevertheless she is the fourth most translated writer behind William Shakespeare, Agatha Christie and Jules Verne. There is a very interesting and very long account on Wikipedia.  The controversy remains active as recently the Royal Mint refused to put Enid Blyton’s face on a Commemorative coin after being known to be a “racist”, “sexist” and “homophobe” according to the Royal Mint Advisory Committee.

Despite all the controversy Noddy  came with us in our various private clinic locations from 20 Clarendon Road, in Leeds, then to the Nuffield Hospital in Horsforth and finally at the Spire Hospital in Roundhay, Leeds.  He used to stand on my desk welcoming the young patients who usually noticed him when they entered the room. When he was squeezed he used to squeak.  Over the years this was increasingly distracting so we removed his squeaker. One jovial parent, whose child came periodically for follow up, was in the habit of giving Noddy a squeeze when he came into the consulting room with his wife and child.  On the occasion when there was no squeak he was obviously surprised, roared with laughter and asked what operation he has had!!

 

 TWO THRIFTY PIGS FROM HAMBURG

In June 2011 Ann and I attended the 11th EUropean Cystic Fibrosis Meeting in Hamburg. The weather was good and we had plenty of time for sightseeing, shopping and meeting with friends.

Hamburg is a major port in northern Germany  and is connected to the North Sea by the Elbe River. Near the centre is the impressive Inner Alster Lake dotted with boats and surrounded by cafes

While strolling around the city we entered  a long street market where I spotted a small antique pig money box which I could not resist for my souvenir shelf so I bought it – not sure for how much but it was not expensive. On another stall at the other far end of the street market there was a larger more impressive pig money box I couldn’t resist and so made a second purchase!

Smaller Pig.  An identical pig is described in a recent (2019) catalogue as “Smaller pig Vintage Cast Iron Brass Pig Coin Piggy Bank 4.5”   Condition: Used  “Good”   Price: US $148.75 (Approximately £107.53)

Larger Pig.  An identical larger pig is described on the internet as The Antique The Wise Pig Thrifty Cast Iron Original Painted Piggy Bank Price $35 There is additional text as follows –
“Wise Pig has been making saving pennies adorable since the 1930s! And he looks really good for being 90. The original peachy cream and pink paint has been worn away in some areas (not so on our pig), but gives it a sophisticated timeliness. Antique piggy pig  banks should be cherished like the works of art they are. Perch this cast iron cutie in a kitchen or den to add an element of playful charm!”

The message the larger pig is holding reads “The Wise Pig: Save a penny yesterday, Another save today, Tomorrow save another, To keep the wolf away.” On dangle plaque. Marked “Thrifty” on base. Size: 6.75” height; 2.75” width; 2.75” depth

I don’t remember what I paid for these but it was not much – I was surprised to see the price of the smaller one in a recent internet catalogue.

These two pigs bring back pleasant memories of our stay in Hamburg – we had never seen a “BierBike.de” before – cheerful young men all peddling and drinking beer on a “BierBike.de” at a stag party

At the end of April in 1995 we combined a two day working visit to the headquarters of the US CF Foundation in Maryland with a holiday traveling down the Blue Ridge Mountains Parkway and into the South. 

The Blue Ridge Parkway runs for 469 miles down the Blue Ridge Mountains

from Virginia all the way down to Cherokee, North Carolina. It was started in 1935 as part of the massive move in the economics depression to get America back to work; half of the Parkway was completed before the Second World War.

The other animal we looked out for all the way down the Blue Ridge Parkway was a black bear. We had no luck until our very last morning driving down the final mile or so of the Parkway. On our left, on the left hand side of the road, a small black bear was peering over the grass verge. I stopped the car at once and reached for the camera by which time the bear had disappeared – that was our only sighting of a black bear!

That was our only sighting of a black bear although there are said to be many in the mountains! The lady at the shop at the bottom of the road, where we bought the postcard, said she had lived there 12 years and never seen a bear!    

When we left the Parkway  and travelled further south, we stayed in Plantation houses that were now bed & breakfasts. These were very grand as they had been the plantation owners residences in the old days. The proprietors were very welcoming as are most Americans. Breakfasts where in the large dining room at a large table; it was interesting talking to the other guests. One farmer insisted on showing us round his vast farm.

 

  NunZilla

In 2000 we visited San Francisco. I had a meeting at the headquarters of Genentech, a drug company that manufactured Pulmozyme – a very successful drug which, when inhaled, dramatically reduced the stickiness of the sputum of people with cystic fibrosis.

Undoubtedly Pulmozyme was one of the major new treatments introduced during the `nineties

 

This meeting was arranged to discuss the final results of a recent large trial of the drug for relatively “mild” CF patients with less severe chest involvement. I was one of three senior clinicians who were asked to be available to advise if there were problems or issues during the trial – fortunately there were none!  The trial confirmed the drug was also valuable in these “mild” cystic fibrosis patients demonstrated by this present trial.

Quan JM, Tiddens HAWM, Sy JP, McKenzie SG, Montgomery MD, Robinson PJ, Wohl ME, Konstan MW. Pulmozyme Early Intervention Trial Study Group. A two-year randomised placebo controlled trial of dornase alfa in young patients with cystic fibrosis with mild lung function abnormalities. J Pediatr 2001; 139:813-820. [PubMed]

We had the opportunity to do some sightseeing around San Francisco – the iconic bridge, harbour with view of the prison Alcatraz and the trams etc. It was an interesting trip.

On one day we went on a tour of the wine region of the Napa valley to view the vineyards, small towns and the general scenery. The tour included a very pleasant lunch with wine at one of the vineyards.

   There was time to look round the shops where, rather than a wine-related souvenir, I spotted this quite unusual little nun. On winding, she walks or rather totters and sparks fly out of her mouth. She was called NunZilla.  A homonym of Azilla the Hun,  a man later branded as “the scourge of God”, one of history’s most infamous characters, standing as the ultimate barbarian”     This is the original description this toy from the Archie McFee’s Seattle website – there are numerous other references to the toy on the internet –  “Say your prayers! No one is safe from the wrath of Nunzilla! This fire-breathing wind-up sister trudges straight out of a Catholic-school student’s nightmare like a determined disciplinary force, with green eyes blazing and sparks flying from her mouth. Wearing the traditional black and white habit and carrying a Bible in one hand and a ruler in the other, this holy terror will have you owning up to transgressions from as far back as birth. 2″ tall and made of hard plastic, packaged in a custom cathedral-style box”.

I proudly demonstrated NunZilla’s impressive functions to one of our young grand daughters – who immediately screamed and  dissolved into floods of tears.  Well done Grandpa!

 

  THE SWISS BUTANE COW LIGHTER

Switzerland is a great place for souvenirs. I  recall on our first visit to Davos we came back with assorted goods including the inevitable cuckoo clock.   However, this little Coney butane cow lighter  was purchased in the airport on a visit to Basel. If one depresses the plunger on the back of her head flames gush from the nostrils – most impressive!

Aerugen was a vaccine developed in Basel by Berne Biotech Ltd intended to reduce the likelihood of a person with CF being colonised and subsequently chronically infected by Pseudomonas aeruginosa. There had been an encouraging, but very small, trial some years previously where the authors concluded that regular vaccination of young CF patients for a period of 10 years with a polyvalent conjugate vaccine reduced the frequency of chronic infection with P. aeruginosa. This was associated with better preservation of lung function. Vaccinated patients gained more weight during the study period, a possible indication of an improved overall health status. (Lang AB et al, Pediatr Infect Dis J 2004;23:504-510).

On the basis of this study a major Phase III multicentre trial of the vaccine (Aerugen) was undertake  from April 2001 involving 476 children of whom 458 completed the study essentially involving two initial vaccinations and then annual vaccine or placebo for four years. Unfortunately, the vaccinated group showed no advantage over those receiving placebo. We attributed the failure to the change in clinical practice with a more widespread practice of early Pseudomonas eradication. In view of these disappointing results further development of the vaccine was halted in 2006. I was asked by the firm to advise as to  whether any useful information could be salvaged from the results. A real disaster.

The representative responsible for the trial, Rebecca,  looked after us and ensured we saw some of the sights of this very pleasant city. The failure of the vaccine was very disappointing for her as the main coordinator of the trial.

It was very sad and the immunology doctor in Basle responsible for development of the vaccine, Dr Alois B Lang, was totally devastated and retired from the firm when they withdrew production of the vaccine. However, he subsequently returned to a senior position as Chief Development Officer of GeNeuro SA, Geneva since 2007.  He held the position of Chief of Research and Immunology and Project Director for Berna Biotech, in Berne.

Even as I write, in 2022, there is still no effective vaccine to prevent the colonisation and chronic infection by Pseudomonas aeruginosa in people with cystic fibrosis. This is perhaps less important now as there are very effective early antibiotic eradication regimes.

So this little butane lighter reminds me of two of my visits to Switzerland in connection with this particular project . One to look round the factory in Berne with Lois Lang soon after the start if the trial where there was an optimism that the trial was underway and the sad one described here to the drug firm’s headquarters in Basle to comment on the reasons for the disappointing results.   All very sad and disappointing as this was a huge trial during which nearly 500 children had two initial and subsequent annual injections of either active vaccine or placebo.

 A VERY TALENTED GIRL WHO HAD CYSTIC FIBROSIS

From 1980 during my time as Director at the Regional Cystic Fibrosis Unit at St James’s University Hospital in Leeds. we had some 600 children referred for assessment from around the UK and abroad.

Many came from the Leeds and surrounding towns and cities in the Yorkshire region.  Those who attended St James’s for all their hospital medical care and they became well known to the staff who had an important supportive role for the children and their parents.  Their childrens’ frequent prolonged admissions for intensive treatment with intravenous antibiotics and physiotherapy. Sadly in the Seventies some children were not referred from their local hospitals until their chests were badly damaged.

On such child was Anna who was referred at around the age of ten years when her chest was quite severely infected necessitating regular course of inpatient treatment.  Anna was a very intelligent girl but attended a school for physically handicapped children due to the fact that her mother was physically handicapped and unable to carry out Anna’s twice daily physiotherapy.

Anna produced two booklets one “written for CF sufferers from about the age of 5 years” and another by “a CF patient, for other CF patients from about 6-12 years”. The text and illustrations of these booklets was really excellent and the printing was funded by Duper Laboratories the makers of Creon, a very effective pancreatic enzyme preparation.

 

 

 

 

 

 

 

 

 

 

 

 

Another of Anna’s achievements was to design a wall chart relating to various aspects of cystic fibrosis.

Anna designed badges for members of the staff with humorous titles  – I am described as”Boss Germ” – hence my choice of my badge as a VERY memorable souvenir.

Anna was a great character and very talented despited numerous negative aspects to her life – which she certainly lived to the full. As was the case with many children with cystic fibrosis in the Seventies and Eighties, lung damage sustained in early childhood steadily progressed despite being slowed by intensive treatment.     Anna died in her early teens.

    CUFF LINKS FROM MECCA

There were many great characters amongst our hundreds of young cystic fibrosis children. Those who more severely affected, required more frequent admissions and became well know to the nursing and medical staff.

One particularly memorable boy was Asif from an Asian family who lived in Bradford.  His chest was already severely affected when he was referred to St James’s to the extent that his growth had been severely restricted.  He was very witty cheerful boy who would sit on  his bed and comment on the world around him.  He was a great favourite with the staff and all on the ward..

This was the early days of lung transplantation at the end of the Eighties and the prospect was raised with him on a number of occasions.  Asif was quite adamant – “I don’t want someone else’s lungs in me”. Asif always refused to be referred for a lung transplant assessment and died in his early teens.
Asif was from a Muslim  Pakistani family in Bradford and believed in life after death. He enjoyed his trip to Mecca and returned with souvenirs  for the staff – mine was was a pair of cuff links.

As we had a large number of CF patients and were close proximity to Bradford we had more Asian patients than most centres. In 1993 Ian Bowler, our CF Research Fellow at the time, reviewed them and we  published the details of nine Asian patients and compared their course with that of Non-Asian patients.                                     (Bowler et al, Cystic fibrosis in Asians. Arch Dis Child 1993;68:120-122).
The Asians grew Pseudomonas aeruginosa at an earlier age (4.0 v. 7.5 yrs) and had worse respiratory function (forced vital capacity 58.5 v. 76.8 % and forced respiratory volume in one second 79.8 v 100.3%). They had lower weight for height and for age. Only four of the Asians carried the dF508 mutation compared with 17 of 18 Non-Asian controls. Two Asians had other genetic disorders. One had glucose 6 phosphate dehydrogenase deficiency and the second had distal renal tubular acidosis and b-thalassaemia trait.                                                                                                                               (Fallon JS et al, Cystic fibrosis and renal tubular acidosis. Arch Dis Child 1989;64:1054-5).
Although all the Asian children were born in the UK, seven of the mothers had severe language difficulties with English.

I still have a clear picture in my mind of Asif.  On ward rounds he would be sitting on his bed and greet me with a cheery “How are you this morning Dr Littlewood?”.  Quite a character.

TWO ROLEX WATCHES

I was in the Royal Army Medical Corps in Malta between 1957 and 1959. Service personnel serving in Malta at that time were allowed to purchase items such as watches free of duty. However, they were left in customs and handed over to the owner on leaving the island.  I bought a Rolex Tudor wrist watch with gold case for about £18 and opted for a gold back for which I think I paid  an extra £5. I can’t remember exactly how much the watch cost.

On my last day in Malta we had a celebration  at lunchtime in Valetta.    After a meal and many drinks (Pernod was my favourite at the time!), I was walking down the main street searching for a taxi when  I passed a jewellers shop. In the window were various watches including a Rolex Oyster priced at £27. What a bargain I thought. I’ll buy it and offer one of my watches to my brother Douglas when I get home. So I spent my last £27 on the Rolex Oyster.

Now I had problems. The gold Rolex Tudor would be given to me at the airport and would obviously be declared and was not due for duty. However, the new Rolex Oyster would need to be declared and duty would need to be paid. I did not have any money left so I wore it. All went well. Subsequently, when I asked my brother Douglas if he would like to buy one of the watches he said, “I’ve already have a watch. What would I do with another one?”. So, sixty five years later, I still have the two watches!

Of some interest, an identical Rolex Oyster Speedking, the same even to the slightly yellowish face, recently (2022) sold on the net for £1350.   Not sure of value of the Tudor Oyster – possibly around £500 as judged by those for sale on the internet

Some interesting Rolex facts from Wikipedia – Rolex SA  is a British-founded Swiss watch designer and manufacturer based in Geneva, Switzerland. Founded in 1905 as Wilsdorf and Davis by Hans Wilsdorf and Alfred Davis in London, England, the company registered the word ‘Rolex’ as the brand name of its watches in 1908, and it became Rolex Watch Co. Ltd. in 1915.
After World War I, the company moved its base of operations to Geneva because of the unfavourable economy in the United Kingdom. In 1920, Hans Wilsdorf registered Montres Rolex SA in Geneva as the new company name (montre is French for a watch (timepiece)); it later became Rolex SA. Since 1960, the company has been owned by the Hans Wilsdorf Foundation, a private family trust. Rolex SA and its subsidiary Montres TUDOR SA design, make, distribute, and service wristwatches sold under the Rolex and Tudor brands.

Rolex did not produce their watches in-house since its foundation until the early 21st century where they bought over the components’ manufacturers which made the watches for Rolex, notably Jean Aegler. Rolex’s past business model consists of purchasing all the watch components from third-party manufacturers and finishing the final assembly in the Rolex headquarters.

Rolex SA offers products under the Rolex and Tudor brands. Montres Tudor (SA) has designed, manufactured and marketed Tudor watches since 6 March 1946.

Rolex founder Hans Wilsdorf conceived of the Tudor Watch Company to create a product for authorized Rolex dealers to sell that offered the reliability and dependability of a Rolex, but at a lower price. The number of Rolex watches was limited by the rate that they could produce in-house Rolex movements, thus Tudor watches were originally equipped with off-the-shelf movements while using similar quality cases and bracelets TUDOR SA is a Swiss manufacturer of luxury wristwatches based in Geneva, Switzerland. Registered in 1926 by Hans Wilsdorf, the founder of Rolex, the brand remains a sister company to Rolex, both companies being owned by the Hans Wilsdorf Foundation.

I have described my 2 years in the RAMC in Malta from 1957-59 elsewhere on this website  –   “1957-1959 Royal Army Medical Corps”.

As an addendum, I recently had the winder of the Tudor replaced at a cost of £200 which seems rather steep. However, I do enjoy wearing the watches regularly and the memories they bring – even in the era of Swatches and Apple watches!

 

REPLICA OF SNOWDEN TRIANGULATION STATION

During one of our stays in Anglesey in October 2015 we took a trip up Snowden.

The souvenir is a replica of the top of the Snowdon ordinance survey triangulation station which is on the summit.

A triangulation station, also known as a trig point, is a fixed surveying station, used in geodetic surveying and other surveying projects in its vicinity.  In the United Kingdom, trig points are typically concrete pillars and were erected by the Ordnance Survey. The process of placing trig points on top of prominent hills and mountains began in 1935 to assist in the accurate retriangulation of Great Britain. The Snowden trig point was rebuilt in 2000.

We travelled up and down on the ancient steam train which took an hour each way.  There is a cafe and toilets at the top. The weather was glorious for early October.  The views were very impressive in every direction.

 

 

We have had many happy weeks with Mary and George Dawson at Holiday Property Bond Henllys  Golf Course in Beaumaris.

 

 A BALL POINT PEN FROM INVERCARGILL – NEW ZEALAND

In March 1990 I was invited on a CF Lecture Tour in New Zealand.

Ann and I had just finished a similar lecture tour in South Africa. In fact, it was on the escalator in Johannesburg Airport  that I answered a phone call from New Zealand with an invitation to visit there for a similar tour! The visit would be funded by the pharmaceutical firm Janssen Cilag whose representative Angela would look after us for the first two weeks which she did very efficiently.

We arrived in Auckland on Saturday March 3rd and stayed at the Hyatt Regency in that city. The local CF paediatrician,  Alison Wesley, had been to visit our CF unit in Leeds and was partly responsible for inviting us back to New Zealand. On the day we arrived, almost as soon as we stepped off the plane, Alison drove us around Auckland to see the views; we were very tired after our long journey and found it difficult to keep awake! However, I managed to do a radio interview with Donna Chisholm from the Sunday Star at I pm. Our hotel room had a very good view of Auckland’s impressive harbour.

Our first day in New Zealand was a Saturday and when we walked into the main street in Auckland we were surprised to find all the shops were closed for the day at lunch time.

On Sunday we met with Alison Wesley and had dinner with John Weary -p we were shown round the relatively new Starship Children’s Hospital (photo) and I did a ward round and had informal discussions with the staff. I had lunch with Professor Bob Elliott (photo) the head of paediatrics in Auckland who had published on a number of aspects of CF including neonatal screening, dietary supplements and the phenomenon of  wrinkling fingers when immersed in water.. When I visited him he was keen to tell me how he was developing an insulin preparation for inhalation – obviously a lively researching mind!

Elliot’s paper in collaboration with the Auckland biochemist, Jeanette Crossley in 1979, described the immunoreactive trypsin (IRT) heel prick blood test for neonatal CF screening which is still used today – undoubtedly a “megapaper”.  Megapaper is a term I use in my History of Cystic Fibrosis  website (www.cysticfibrosis.online/history) to describe publications which have had a major influence on the understanding of or treatment of cystic Fibrosis. This one certainly did have a worldwide influence as I have described in detail on the our history website. Also I obtained comments for the website from Jeanette Crossley and Anthony Heeley – the biochemist from Peterborough who was an early pioneer in using this test since 1980 in East Anglia.

On the Monday afternoon there were two interviews with reporters; one with Michael Collins from the GP Magazine and another with Jill Mckenzie from a NZ newspaper.  In the evening we had a meeting with the Auckland Cystic Fibrosis Association branch in the ballroom of the Hyatt Hotel. Over 100 people attended. Both my lecture and the following extensive discussions went very well.

 On Tuesday 6th. A full day CF symposium had been arranged in the Marion David Theatre of the Auckland hospital. I gave two 45 minute lectures – one on the management of chest disease with particular reference to Pseudomonas in the morning and the other on the management of nutrition in the afternoon.                   In the evening after the symposium the Auckland Medical Society entertained Ann and me to dinner – I gave a short talk and answered some questions.  The first course was Auckland oysters – a first for me!  

The next morning we flew to Wellington – a short flight of only an hour – and were met by Bruce Kerr the Chairman of the Wellington Parents Group.

Tuesday March 7th. To Wellington – the capital of New Zealand
In Wellington we stayed at the Park Royal Hotel. In the afternoon we had a look round – cable railway, botanical gardens and tour of parts of the city. In the evening we met with Wendy Calnan and Sally Fortescue – the publicity officer of the NZ CF Association to discuss a radio interview booked for the next morning.

Angela, from Janssen Cilag, the pharmaceutical firm, escorted us during the whole working part of the tour. She was an expert on New Zealand wine and looked after us very well both re. travel, accommodation, food and wine.

We had a brief tour of Wellington, around the city and up the scenic railway 

On Thursday 8th at 9.00am there was an interview with Pauline Swane from the Dominion Newspaper.  At 10 am we were off to Broadcasting House for an interview with Maggie Barrie of Radio New Zealand

On Friday 9th I attended the Journal Club at the Wellington Hospital and in the afternoon attended a clinical presentation at the hospital. 

At 4.30 we left Wellington by car to attend a CF branch meeting at Palmerston North.
The weather was really terrible and there was some flooding; we nearly didn’t make it. However, we did and I gave a lecture at the arranged time of 7.0pm. Palmerston North is a city of some 80,000 people situated 87 miles north of Wellington.

Saturday 10th we had free and had dinner with Angela in the evening. She was very skilful at choosing restraunts

Sunday March 11th. A 45 minute flight to Christchurch.
Subsequently the city suffered a number of severe earthquakes between 2010 and 2012. Apparently, the one in February 2011 was the strongest to be recorded in an urban area and 185 people were killed.

We were met at the airport by Peter and Sally Haughey of the Christchurch branch and we stayed at the Park Royal Hotel Christchurch. It was built in 1988 in the north-west corner of Victoria Square after much public protest, as it cut off the first part of Victoria Street, its construction happened at the same time and enabled the substantial redesign of Victoria Square.
The building had New Zealand’s largest atrium, and was one of the city’s largest hotels. The building suffered significant damage in the 2011 Christchurch earthquake and was demolished in April 2012.

Monday 12th. At 10am I had an interview with the Christchurch Press. Between 2pm and 5pm I was in the Adult CF Clinic at Christchurch Hospital with Dr Peter Thornley the Respiratory Physician – a very enjoyable an interesting afternoon – he is a very nice chap who organised the work part of our visit to Christchurch.

Tuesday 13th. At 12.00 noon there was a Registrars Meeting with presentation of CF patient histories on which I was asked to  comment. At 7.30 pm we attended a Canterbury CF Association Branch Meeting in the Mckenzie Room of the Auto Lodge Hotel. 

Wednesday 14th. At 9.30 am attended a departmental meeting of paediatricians, GPs, students and staff from the paediatric department. Then at 11.00 am over to the Princess Margaret Hospital to a clinical meeting relating to CF Adults organised by Peter Thornley. I did not give a presentation at this meeting but was asked to comment on the patients presented.

In the afternoon we saw a few of the sights during a short bus tour and later in the afternoon were guests at the Coringa Country Club where I  presented the prizes to the winners of their golf competition    This was the end of our visit to Christchurch. We flew to Dunedin the following morning.

Thursday 14th – on to Dunedin
The flight to Dunedin took only 45 minutes.  We met the local paediatrician Chris Hewitt and his family who lived in a pleasant house overlooking the sea.

It became a routine on our tour that I would do a CF clinic with the local paediatrician and also a lecture to the hospital medical staff during the day and a parents meeting in the evening. So I spent much time shuffling hundreds of slides in the evening in our hotel room. This was before the days of PowerPoint!

 

Dunedin was very reminiscent of Scotland and, indeed, has been described as the Edinburgh of New Zealand; it is said to “wear its Scottish heritage with pride”. Surrounded by dramatic hills and at the foot of a long harbour, Dunedin is one of the best-preserved Victorian and Edwardian cities  in the Southern Hemisphere    One definitely seemed to be getting into a more outdoor type of mode here and we were able to see the albatross colony.  There is a definite Scots influence in Dunedin. Apparently the early immigrants built their houses facing south to catch the sunlight not realising the sun came from the north when in the Southern Hemisphere! 

Dunedin was linked to Christchurch by rail in 1878, with a link south to Invercargill completed the following year, and the first railway workshops were opened at Hillside in South Dunedin in 1875. Early plans were for a grand main station on Cumberland Street, but these did not get further than the laying of a foundation, and a simple temporary weatherboard station was built next to the site in 1884. It took close to 20 years for government funding to be allocated, and planning only really commenced as the 19th century was drawing to a close.

The logistics of constructing what was at the time New Zealand’s busiest railway station took three years before construction began in 1903. Dunedin required a station for a wide range of activities: it was a commercial and industrial centre, close to gold and coalfields, with a hinterland that was dependent on livestock and forestry for its economy.

The city’s largest industry now is tertiary education – Dunedin is home to the University of Otago, New Zealand’s first university (1869), and the Otago Polytechnic. Students account for a large proportion of the population: 21.6 percent of the city’s population was aged between 15 and 24 at the 2006 census, compared to the New Zealand average of 14.2 percent.

Our work in Dunedin started at 1.00pm on the day we arrived (15th March) with an open lecture at the Children’s Pavilion at the Dunedin Hospital on “The treatment of early Pseudomonas infection”. I spent the afternoon in the Children’s Department of Dunedin Hospital doing a CF clinic with Dr Hewitt. In the evening I gave a lecture on “Modern expectations in Cystic Fibrosis” to CF parents and adults in the seminar room of the Children’s Pavilion.

On Friday March 16th morning there was a CF Symposium where we discussed nutritional management, physiotherapy, case presentations and outpatient management. In the afternoon Chris Hewitt took us sightseeing when we saw the albatross colony. We also had the following day off went on a bus tour.

March 19th. On to Invercargill
The flight from Dunedin to Invercargill took only 35 minutes. We stayed at the Ascot Park Motor Hotel.

In the evening there was a meeting of the Southland Cystic Fibrosis  Association branch at the Kew Hospital organized by Dr Ralph Pinnock, the local paediatrician, and Colin and Judy Millar of the local CF association. The audience were very pleasant people with a wide variety of questions. After the meeting one of the audience presented me with a ball point pen (I hope you like it he said).  I recall this as being a really significant present from a really lovely community – more memorable than many of the Kiwis and other traditional commercial souvenirs.

Monday March 19th I attended the CF clinic at Kew Hospital. At lunchtime I gave a lecture for the hospital doctors and in the afternoon continued the CF clinic. Later in the afternoon we went sightseeing with Ralph Pinnock.  Invercargill was interesting. It is one of the southern most cities in the World and most New Zealanders have never been that far south!  

During the day Ann was shown round the city by the wife of the local paediatrician. She gained the impression that Mrs Pinnock was unsettled there as the place seemed so quiet and under populated. I remember Invercargill better than some of the larger cities we visited – in particular the garlic oysters we had the previous evening at the paediatrician’s house.  We started our working trip with oysters in Auckland and finished it in Invercargill with oysters!

Ralph Pinnock took this photo during our tour of the city on our last afternoon. It was taken on the southern most part of the coast. We heard some time later that he and his wife had moved from Invercargill

In the evening we flew at 7.10 pm to Auckland via Christchurch. 

 

  HARRY RAMSDEN’S FISH AND CHIPS

The story of Harry Ramsden’s Fish and Chips business is quite remarkable.This small model of a Harry Ramsden’s vehicle from the restaurant souvenir shop brings back many happy memories of visits to the original iconic fish and chip restaurant in Guiseley, Yorkshire.

The business was started by Harry Ramsden (1888–1963) in 1928 in a wooden hut in White Cross, Guiseley, West Yorkshire, northern England. Three years later Harry moved into a new premises, complete with fitted carpets, oak panelled walls, and chandeliers. The original hut still stands on the same site adjacent to the main restaurant, which once held the Guinness World Record for the largest fish and chip shop in the world, seating 250 people, serving nearly a million customers a year.

There was often piano music or other musical entertainment in the elegant restaurant. The waitresses were in traditional black dresses with white aprons and lace headgear. Many celebrities visited Harry Ramsdens – even including Mrs Thatcher.

In 1954, the business was sold to Harry Ramsden’s long term business partner Eddie Stokes for the (then) large sum of £37,500, and subsequently in 1965 to the Essex-based Associated Fisheries.  The business achieved international recognition although following various financial changes in the years that followed, including the remarkable expansion to fast food outlets, in 2012 the business was in trouble and taken over by the very successful, family-owned Yorkshire Fish and Chip firm – the Wetherby Whaler.

 

 

 

 

 

 

The Wetherby Whaler is a chain of quite excellent fish and chips restaurants in the Yorkshire region. The first restaurant was founded in 1989 in Wetherby by Phillip and Janine Murphy with four more having been subsequently opened across Yorkshire – undoubtedly due to the excellence of their fish and chips.  This was a great move as Harry’s was the most famous business in the North and the Wetherby Whaler had since its opening in Wetherby in 1989 produced the best fish and chips in the region; other “Whalers”  had opened in York, Wakefield and Pudsey prior to the Harry Ramsden’s in Guiseley in 2012

I include this piece about the Harry Ramsden’s as Fish and Chips are very popular in the North.   We visited the original Guiseley restaurant many times often with guests who came to stay. We took them for fish and chips in the original Harry Ramsden’s restaurant as one of the important landmarks of our area!  We usually provided them with a small gift from the souvenir shop    situated under the main building.

Undoubtedly, the “Whalers” have carried on the very high standard already in their other branches. I think Harry would have been pleased with how things have turned out.

 

    SALT FROM LUNEBURG IN GERMANY

I received an invitation from a gastroenterologist in Luneburg, Dr Paul Lankisch, to take part in a meeting devoted to the Pancreas. It was to be the basis for a subsequent publication on pancreatic enzymes. It was a relatively small group of the people, particularly involved in pancreatic matters,  who would be writing the various chapters. my involvement was with the pancreas in cystic fibrosis.

I met some well known gastroenterologists at the meeting such a Eugene Di Magno from the USA.  I gave a talk on “Pancreatic  Enzymes in Cystic Fibrosis” and wrote the subsequent chapter in the book.

The city of Luneburg is interesting and famous for the production of salt so, of course, I purchased a small sack as a souvenir for my study shelf which was becoming quite full even by then. The photos show various views of the historic city in the state of Lower Saxony.  The houses in the historic quarter between the Lüneburg Salt works (today the German Salt Museum) and the Kalkberg were built above a salt dome that was excavated by the saltworks and which extended to just below the surface of the  ground. As a result of the increasing quantities of salt mined with improved technical equipment after 1830, the ground began to sink by several meters. This resulted in the so-called Senkungsgebiet or “subsidence area”. The houses there and the local church (St. Lambert’s) lost their stability and had to be demolished.

Because of this subsidence, and because salt mining was increasingly unprofitable, the saltworks were finally closed in 1980. Today, only small amounts of brine are extracted for the health spa in the Lüneburg Thermal Salt Baths (the Salztherme Lüneburg or SaLü). One side of the saltworks now houses a supermarket, while the other is the German Salt Museum.

The closing of the salt mine in 1980, ended the thousand-year tradition of salt mining, although small amounts are still mined for ceremonial purposes. Small bags of salt may be purchased in the town hall, and bags are given as a gift from the town to all couples married in the town. After the closing of the salt mines, the town gained new relevance from its university, which was founded in 1989.

 

A CANDELABRA

A Leeds family doctor asked if I would see a child whose parents had recently brought their 6 year old daughter from Bangladesh in view of a serious progressive illness. She had been well to the age of 3 years when her tongue became red and painful; she suffered unexplained episodes of severe anaemia despite repeated courses of iron and folic acid and there was a gradual onset of muscular weakness. From 5 years she developed a coarse tremor of the limbs and face.

On examination the child was very weak and wasted (weight < 3rd and  height 10th centile). She had difficulty swallowing, had slurred speech and saliva drooled from the side of her mouth. Her tongue was red, wasted and showed fasciculation.

Initial clinical assessment suggested a brain stem tumour but computed tomography showed unexplained mild hydrocephalus and a general decrease in size of other parts of the brainstem. Extensive metabolic investigations were also normal.

However, a second blood sample taken during a febrile episode was abnormal showing severe pancytopenia prompting bone marrow examination which was also very abnormal and megaloblastic (cells larger than normal). The serum B12 was only 55 ng/l (low normal range 110ng/l. Further tests confirmed gross B12 deficiency which subsequently we showed was due to defective absorption

 

Treatment with vitamin B12 1 mg daily brought about an almost miraculous improvement. There was rapid response in the anaemia and bone marrow. Growth and weight accelerated (Ht to 25th, Wt to more than 25th centile) over 4 months and she became an active child, able to run unaided.  The only residual abnormalities were some loss of peripheral sensation and absent tendon reflexes with slight reduction in power.

We concluded there was a failure of absorption of vitamin B12 from the small intestine. This was really a remarkable case and wonderful to see her gradually recovering.  The parents and referring doctor were obviously delighted.

It was a good example of how many experts in a massive hospital, such as St James’s, working together solved a very serious and potentially fatal problem.    As our wise Professor of Medicine at St James’s,  Monty Losowsky, used to say “The Buck stops here Jim!”

Dr Steve Conway was my general paediatric registrar at St James’s at the time of this report. He subsequently went on to head the Leeds Adult Cystic Fibrosis Unit and finally become Director of both the Paediatric and Adult Leeds Regional CF Units at Seacroft and St James’s. He also became a leading international authority on cystic fibrosis. Steve and his wife Ella have remained our good friends over the years.

So why the candelabra?   When their daughter was discharged the grateful parents kindly presented Steve and myself with candelabras – mine for  three candles and Steve’s for a single candle!  This souvenir brings back vivid and very pleasant memories.

 THE CUTTY SARK MODEL

 In 2006 Rosie Barnes had a big 60th Birthday Party for her wide range of friends on the old clipper, the Cutty Sark, moored at Greenwich.

Ann and I came to know Rosie and her husband Graham very well during Rosie’s time as Chief Executive of the CF Trust from 1996 to 2010.  I was Chairman of the Research and Medical Advisory Committee when she was appointed and from 2003 to 2011 Chairman of the CF Trust. So Ann and I became good friends with Rosie with whom we attended numerous meetings on behalf of the CF Trust both in the UK, Europe and North America.

Rosie came to national prominence as a member of parliament for Greenwich.  Her husband Graham, who in 1986 had become an SDP local councillor in Greenwich, acted as her agent at the subsequent 1987 general election four months later when she was returned to parliament.. After the next election she retained the seat with a reduced majority.   With the SDP split over whether to merge with the Liberal Party, Rosie strongly supported David Owen in his resistance to the  merger but when the party was disbanded in 1990 she continued to sit in parliament as an independent Democrat. In 1992 she lost the seat to the Labour Party.  Rosie’s likeable personality, experience with human relations and public speaking were of immense value to the  CF Trust.

So Rosie had her 60th Birthday Party on the Cutty Sark for their many friends.  The dress was 60s period time theme – Ann had the Mary Quant look and I did a rather mature Elvis

It was a very good party with a disco below decks after the meal. There were quite a few political friends of Rosie’s and she introduced us to a few of including Lord Owen – Dr David Owen who was at one time the Foreign Secretary;  when younger David was her contemporary in Parliament and even earlier he was a colleague and friend of our Roy Meadow’s at Guy’s Hospital

The Cutty Sark is a British clipper ship. Built on the River Leven, Dumbarton, Scotland in 1869 for the Jock Willis Shipping Line, she was one of the last tea clippers to be built and one of the fastest, coming at the end of a long period of design development for this type of vessel, which halted as steamships took over their routes. She was named for the fictional witch, Cutty-sark. (There is a long interesting history on Wikipedia)

On the morning of 21 May 2007, Cutty Sark, which had been closed and partly dismantled for conservation work, caught fire, and burned for several hours before the London Fire Brigade could bring the fire under control. Apparently an industry vacuum had been left running for 2 days and overheated.  Initial reports indicated that the damage was extensive, with most of the wooden structure in the centre having been lost. The Cutty Sark did not reopen again for visitors until 2012 after extensive renovation.

The model we have of the ship brings back memories not only of this excellent party but also of many happy times we had with Rosie and Graham over many years from 1996 to 2010.

THE ROSSI MEDAL OF THE EUROPEAN CF SOCIETY 

Every year, at the opening ceremony of the European Cystic Fibrosis Conference, from 2003 onwards the ECFS honours “a person who has made a significant contribution to our basic understanding of cystic fibrosis or to the treatment or care of patients with cystic fibrosis”. I was delighted and proud to receive the award in 2004 as recognition to the contribution made by the Leeds CF unit over the past 25 years.

AN ARTICLE IN POLISH

In September 1995 I was invited to give a talk on “Pancreatic Enzymes” at the Annual Meeting of the Polish Paediatric Society

They were a very friendly audience and prior to my arrival had arranged for my talk to be prepared in Polish for publication – a first for me – hence it’s my souvenir of the trip!

My talk seemed to go well. I had spent some time preparing my greeting to the audience in Polish-  “JEN DOBRE”!  (Ann had an excellent phrase book!).  Seemed to get the proceedings off to a good start.

The other interesting feature of the meeting was at the conference dinner which was followed by a ladies fashion show!   Apparently this was usual after the conference dinners as most of the paediatricians in Poland who attend the meeting are ladies.

According to Wikipedia the city’s history is complex, with periods of Polish, Prussian and German rule, and autonomy as the Free City of Danzig.

An important shipbuilding and trade port since the Middle Ages, in 1361 it became a member of the Hanseatic League which defined its economic, demographic and urban landscape for several centuries. In 16th century, Gdańsk experienced its Golden Age and thanks to its grain exports became one of the wealthiest cities in Europe.

From 1918 to 1939, Gdańsk lay in the disputed Polish Corridor between Poland and Germany; its ambiguous political status created tensions that culminated in the Invasion of Poland and the first clash of the Second World War at nearby Westerplatte.

The contemporary city was shaped by extensive border changes, expulsions  and new settlement after 1945. In the 1980s, Gdańsk was the birthplace of the Solidarity movement, which played a major role in bringing an end to Communism in Poland and helped precipitate the collapse of the Eastern Bloc, the fall of the Berlin Wall and the dissolution of the Warsaw Pact.

We had a pleasant two days exploring the very impressive city. In the photo of me in the distant background can be seen the oldest medieval crane.   The giant treadwheels, human-sized hamster wheels, supplied the force on the ropes that lifted the cargo to and from the waiting ships below.

(both illustrations from Geoffrey Robinson’s website)

KENTUCKY FRIED CHICKEN

Although I have no solid souvenir of Kentucky Fried Chicken, Ann and I recall clearly the first occasion, many years ago, when we were  introduced to this great food!  It always reminds me of a very pleasant evening we spent with a respected colleague.

It was in the mid-Sixties, when I was a Tutor in Paediatrics and Ann was retired from nursing to look after Susan our first child born in 1964.   Around that time I was doing work for my MD thesis on neonatal urinary infections at the Leeds Maternity Hospital (LMH).   I had considerable contact with the laboratory there and much assistance from Peter Kite the Chief Technician and his wife Beverley; also from Dr Hans Gerhart Kohler the consultant pathologist at the hospital.  All three were of enormous help to me as I toiled to microscope, do cell counts and culture thousands of urines from newborn babies collected for me by the really wonderful Ward Sisters. The work eventually led to a number of combined publications with the Kites and Hans Kohler and  incidentally to an MD for me.
– Littlewood JM. Kohler HG. Urinary tract infection by Trichomonas vaginalis in a newborn baby. Archives of Disease in Childhood. 41(220):693-5, 1966 Dec. PMID: 5927928
– Littlewood JM. Kite P. Kite BA. Incidence of neonatal urinary tract infection. [ Journal Article] Archives of Disease in Childhood. 44(237):617-20, 1969 Oct. PMID: 4981204       

How does allthis lead to KFC you ask?   Well, I obviously became friends with the laboratory staff at the LMH and had many discussions with Hans Kohler whom I came to respect for his meticulous approach to all he did.

Hans was Consultant in perinatal pathology the Leeds Maternity Hospital 1963-80 (born Spaaz, Bohemia, 1915; qualified at Charles University, Prague, 1938; FRCPath 1966). He died from the complications of Parkinson’s disease on 13 June 2004)

Hans’ early life reflected the turmoil in central Europe caused by two world wars. He was born in Bohemia, then in Austria but later in Czechoslovakia, to parents ethnically Jewish and culturally German. Hans, a free thinker, became an atheist aged 12 and a Young Communist at 15. He was politically active while a medical student in Prague and when fascism darkened Czechoslovakia, he decided to leave. Using false papers he was on the last Kindertransport for Holland. Once in Britain he enlisted in the Czech army-in-exile, becoming an RAMC captain. His parents survived Auschwitz, but his only brother died on the forced march from Auschwitz to Dachau.

Hans was appointed consultant pathologist at Leeds Maternity Hospital in 1963. A believer in education he successfully encouraged his technical staff to take degrees (unusual at that time) and found time for research and many publications. An expert in placental pathology he contributed the chapter on the umbilical cord in several editions of Haines & Taylor. Fluent in German, Czech, and English he read widely in these languages—poetry, politics, as well as medicine. He was particularly interested in the poet Eduard Meissner and wrote a BMJ article about him (BMJ 1990;300:1123-6). He loved his adopted county of Yorkshire—walking its dales, swimming in its reservoirs, and exploring its history into his 80s.   In 1994 he was diagnosed as having Parkinson’s.   At his funeral the mourners sang, at his request, “The Internationale” and “Ilkley Moor.”

Hans married twice—to Anna and later, as a widower, to Hanna, both of whom had been fellow students in Czechoslovakia. He leaves a son and two daughters. (Details from http://www.gene.com/people/Dr Hans Kohler).

Again, I hear you ask  “How do we get back to Kentucky Fried Chicken?”

Hans Invited Ann and myself and another colleague to his flat in Weetwood North Leeds for supper. After a drink and some conversation Hans excused himself for a few minutes. Unbeknown to us he travelled the half mile to a newly opened Colonel Sanders KFC outlet and a few minutes later returned with our supper – a Party Bucket of KFC!  It was delicious and to this day has remained one of my favourite meals.

KFC is an American fast food restaurant chain headquartered in Louisville, Kentucky, that specializes in fried chicken. It is the world’s second-largest restaurant chain after McDonald’s, with 22,621 locations globally in 150 countries as of December 2019.