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This is a German trial being interviewed by Derek Hockaday, a fifth of March, June, what really took you to Oxford?

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What brought you to Oxford? Well, I came to Oxford at a stage of my career when I'd been at the Hammersmith Hospital and interested in hepatitis B,

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and at that stage, fright was in Oxford and working and having come back from the states on what was then called Australia antigen,

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I completed my post at the Hammersmith, but as at that stage, I was also getting married and my husband had a university appointment in Oxford.

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It seemed reasonable to approach raths and see if between us we could put a grant

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application into the MRC so that I could transfer the research work I was doing to Oxford.

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And that's in fact what happened. What we hadn't quite predicted was that within a month that the MRC giving us a

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five year grant Ralph applied for and got the chair of medicine in Southampton.

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And at that point, the MRC said to me, well, we won't leave you high and dry, but this isn't going to be five years.

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It's going to be one year. So I then had to become somewhat more resourceful and look for other forms of

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funding and ways of staying afloat through the early years of my time here.

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So initially you'd have been a lecturer in the anatomy department.

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I was in the Nuffield Department at the stage. Orbison was the professor and Ralph at that stage was my reader.

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And I stayed on.

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And when Ralph moved to South Hampton, I was adopted, as it were, by Sidney Truelove, who was the father figure of all gastroenterologists at Oxford.

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That's I mean, my feeling is that really Sidney was running into part of the is that Sidney was running a Department of Gastroenterology.

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And his words to me were, you know, something about liver disease.

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I don't why don't you take on the liver patients when Ralph goes?

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I mean, it was as casual as that. And I was grateful for the opportunity.

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I mean, from the personal point of view, I might not have looked for that level of work and responsibility as I think I was pregnant at the time.

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But, you know, you don't turn up offers like that. And I was grateful for his support.

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And I'm very grateful for the way in which he continued to take an interest in what I was doing, but not actively interfering or really directing it.

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How did you get on with him? He he's an incredible blow for these very late hours of work and this very slow way of talking.

24
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He he was a great character.

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He if you got on with him, he was very supportive and very affectionate and very casual and relaxed in his approach to work.

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But he actually achieved a lot and worked very hard.

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And people who saw him meandering into the hospital at 11 o'clock hour past eleven in the morning had completely missed the idea that he was,

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you know, working until well after midnight. And I think the after about two years, he'd started doing his annual January courses in gastroenterology.

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And Derek Jeter helped him with the first one. He invited me to help him with the second one.

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And at this stage, I think I was pregnant with number two.

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And he said, well, given that you're pregnant, Joan, he said, we'll have a slightly later start, come for lunch and we will work late.

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So I used to arrive home at about half past and it was very incredible.

33
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But unfortunately, I had a long suffering husband who understood what I was doing.

34
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And based on what your memories of him and his place, Basan, I think, came to Oxford having established his reputation really.

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And I think that by the time he came, he adopted what I saw as the American model of really chairing a department rather than directly leading it.

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He was very happy to allow me desk space and whatever I needed in the way of other supporting facilities.

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But he never took more than a very passing interest in what I was doing.

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I think, um, I think that the Nuffield Department at that stage had quite a number of very distinguished senior members.

39
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And I think my initial impression was of being slightly overawed when, for example,

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the door that said AHJ Krebs on if this had happened to me, but you would be getting on rounds with this.

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And I went I went to his one sort of general round.

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I didn't go on his. Clinical ward round around the ward, I went on Sydney's, which inevitably started at half past four in the afternoon,

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but the basin had a Thursday morning session in which students presented cases and they were discussed.

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And I was went to that, which was the sort of departmental meeting.

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And, you know, we ended up drinking coffee together and generally meeting each other and I think provided quite a nice focus for the department.

46
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And you would have had admitting rights to beds? Technically, no.

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My patients came in with Sydney True Love's name on the sticker.

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At that stage, I had a senior registrar contract and I had in fact, I had the senior registrar contract for ten years as it worked out.

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But it you know, nobody counted years at that stage.

50
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And defacto Sydney was giving me the management of the patients and supporting me when I needed, you know, somebody more senior.

51
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But they'd be seen on Sydney's water. And I did a ward run on Monday.

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He did his on Thursday. And if I had anything of interest, I would show it to his research fellows and discuss it with him.

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But I don't remember him ever interfering or in altering things at all.

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But he used to ask me, you know, to produce anything that he thought would be informative or educational for the sort

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of United Nations team is because he had a large number of overseas research fellows.

56
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And you would have been live about so it was well established by then?

57
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No, no, it wasn't. I had done liver biopsies both as a husband at the Royal Free and as a registrar subsequently.

58
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So I came to Oxford knowing how to do liver biopsies. But apart from Rouf, there was nobody else in Oxford who had ever done liver biopsies.

59
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And I think, to be honest,

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RAF hadn't done as many as I had at that stage because he'd very much only picked up his livers during his year or so in the States.

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But what we did do was to establish a weekly liver biopsy session and persuade the pathology department that

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it was a good idea to have at least one state pathologist who saw the liver biopsies and gained an expertise.

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And in turn, those mortgages. Er and Harry Sandler, who also went to Southampton, subsequently took on that role.

64
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So we used to review all the liver biopsies done in the hospital because they would all end up going to the one pathologist.

65
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I mean, all the needle biopsies would I would know about anyway because I used to do them and then trained registrars to do them.

66
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But the other biopsies would be surgical ones.

67
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They'd be which biopsies taken by surgeons at operation. Yes.

68
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Knowing there were three and the Hammersmith, how do they compare in your mind with Oxford in your first when you came in first year or two?

69
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Well, the all there are three. I was there as a clinical student and as a house officer and I moved on from there very quickly.

70
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But I was aware that Sheila ran a very active research unit, but it was entirely focussed on liver disease.

71
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At that stage. There wasn't a great deal of academic work going on in other fields.

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I think the exception to that would have been standard children who had really the first.

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Dialysis unit in London. And I can remember as a student being pulled in to help with dialysis there,

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so I was trained a little bit on on sort of electrolyte management and renal failure type problems and.

75
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The Hammersmith, of course,

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was the complete opposite because every department had its academic professor at its heads and I'd been a house officer there,

77
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I'd done a registrar job in Cambridge, a general registrar job for Lawrence Martin.

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And then I was invited to go back to Hammersmith as a registrar and a lecturer.

79
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Really, I thought at the time not to do to the disease at all,

80
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but to work with Graham intestinal absorption and small bowel disease, which is what he wanted.

81
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And this is where fate takes over and people's lives, because about a fortnight after I'd started their.

82
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The Lancet published the first paper on Australia antigen from Bloomberg,

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and it was summoned to Crispus office and he said, you know, you trained at the Royal Free.

84
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You probably know more about this than the rest of us. Start a little clinic.

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And I had the rather unusual privilege of having an active virology department, including Jude Alvida, who was very expert,

86
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biological electron microscopist, wanting blood samples from people with liver disease, looking for viral particles in their blood.

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And so, in fact, within a very short time,

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I had a large and flourishing referral practise because we were the only service in London that if you sent somebody up jaundiced,

89
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say, has this person got hepatitis B, we could give you the diagnosis in three hours.

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The vast majority of the referrals inevitably didn't have hepatitis B, and I was then left to sort out what was wrong.

91
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So when I came to Oxford, I got a certain amount of experience of that kind of referral pattern.

92
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Oxford at the stage. I came here, got an active liver service at all.

93
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Ralph was only really months back from the States. What year was that?

94
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I came in 1970. Yes. And he'd become a reader, I think, the previous beginning of the previous academic year.

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And he had certainly started.

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With what he took to be a growing referral practise,

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but he was much more interested in the immunology of liver disease, that was his particular field.

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And the idea was that I could bring some of my experience with the virologists and work

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perhaps with some of the electron microscopist to try and continue some of the work here.

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How did you think the clinical standard would compare to, say, the Hammersmith?

101
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It was high in both places, I think.

102
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I think in both places, there was a tradition of all the technicians doing some technical work and being actually clinically trained,

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but the big advantage in those places was that if you didn't know the answer to something, there was always somebody around who did.

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And people were very happy and very willing to give opinions and see each other's patients.

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The Hammersmith, perhaps if you made a diagnosis, you more readily handed somebody on to a specialist service, I think in Oxford,

106
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because we take physicians and certainly most of the general surgeons were generalists as well as specialists.

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They were quite happy to keep control of what one did was to give opinions and not necessarily take people over.

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But I know I found from the clinical point of view, the standard of practise in both places was high.

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What about the nursing practise?

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At that stage, Oxford had its own nursing school and most of the nurses here were Oxford trained and Oxford brought up,

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as it were, I think the Hammersmith being in West London was a much more cosmopolitan practise of nurses.

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Certainly the senior nurses on the wards that I was responsible to work with were extremely competent and very good.

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Some of the other nurses. The standards were perhaps a little bit more tenuous in that some of them didn't perhaps have

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the language and communication skills and the understanding of sociology that was necessary.

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But of course, even then, West London was a much more cosmopolitan practise of patients as well.

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And I don't know if you had patients on the heights you wouldn't have except now and then.

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What did you think about the buildings and the cleaning and the food?

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That I did have patients in the heart because Sydney, in fact, used to admit that at the very end to Wall Street.

119
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I mean, they were bizarre. They they they really were.

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But you see, when I trained at the Royal Free Sheilas, world famous research unit was HUTZ on top of flat roofs.

121
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And in the wet weather, you had to walk on duck boards, you know, just to avoid the puddles on the roofs.

122
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So I was kind of used to working with distinguished people in slightly primitive circumstances.

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You mentioned immunology. Was McClellan still there? Is that the right name?

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There was an even ologists that Bissonnette brought in who worked above Crib's on the floor above Graham's.

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And I think he interacted a bit with Derek Jeter.

126
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He did, but I think he did. Didn't he leave to go? Didn't he go to he went to Birmingham.

127
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He could have left before you went about a year or two after I came back, he was around because I do remember him in those early years.

128
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But I think by the time Raafat moved on, he probably moved on the next year.

129
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And so the liver scene was dominated by alcohol or hepatitis, while I think the liver scene in Britain is dominated by alcohol.

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I mean, what we became aware of was compared with West London, where we saw quite a lot of hepatitis B in Oxford.

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Hepatitis B was virtually unknown.

132
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And I realised very quickly that if I was going to have a research interest, it had to shift somewhat to something that,

133
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you know, had the clinical patients available and readily visible and referred.

134
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And that was where alcohol being the commonest toxin in our society became one line.

135
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But in fact, my research in the early years was very much around anaesthetic,

136
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drugs and agents, because, again, very shortly after I arrived in Oxford,

137
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there was a series of rather unfortunate deaths of women who had had repeat anaesthetics,

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and you only had to read their notes to realise that had repeat halothane, anaesthetics.

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And there was considerable conflict between the anaesthetic fraternity and the

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logical fraternity nationally as to whether halothane was the poison or not.

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And I remember going to national meetings in which senior hepatologists and senior anaesthetist virtually came to blows on stage.

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I mean, it really got very, very heated because halothane was thought to be a very good anaesthetic agent,

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which I'm sure from the point of view of the patients comfort unit compared with the sort of chloroform, it was comparatively safe.

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But in fact, the professor of anaesthetics at that time, Alex tinsmith, I realised, I think, as he said to me,

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having had to go and give evidence at two successive coroners inquests, that this was a topic for research.

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And as I was then the sort of free lance hepatologist in Oxford, I was pulled into that very quickly.

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And with help from Sydney and from Richard Peto, we set up controlled trials,

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looking at different agents and had some interesting experiences, randomising patients for repeat anaesthetics.

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I think trying to explain to people who at that stage, it had very little exposure to controlled trials,

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that when a patient was randomised to either having a halothane anaesthetic or a non halothane anaesthetic,

151
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and this information had been stapled to the front of their notes, we would be grateful if they didn't just pull it off.

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If they disagreed with this, the surgeons were better news to know.

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And then I think the surgeons had very little to say and what anaesthetic was given.

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But, you know, one of two seminars with the anaesthetic department and I think they were very supportive.

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I mean, they realised the advantage of looking at this objectively.

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And within a year and a half, we got very convincing evidence that the liver damage at that stage was in there.

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People with repeated halothane, roughly how many patients would have been in that?

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It was 42 patients, but that's not a lot.

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Wow. What I did was to look at where the liver damage had been.

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And it was very obviously in the people having repeat anaesthetics.

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And the commonest group of repeat anaesthetics were the women with carcinoma of the cervix

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who were having weekly or fortnightly anaesthetics to have regular insertion stuff.

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So they just needed to be rendered unconscious for long enough for the cervix to be dilated and

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the radium inserted and say they were short procedures and they were in and out of hospital.

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And I thought that if I was going to look for a toxic reaction, I needed to look where it was most likely to have.

166
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Yeah, yeah. And so we got in fact, we we had tried to set up a trial just looking at anybody who had had an anaesthetic in the previous six months,

167
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and that did produce results. And he went on doing it in Southampton.

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But he had to put several hundred patients because we looked at the women who had

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carcinoma at the cervix and were having weekly or fortnightly anaesthetics and had three,

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four, five. And we picked up four women out of 21 whose liver function tests were bizarre after the second anaesthetic.

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And we set up with with cooperation of the biochemistry department, we set up a speedy service.

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I mean, in those days, you couldn't get liver function tests of the day. You asked for the play, only did them once a week.

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But we managed because I got money for a Années technician to take the blood and to actually run the tests.

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If we saw the patients at half past nine in the morning, we could know by noon whether the liver function was still normal or not.

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But we picked up these four and we're able to warn the anaesthetist so that these were high risk patients.

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And the procedure, the the gynaecologists very kindly agreed to cooperate on that one.

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And I think we probably saved four women from, you know, just by doing this research for four women from having severe liver failure.

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It was Richard Wilkinson. Yes, yes, yes.

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It was Richard Wilkinson who was head of the biochemistry department.

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And I got a receptionist who worked just the two mornings a week that the patients came in and and learnt how to do,

181
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you know, operate the necessary biochemistry equipment under Australian supervision.

182
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So it really worked extremely fast.

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And we were very fortunate to have prepared minds, people who are prepared to look at what needed to be looked at.

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And I took I, I got these numbers not being at that stage, a very skilled statistician.

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They seemed even to me to be fairly obvious. But, you know, one one, they did the right statistics.

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And I knew that if I could get it right, it would probably get published.

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But I was running out of research grants at that stage. So I took my results up to the top floor where the richest professors department was

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thinking that was where the highest density of statisticians would exist if they had left.

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By then, Hikaru had left it to and I went into the professor's secretary and I said,

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Do you have a statistician at who would have a few minutes to just look at these numbers, you know, to advise me on something?

191
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And she was sort of looking up and hesitating slightly on the voice from the inner sanctum, said, do you have the data on you?

192
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And I said, yes, I do. And he said, come in. The average adult properly got out his calculator and sat down and did the number cracking great.

193
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You know, which again was the accessibility of people in Oxford. But then you switched to Peter.

194
00:21:46,210 --> 00:21:57,010
What do you see? Well, what happened was that Richard Doll said, I'm quite sure these are convincing numbers,

195
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but I chair the Committee of Safety on medicines and I ought not to be your co-author on this, but I'll get.

196
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To have a look at the data for you and Richard took it on the next day and co-authored the paper, which The Lancet sort of took two weeks later.

197
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Did you think at the time that was the most important paper published?

198
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I think it got me a job in Oxford. You were talking to the right people?

199
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Well, I was looking for help. And but I meant I guess I had learnt during my time at the Free and the Hammersmith that if you

200
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didn't know the answer to a question that usually were people who are happy to take it on.

201
00:22:37,530 --> 00:22:45,750
I hadn't expected Richard all to take it on, but I just instinctively knew that that was the place to look for a statistician, I think.

202
00:22:45,750 --> 00:22:56,200
So life is full of fortunate chances. As far as I'm concerned, then how did the move to up the Hill to heading to affect you?

203
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Well, about the time that we moved up, Richard Doll had given me a coin collectors post in his department as a result of that publication.

204
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That's what I say. It got me a job out of the end of it.

205
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And so I moved into the R.P.M. And then when Richard retired, I was given a post and David was forced to,

206
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partly because he inherited the clinicians from Richard's department.

207
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And basically that was Robert Turner, Jim Mann and myself.

208
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Those were the three of us. And we had a.

209
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Small office up in Richard's department at the old Raclette,

210
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and we transferred to a medical secretariat in the new hospital and a shared room up on the top floor in the Nuffield Department,

211
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but not by that stage. My collectors post was coming to its end,

212
00:23:54,670 --> 00:24:05,460
which was when there was a fairly new university statute that you couldn't just keep renewing clinical entrance posts indefinitely.

213
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So I can remember talking to Sydney Truelove about it and asking him if I should start applying for consultant posts around the region.

214
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I said, I think there's one coming up. And I wake up and you know that from where I live, this would be quite comfortable.

215
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Uh. And he looked at me and he said, I think I'd better talk to one or two people about this,

216
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but I was then very fortunate because a combination of Rosemary Roux at the Regional Health

217
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Authority who realised I was basically providing a regional service for hepatology by that,

218
00:24:38,170 --> 00:24:42,760
and David was more prepared to fund between them.

219
00:24:42,760 --> 00:24:50,830
I think Rosemary put a lot of the money into it at the specialist hepatology purse, which was advertised in Oxford, and I got it.

220
00:24:50,830 --> 00:24:59,800
So that was when I got my consultant for Untravelled. And the move up the hill was at about the same time, sort of nineteen eighty six.

221
00:24:59,800 --> 00:25:05,440
So I got admitting rights to a bet on the gastro ward in my own right.

222
00:25:05,440 --> 00:25:11,170
At that stage I think that was the first time that my name actually went on patients and stickers.

223
00:25:11,170 --> 00:25:16,210
So you say a regional service. Did you travel to the region.

224
00:25:16,210 --> 00:25:25,600
I done quite a lot of going around the regional hospitals, talking to colleagues about liver disease, giving lectures at postgraduate centres.

225
00:25:25,600 --> 00:25:32,980
And I used to do quite an active line in sitting on consultant appointment committees for the College of Physicians.

226
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I think that was where for the first time in my life, I realised that being a woman probably was an advantage rather than a disadvantage in medicine,

227
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because both the College of Physicians and the university woke up to the fact that they had to have some sort of diversity on appointments committees.

228
00:25:51,160 --> 00:25:57,040
And I think I was appointed senior staff in every academic department, clinical academic department in Oxford,

229
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because there weren't very many senior academics, because we had to sit on appointments committees.

230
00:26:03,790 --> 00:26:08,030
But that was really how I got to know consultants around the region as well.

231
00:26:08,030 --> 00:26:13,720
Let's say liver biopsy that would have started in Northampton reasonably early after.

232
00:26:13,720 --> 00:26:18,520
Oh, no, no, they didn't provide the histology service at all.

233
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And it really only began to happen in regional hospitals when some of the registrars I trained moved out to work there.

234
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And at that stage, we quite often used to get the histology samples, Dorset back to Oxford because there was no astrologist in the regional hospitals.

235
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You could read them. You know, it's a specialist office and it is it is somewhere where good discussion between

236
00:26:43,240 --> 00:26:47,330
the clinicians and the pathologists straightens both sides and actually,

237
00:26:47,330 --> 00:26:51,850
to that extent, multidisciplinary working amongst medicks as well as amongst other.

238
00:26:51,850 --> 00:26:56,590
Yes. Branches in that could work, I think is terribly important.

239
00:26:56,590 --> 00:27:05,020
And we did have supporting facilities in Oxford in the surgeons were prepared to take on the high risk patients that might get a while.

240
00:27:05,020 --> 00:27:13,090
And Julia, Britain would be very willing with discussion with me and we would talk about what the risks were

241
00:27:13,090 --> 00:27:19,360
in operating on some of the bleeders or some of the patients who needed better interventions.

242
00:27:19,360 --> 00:27:23,440
So they were providing a specialist service and we had, for example,

243
00:27:23,440 --> 00:27:32,290
specialist dietitians who turned on the special diets and things that one couldn't get elsewhere in the region where the haematologists to go to.

244
00:27:32,290 --> 00:27:38,500
For the rest, the haematologists were very good at providing the blood products we needed very quickly.

245
00:27:38,500 --> 00:27:41,480
And we did meet them very quickly sometimes.

246
00:27:41,480 --> 00:27:52,840
Um, so, you know, I think that over a number of years, the idea that this was an active service that interacted with other people was necessary.

247
00:27:52,840 --> 00:28:00,550
And of course, we we got the medical students through. So a generation came through understanding about the problems of looking after

248
00:28:00,550 --> 00:28:05,890
people with the disease in a way that I think hadn't happened a generation before.

249
00:28:05,890 --> 00:28:08,890
I'm sure this was happening in other centres over the country.

250
00:28:08,890 --> 00:28:20,950
But certainly when I started taking referrals in Oxford, I was taking them from well, the nearest centres were Southhampton, Birmingham and Bristol.

251
00:28:20,950 --> 00:28:27,760
So, you know, between us, there was somewhere around Swindell that there was a Cut-Off point somewhere around Basingstoke that was at that point.

252
00:28:27,760 --> 00:28:35,620
And I was certainly taking patients from Redding and certainly taking patients from Highwood to Aylesbury.

253
00:28:35,620 --> 00:28:48,010
Right. So how many future consultants would you reckon you trained as medical staff, not students?

254
00:28:48,010 --> 00:28:56,930
So roughly, I would say something between five and 10 years old still in this country, but they're active in this field.

255
00:28:56,930 --> 00:29:04,640
That's great. You know, I mean, that I keep in touch with them and they're very generous in their invitations.

256
00:29:04,640 --> 00:29:11,990
And I've been up and visited them in Australia and in Bangladesh. I mean, I said can't you can't work with Sydney, for example.

257
00:29:11,990 --> 00:29:20,600
I've done some sabbatical gleaves working there, which has been very interesting. Did you get into genetics at all the genetic aspects of this?

258
00:29:20,600 --> 00:29:27,350
The only one of our team who worked actively with the molecular geneticist was Guarascio.

259
00:29:27,350 --> 00:29:35,710
And he looked and really got very near to the question of the Hippocratic TotEx and the genetics of that.

260
00:29:35,710 --> 00:29:40,850
Jeff said you did Jack six and he was looking at inflammatory bowel disease.

261
00:29:40,850 --> 00:29:51,060
He didn't look so much at the the livers, although know Jackie is a senior person who was my registrar, but he his work is more as a gut gastrique.

262
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He had something to do with hemochromatosis. I that I suspect when he was helping with my patient is because we did have an active practise of

263
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haemochromatosis who came up regularly to be blad and the blood would go straight to the malaria lab.

264
00:30:07,070 --> 00:30:11,270
This was a little bit of positive interaction that took place because all the patients

265
00:30:11,270 --> 00:30:15,500
with liver disease had a very nice large red liver cells with matricide doses,

266
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which the malaria parasites were quite fond of. That was for the research.

267
00:30:21,620 --> 00:30:28,520
So although I don't claim to have myself done any malaria, I have indirectly contributed to its activity.

268
00:30:28,520 --> 00:30:34,220
And we're interacting much with David, whether I went directly to the idea meetings.

269
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And, you know, he was very much the head of the department, but I was aware that he had a huge department.

270
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And really, I think at that stage, his his national and international responsibilities were quite important.

271
00:30:50,390 --> 00:30:58,740
But John Madigan would have been there to John Ledingham was by that stage, he'd taken over the what had been the major leadership,

272
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the professorship as it was and is and that he was very much the the number two to David Wetherall when David was well,

273
00:31:07,940 --> 00:31:11,150
wasn't that he would lead the clinical meetings.

274
00:31:11,150 --> 00:31:17,900
And I also went regularly to the gastroenterology meetings because when Sydney retired Derek Jeter took over,

275
00:31:17,900 --> 00:31:26,030
we continued to have regular gastroenterology meetings, which ironically have stayed at Sydney's time of for 30 odd.

276
00:31:26,030 --> 00:31:34,970
I don't know whether they are now retired, but we do know some habits die because Derek had been away for a year and come back.

277
00:31:34,970 --> 00:31:43,700
Derek had been a consultant at the Royal Free, came back to work in Oxford and very much inherited Sydney's very large practise

278
00:31:43,700 --> 00:31:48,230
with inflammatory bowel disease and set up his own very active research unit.

279
00:31:48,230 --> 00:31:58,370
But that physically stayed the old. So in fact, Derek was not physically at the John Radcliffe very much more when he was,

280
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you know, did not take possession or part of the active side there.

281
00:32:01,850 --> 00:32:11,480
But when he was supervising all his research, those were based out of the old practise after having say, what was your research topic?

282
00:32:11,480 --> 00:32:14,600
Well, we looked at other anaesthetic agents for four somewhat.

283
00:32:14,600 --> 00:32:21,590
And then I got involved with the haemophilia centre looking at the blood products that were produced.

284
00:32:21,590 --> 00:32:26,300
And we had very much the same story with them that we'd had with the halothane,

285
00:32:26,300 --> 00:32:30,380
which is the when we started looking objectively at the blood products,

286
00:32:30,380 --> 00:32:35,210
even the ones that were being produced in this country, we realised that hepatitis was being transmitted,

287
00:32:35,210 --> 00:32:39,830
that so in fact, I reverted back to my biological past at that point.

288
00:32:39,830 --> 00:32:47,420
And, um, whereas when I first was invited to go and regularly see haemophiliacs,

289
00:32:47,420 --> 00:32:56,780
the belief was that all of the contamination came from commercial products largely made in the states from paid donors.

290
00:32:56,780 --> 00:33:00,920
We realised very quickly that the.

291
00:33:00,920 --> 00:33:11,170
Factor eight that was being made at the Churchill and was being made for a much smaller pool of donors, was also contaminated.

292
00:33:11,170 --> 00:33:18,110
And we did a number of follow up studies there looking at people having their first dose effect.

293
00:33:18,110 --> 00:33:25,100
These were largely either children or young people with mild bleeding disorders who were having their first dose effect.

294
00:33:25,100 --> 00:33:32,690
Right. And we realised that one hundred percent of them had abnormal liver function tests two months later.

295
00:33:32,690 --> 00:33:37,790
This again involved follow up after people have been discharged from hospital.

296
00:33:37,790 --> 00:33:39,740
But we got good at doing Home-Based.

297
00:33:39,740 --> 00:33:46,160
Follow up had set this up when I was doing the same work and having got a small team of researchers who could do it.

298
00:33:46,160 --> 00:33:56,780
It worked quite well, so we followed through and progressively with Charles Ritz's cooperation and he was very positive about this

299
00:33:56,780 --> 00:34:03,860
and the pools of donors from which they were making the fact greatly reduced in size very significantly.

300
00:34:03,860 --> 00:34:13,520
And it meant technically a much harder job because obviously doing it in large quantities was a much more industrial process, much more efficient.

301
00:34:13,520 --> 00:34:21,290
But they did we did, in fact, even follow up down to Truls, about 100 donors.

302
00:34:21,290 --> 00:34:27,170
And even so, we were finding that they were all getting abnormal function tests.

303
00:34:27,170 --> 00:34:30,950
And this was before hepatitis C was described at all.

304
00:34:30,950 --> 00:34:37,130
But we just we predicted on epidemiological grounds that the incidence of the donor population of these were people who

305
00:34:37,130 --> 00:34:43,680
had no history of liver disease that they were aware of and would probably be of the order of perhaps one percent,

306
00:34:43,680 --> 00:34:49,970
something around or up to two percent anyway, which I think is what it turned out to be in the general population.

307
00:34:49,970 --> 00:35:02,030
And of course, most of it is not transmitted, but there are people who many years before may have had an illness with.

308
00:35:02,030 --> 00:35:04,340
Possibly a slight fever,

309
00:35:04,340 --> 00:35:11,720
but not of this jaundice that it would have been at a time that they might have experimented with intravenous drugs as a young person.

310
00:35:11,720 --> 00:35:15,980
And when we look back at the evidence that more and more came to light,

311
00:35:15,980 --> 00:35:21,500
which is how the whole pattern of what the clinical picture of hepatitis C really became of this.

312
00:35:21,500 --> 00:35:23,750
But so as with the hepatitis B,

313
00:35:23,750 --> 00:35:30,260
I was involved with some of the clinical work and some of the epidemiological work around the description of the virus.

314
00:35:30,260 --> 00:35:35,040
How much of a national problem was this with the blood transfusion service?

315
00:35:35,040 --> 00:35:39,310
It's it is a big national problem. I mean, now they can test more.

316
00:35:39,310 --> 00:35:45,050
And so it's much less of a problem to say that blood transfusion is safe.

317
00:35:45,050 --> 00:35:55,190
Always is to turn one's eyes to war against what the next problem is going to be and obviously other things, other transmitted virus.

318
00:35:55,190 --> 00:36:00,350
So viruses and various other things. And of course, then there was the AIDS problem and HIV.

319
00:36:00,350 --> 00:36:07,970
And quite without realising it, I got drawn into the HIV problem because about half of my patients that were haemophiliacs

320
00:36:07,970 --> 00:36:14,750
with hepatitis C or what with that Cordano may not be turned out to be HIV positive.

321
00:36:14,750 --> 00:36:22,430
And we very quickly describe the pattern whereby hepatitis C itself is a fairly benign disease.

322
00:36:22,430 --> 00:36:29,900
And as with the blood, that as you can live healthy for many years carrying hepatitis C, but if you also get cancer today,

323
00:36:29,900 --> 00:36:38,750
date to it alters your immune status and your hepatitis C virus becomes much more virulent and much more active.

324
00:36:38,750 --> 00:36:43,820
And these people would get very rapidly progressive liver disease and the complications of liver failure.

325
00:36:43,820 --> 00:36:51,200
And so most of the haemophiliacs who died in the early days in Oxford with HIV died under my care of that idea.

326
00:36:51,200 --> 00:36:56,720
And we used to have two side wards on 57th where we would have people with HIV.

327
00:36:56,720 --> 00:37:01,640
That anyone is probably a stupid question, but did they have clinical HIV?

328
00:37:01,640 --> 00:37:03,470
Because this was often the first presentation.

329
00:37:03,470 --> 00:37:10,340
I mean, in retrospect, they began to realise that some of the other infections were perhaps the early presentations of,

330
00:37:10,340 --> 00:37:17,090
but they hadn't appreciated that this was an act of HIV until the liver became the presenting feature.

331
00:37:17,090 --> 00:37:21,620
And I think this is one of the differences in HIV, in people with blood products,

332
00:37:21,620 --> 00:37:29,390
as opposed to HIV from sexual transmission, and perhaps that they had such opportunity, for example.

333
00:37:29,390 --> 00:37:38,060
So I saw a very skewed view of HIV, but it was nonetheless a pretty lethal form amongst the young people who had it.

334
00:37:38,060 --> 00:37:43,480
Do you think that's why Oxford made such big provision against HIV?

335
00:37:43,480 --> 00:37:55,040
Yes, because of the experience with the blood. We had the experience with the blood products and we realised that we had an unusual catch of HIV.

336
00:37:55,040 --> 00:38:00,500
If you if you go to the London hospital because HIV is a sexually transmitted disease,

337
00:38:00,500 --> 00:38:05,120
if you come to Oxford, certainly the early days it was blood transfusion.

338
00:38:05,120 --> 00:38:13,450
So were you working with David World or to Peter or Ben, Tim, Peter, Chris Kamden and Groff's Alexandra.

339
00:38:13,450 --> 00:38:22,120
I did a morning a week over there. Is is when did you get into the Jamesy world?

340
00:38:22,120 --> 00:38:30,970
That was much later, right? I had I had been very active with the students, I mean, looking back.

341
00:38:30,970 --> 00:38:39,220
About the time no, it was before we moved up to the new hospital, even down at the old Radcliffe,

342
00:38:39,220 --> 00:38:50,520
I was asked if I would take on the role of clinical tutor to perhaps two students a year, which I did, and thoroughly enjoyed interacting with them.

343
00:38:50,520 --> 00:39:02,470
And when I moved when we moved up to the new hospital and I think by that stage, Basil Shepstone was the director of clinical studies.

344
00:39:02,470 --> 00:39:11,410
He asked me because I'd worked with Basil quite a lot on the imaging issues as part of a sort of technical service we were providing.

345
00:39:11,410 --> 00:39:16,540
So we were colleagues who'd work together and he asked me if I would take on problems,

346
00:39:16,540 --> 00:39:21,460
some of the problems that came to him as director of clinical studies that he thought

347
00:39:21,460 --> 00:39:27,070
might be handled perhaps more tactfully by a woman or with a different slant Bible.

348
00:39:27,070 --> 00:39:35,290
And so I would get one or two, in addition to the students with the most clinical tutor, I would be asked to see one or two girls each year.

349
00:39:35,290 --> 00:39:41,830
And the two you had with there, always with the girls next year and.

350
00:39:41,830 --> 00:39:50,530
Sure. But the sort of referrals that I got from Basil were much more the ladies.

351
00:39:50,530 --> 00:40:01,360
And then I was, um. And I suppose I got to know them and, you know, I would obviously talk with them about very personal matters sometimes.

352
00:40:01,360 --> 00:40:06,220
And I'd talk about how much they wanted this to go on the medical school record and how much they didn't.

353
00:40:06,220 --> 00:40:10,360
And Basil respected that to a degree. I was acting as a confidential counsellor.

354
00:40:10,360 --> 00:40:16,980
Really, this wasn't necessarily at all in the public domain.

355
00:40:16,980 --> 00:40:28,610
And then after that, Bassal had moved on and and John Seah had become the director of clinical studies.

356
00:40:28,610 --> 00:40:41,090
I was approached, in fact, by a group of the women students to ask if I would be prepared to do some work, really in a more formal capacity.

357
00:40:41,090 --> 00:40:48,740
And I said, well, I kind of do what I'm asked to do in this case, you know, as part of being a university employee as well as a clinician.

358
00:40:48,740 --> 00:40:59,580
But you don't necessarily choose what arrives on your patch. And I did think about it anymore, but they were obviously highly.

359
00:40:59,580 --> 00:41:05,910
Politically aware that it is because they went to interview the professor, who by then was David Wetherall, to say,

360
00:41:05,910 --> 00:41:15,950
why haven't we got a senior woman in the medical school and quite out of the blue because it was some months later?

361
00:41:15,950 --> 00:41:20,720
I got a bleep in the middle of one of my Waldron's, which I answered at the nursing station,

362
00:41:20,720 --> 00:41:26,820
which was David Wetherall saying we'd like some help in the medical school.

363
00:41:26,820 --> 00:41:32,400
So I said, yes, that's fine, and he said, I think we ought to make you deputy director of clinical studies.

364
00:41:32,400 --> 00:41:41,790
So, you know, that was the nature of appointment processes. I was just wondering, because there's been several women as directors.

365
00:41:41,790 --> 00:41:46,980
Yes. When the directors is there was a man as deputy when I asked about that.

366
00:41:46,980 --> 00:41:55,350
And I never got a straight answer. But, you know, looking back at the early days at my my appointment was completely I mean, it wasn't appointment.

367
00:41:55,350 --> 00:42:00,300
The work I did with Basil was completely Cassilis, you know, so I didn't know who they used.

368
00:42:00,300 --> 00:42:04,590
But that was that sort of percentage of women returning at 30 percent.

369
00:42:04,590 --> 00:42:09,600
You know, by the time I was there, we were much nearer the 50 percent mark.

370
00:42:09,600 --> 00:42:12,420
Forty eight, I think, something like that.

371
00:42:12,420 --> 00:42:20,970
So then I did three years as deputy director of clinical studies, and during that time I'd begun to get more active.

372
00:42:20,970 --> 00:42:31,380
Naturally, I think that my own children were older and I had, um, I had a period as the.

373
00:42:31,380 --> 00:42:37,620
I've tried to think of the order in which things happened, I was locally, I was president, that Gordon's federation in Oxford,

374
00:42:37,620 --> 00:42:48,080
as I think your wife was afterwards, and I then went on to the national executive of the MWF and in due course was national president.

375
00:42:48,080 --> 00:42:54,890
And one of the things that we picked up there, and it was very much due to beauty, beauty,

376
00:42:54,890 --> 00:43:01,920
who alerted us to the fact that there were very, very few women involved with the Jhansi.

377
00:43:01,920 --> 00:43:14,930
I mean, she was one of, I think two or three in a council of more than 100 and that this was not representative of the profession at large and.

378
00:43:14,930 --> 00:43:23,000
You really stimulated by her, we asked people to stand for election to the GMC at the next election,

379
00:43:23,000 --> 00:43:26,960
and if you got a few to get elected, I think three or four.

380
00:43:26,960 --> 00:43:36,140
The other person who was very vocal about this issue, who had been a national president of the MWF was Elizabeth Shore,

381
00:43:36,140 --> 00:43:40,550
and she was a deputy CMO at that Ministry of Health, as it was then.

382
00:43:40,550 --> 00:43:49,160
And she'd been an expert. Yes. And she was on behalf of the chief medical officer.

383
00:43:49,160 --> 00:43:52,310
She was on the GMC, but I think she had built up between them,

384
00:43:52,310 --> 00:43:58,580
realised that actually this was something that, you know, in the future needed to be attended to.

385
00:43:58,580 --> 00:44:11,550
So I think that that was when I became more vocal on the subject and really as I was completing my three years at the medical school.

386
00:44:11,550 --> 00:44:20,810
It was another one of these lovely moments when I went into the office that I shared in the medical school with John C.

387
00:44:20,810 --> 00:44:29,630
And there was a little Post-it note stuck in the corner of the block from David Brown and say, has the Regis spoken to you?

388
00:44:29,630 --> 00:44:38,630
So I thought, well, yes, but not recently. I went in to see David.

389
00:44:38,630 --> 00:44:42,530
And said, is this something I should know or not know?

390
00:44:42,530 --> 00:44:49,970
And he said, Well, I think there's a job for you to do when you finish here, but I'd better let David Weatherall tell you about it.

391
00:44:49,970 --> 00:44:58,280
I think it's something to do with your GMC interests. So, in fact, what had happened at that point, and this was MIT counsel, really,

392
00:44:58,280 --> 00:45:08,820
was that Oxford and Cambridge had a representative on the GMC and did tends to appoint the person.

393
00:45:08,820 --> 00:45:20,130
And the person who had held the post was an academic GP based in Cambridge, and he got the chair of General Practise,

394
00:45:20,130 --> 00:45:27,210
I think in Newcastle or somewhere anyway, that obviously departed from representing Oxford and Cambridge on the GMC.

395
00:45:27,210 --> 00:45:33,180
And so it became Oxford's turn to appoint somebody. And it should obviously become noted.

396
00:45:33,180 --> 00:45:38,730
I think probably it was David Brock that I talked a bit about the GMC and the fact that,

397
00:45:38,730 --> 00:45:44,210
you know, this was one of the things the MWF was interested in and.

398
00:45:44,210 --> 00:45:50,600
Anyway, to story for Dave, David was all asked me to go on behalf of the universities to the Jamesy, right.

399
00:45:50,600 --> 00:45:55,700
So I was in a strange position then, having been a registrar in Cambridge and done my time at Oxford,

400
00:45:55,700 --> 00:46:02,750
that I then had a joint appointment both from the Senate, Cambridge University and the council.

401
00:46:02,750 --> 00:46:06,020
And did you have to report to the universities in any way?

402
00:46:06,020 --> 00:46:13,430
I used to. I used to do an informal report back in Oxford because I could make people talk.

403
00:46:13,430 --> 00:46:19,910
But I did send a little written report back to Cambridge. It was Keith Peters who was the that.

404
00:46:19,910 --> 00:46:24,950
And I'd worked with Keith at the hospital, but that was quite useful.

405
00:46:24,950 --> 00:46:35,900
Getting back to the early days. Did you think gender discrimination was a big issue at the student level in Oxford when I came here?

406
00:46:35,900 --> 00:46:41,410
I was not aware of it.

407
00:46:41,410 --> 00:46:50,440
I mean, it it's again, it's very strange looking back, because now that the intake is, if anything, slightly in favour of women rather than men.

408
00:46:50,440 --> 00:46:57,760
But, you know, if you're looking at hospital staff or general practises, you know, there are as many women around practising as men.

409
00:46:57,760 --> 00:47:05,680
But certainly in my early years, I was quite used to being the only woman in a group of men.

410
00:47:05,680 --> 00:47:10,480
And it it was quite lonely and isolated sort of existence.

411
00:47:10,480 --> 00:47:17,860
I mean, you just must have found. Yes. But, you know, I think that you of you were obviously 40.

412
00:47:17,860 --> 00:47:25,570
There were at every stage of my career, I was very lucky to have male colleagues who were supportive of my position.

413
00:47:25,570 --> 00:47:37,130
And I got a circle of women friends, most of whom inevitably were doctors, just because, well, that was a World War I was working in.

414
00:47:37,130 --> 00:47:47,020
And the S.H. registrar appointment, did you think there was gender discrimination?

415
00:47:47,020 --> 00:47:58,180
I think that's a difficult one to answer. I think as one got more severe and I was certainly aware of this on appointments committees.

416
00:47:58,180 --> 00:48:07,720
There was a tendency sometimes of some of the men still not to be happy with the idea of appointing a woman called,

417
00:48:07,720 --> 00:48:11,260
um, without saying which hospital it occurred.

418
00:48:11,260 --> 00:48:21,780
I can tell you that I was on an appointments committee for a senior gynaecology post in an establishment with no women biotechnologists.

419
00:48:21,780 --> 00:48:29,970
And there was considerable opposition to appointing a woman amongst the other people on the appointments committee.

420
00:48:29,970 --> 00:48:33,670
I think that was the most florid example I ever encountered.

421
00:48:33,670 --> 00:48:45,060
But by and large, in Oxford, I thought that the problem was more one of encouraging the women to think that they could play a role,

422
00:48:45,060 --> 00:48:46,890
because we've had some very able women.

423
00:48:46,890 --> 00:48:53,460
And as you've said, we've had a number of women as director of technical studies since I went into the medical school office,

424
00:48:53,460 --> 00:48:59,220
you know, who've done a very good job and really done what was necessary.

425
00:48:59,220 --> 00:49:03,390
Do you think there is racial discrimination and appointments, etc.?

426
00:49:03,390 --> 00:49:11,810
Registrar. I think that's what I would find very difficult to handle.

427
00:49:11,810 --> 00:49:27,950
I was not aware. In Oxford of many non-white long British colleagues, on the other hand, I worked with a few who've been.

428
00:49:27,950 --> 00:49:33,510
Senior and very distinguished, and you mentioned Jack Society, for example,

429
00:49:33,510 --> 00:49:40,580
and Jack was superb and obviously excellent to what he did and his career has reflected that.

430
00:49:40,580 --> 00:49:49,390
Um. But I think that somebody will have to ask them whether they had felt that they were being discriminated against.

431
00:49:49,390 --> 00:49:53,740
I suspect at times they may have felt a bit what I felt,

432
00:49:53,740 --> 00:49:59,560
which was that they were a bit isolated and a bit lonely and could have done with a bit more support.

433
00:49:59,560 --> 00:50:04,870
It's very easy if one is banging the drum and not many other people are,

434
00:50:04,870 --> 00:50:11,170
that you've become the eccentric rather than perhaps what you're saying is common sense.

435
00:50:11,170 --> 00:50:16,540
And I didn't feel that often, but one just got the feeling occasionally.

436
00:50:16,540 --> 00:50:29,120
Do you think the male students need counselling or do they get enough money with what I read, if there's trouble that they get looked after?

437
00:50:29,120 --> 00:50:32,000
During the time I was in the medical school offices,

438
00:50:32,000 --> 00:50:43,310
I certainly had quite a few male students coming to me for advice and just personal conversations.

439
00:50:43,310 --> 00:50:49,960
One colleague. Both of whose parents died, for example, while he was a medical student.

440
00:50:49,960 --> 00:50:53,680
I got to know very well and still keep in touch with us.

441
00:50:53,680 --> 00:50:58,860
I mean, he's now happily married with his own family, but it was obviously for him a fairly.

442
00:50:58,860 --> 00:51:12,840
Meaningful relationship. I became very aware that because we have a slightly higher proportion of clinical medical students in Oxford who are older,

443
00:51:12,840 --> 00:51:20,730
you know, because they've done high degrees often before they come out doing their critical mass and.

444
00:51:20,730 --> 00:51:28,410
There was two to be quite a high. And a surprisingly high bereavement rate,

445
00:51:28,410 --> 00:51:38,190
I think I worked out that something over 20 percent of the students lose a first degree relative during the three years they're a student.

446
00:51:38,190 --> 00:51:44,400
This is either a parent or a sibling. Occasionally this and that.

447
00:51:44,400 --> 00:51:51,360
That came to me is completely I hadn't expected movement counselling to be part of my role in the medical school.

448
00:51:51,360 --> 00:51:56,160
So what research did you go on to after the haematologists?

449
00:51:56,160 --> 00:52:02,880
Well, the the work that really started through until I got on to the medical school work.

450
00:52:02,880 --> 00:52:09,510
And I suppose that to some extent, although I was still actively looking for folks with the alcoholics and still

451
00:52:09,510 --> 00:52:14,550
with Jeremy Shravan at that stage at the haemochromatosis and the genetics,

452
00:52:14,550 --> 00:52:24,260
we got much more onto the educational side and I became much more interested in the curriculum development and the skills training.

453
00:52:24,260 --> 00:52:34,140
So was there another liver consultant? Liver disease? By that stage there wasn't a liver consultant as such.

454
00:52:34,140 --> 00:52:41,280
There was still initially only Derek and myself as the two gastro consultants.

455
00:52:41,280 --> 00:52:45,600
But then Dr. Chapman was appointed, having been our senior registrar,

456
00:52:45,600 --> 00:52:54,210
and Roger was very happy to involve himself more with Liverpool Plains and and obviously maintain that side of it.

457
00:52:54,210 --> 00:53:02,850
I kept a small number of my patients that while I was in the medical school office, I still had a full and active clinical practise.

458
00:53:02,850 --> 00:53:04,230
But once I was on the GMC,

459
00:53:04,230 --> 00:53:14,010
I recognised that it was slightly irrational to have a acute inpatient practise in Oxford and be more than 50 miles away in London.

460
00:53:14,010 --> 00:53:21,720
It was verging on the irresponsible. So I asked if I could hand over my impatient practise and that was where for

461
00:53:21,720 --> 00:53:27,480
a while Jack Zigzaggy took over my practise and he did it for about a year.

462
00:53:27,480 --> 00:53:34,590
In fact, Jack had worked with me and we got on very well and he used, you know,

463
00:53:34,590 --> 00:53:38,340
he quite often rang me up and asked me about things and still talked about things.

464
00:53:38,340 --> 00:53:41,250
But he was notionally acting as the only consultant.

465
00:53:41,250 --> 00:53:49,180
And the other person who did something similar was William Rosenberg, who subsequently went down to Southampton as a consultant hepatologist.

466
00:53:49,180 --> 00:53:56,970
So both of those two acted, as it were, as my locum while I was otherwise involved.

467
00:53:56,970 --> 00:54:01,500
I kept up. I stopped my inpatient practise when I was 60.

468
00:54:01,500 --> 00:54:07,950
I decided that was not unreasonable to stop getting up a lot in the middle of the night and, um,

469
00:54:07,950 --> 00:54:14,490
but kept my outpatient practise going initially to clinics a week and then latterly just once a week.

470
00:54:14,490 --> 00:54:18,960
And I used to see the patients who I had known for many years.

471
00:54:18,960 --> 00:54:26,760
I kept a group of about 200 who I looked after for sometimes a decade or more, who knew that they could always ask for help.

472
00:54:26,760 --> 00:54:32,130
And they understand they were all told quite clearly that if they needed an inpatient admission, I would hand them over.

473
00:54:32,130 --> 00:54:36,080
And that was the day for Giancola. I was appointed and took over the.

474
00:54:36,080 --> 00:54:46,320
I just don't think the cardinals are demanding of time as the Medical Women's Federation championship when I was doing it initially,

475
00:54:46,320 --> 00:54:58,200
really not, I was probably in London about once a month for half a day off and into the evening.

476
00:54:58,200 --> 00:55:03,200
I mean, we would arrange all council meetings so that people could work a morning and then come up.

477
00:55:03,200 --> 00:55:10,980
And it took a lot more in the way of evenings and weekend work, I guess.

478
00:55:10,980 --> 00:55:14,060
I mean, I. By that stage, my children were older.

479
00:55:14,060 --> 00:55:26,900
I got time to do other things and I was involved, you know, doing things in what might be regarded as my own time, if you like, um.

480
00:55:26,900 --> 00:55:32,630
The other thing that I took on at about that time, initially when it was still in prison,

481
00:55:32,630 --> 00:55:38,800
was that I was on the prison board for a while, something over 25 years in the air.

482
00:55:38,800 --> 00:55:45,460
But the Oxford prison, I started with the Oxford Prison. I mean, the cynics said it was because I wanted free parking in the central box.

483
00:55:45,460 --> 00:55:52,340
But actually, it was a fascinating subset of society, many of whom were by patients,

484
00:55:52,340 --> 00:55:58,850
because I thought that I was going in there because my Marignac and the first time I appeared in the witness box in prison,

485
00:55:58,850 --> 00:56:03,950
I heard a voice shouting to trial. What about the day and everything?

486
00:56:03,950 --> 00:56:11,710
I could go to that particular represented amongst the alcoholics or not.

487
00:56:11,710 --> 00:56:21,530
I've looked after some of the senior academics, undoubtedly so, but whether it was a high risk activity, I'm not sure.

488
00:56:21,530 --> 00:56:25,760
I mean, certainly the top risk without any doubt for Republicans.

489
00:56:25,760 --> 00:56:32,870
Right? I think I could probably put a flag for every single pub in Oxfordshire and Ordnance Survey map,

490
00:56:32,870 --> 00:56:38,500
having looked after a public in there at some stage or other in my career. But the.

491
00:56:38,500 --> 00:56:42,910
Oxford, certain senior Oxford servants had quite a high incidence college,

492
00:56:42,910 --> 00:56:50,740
is it because they could finish off whatever was left and nobody asked too many questions?

493
00:56:50,740 --> 00:56:59,380
But no, I mean, I had a number of academics and Scots college students because that's the nature of the Oxford population.

494
00:56:59,380 --> 00:57:07,570
But it was probably a reasonable cross-section of others in the 70s, living in somebody overseas with a great diagnosis.

495
00:57:07,570 --> 00:57:14,080
We don't have to say something about epidemiology and the management as you go through your career.

496
00:57:14,080 --> 00:57:23,500
Well, I was trained to look after them by Sheila Sherlocks unit and was a housemate and has such an effect on the unit that did the operating.

497
00:57:23,500 --> 00:57:29,590
So I knew quite a lot about the perioperative care. But the I mean, the epidemiology is,

498
00:57:29,590 --> 00:57:34,660
is that people with severe liver disease will bleed from their varices and it's

499
00:57:34,660 --> 00:57:41,590
serious and can be lethal if it's if it is accompanied by a degree of liver failure.

500
00:57:41,590 --> 00:57:47,990
And such as with the alcoholics who were present with epigastric started bleeding from viruses,

501
00:57:47,990 --> 00:57:55,970
it's probably carried something like a 25 percent mortality on the first hospital admission.

502
00:57:55,970 --> 00:58:02,090
You know, if the patient was jaundiced at the time they came in. So it's it's a condition that has a poor outlook,

503
00:58:02,090 --> 00:58:12,170
but it's one that if people are treated energetically and properly and it really does require sometimes 10 or more units of blood,

504
00:58:12,170 --> 00:58:16,580
a lot of blood, it can be controlled.

505
00:58:16,580 --> 00:58:27,800
Sometimes it requires acute surgery. And that was where having a group of surgeons who were willing to take on these people was very helpful.

506
00:58:27,800 --> 00:58:33,320
Initially, the approach to the oesophagus was with trans abdominal fat,

507
00:58:33,320 --> 00:58:43,130
and that led to a lot of complications with fistulas and intestinal leaks and leaking itis, which doesn't suit the patients at all.

508
00:58:43,130 --> 00:58:50,720
And that a particularly good like Kettlewell, he would do some economists and approach the oesophagus directly, which actually,

509
00:58:50,720 --> 00:59:02,030
although it sounds more horrific operation had a much lower mortality rate and they did quite well with his skilled care if the patient survived.

510
00:59:02,030 --> 00:59:07,910
They have as good a chance as anybody else. If they stop drinking, if that's the aetiology.

511
00:59:07,910 --> 00:59:13,760
I mean, the ones who didn't do well with, for example, the celiacs who got basically no,

512
00:59:13,760 --> 00:59:20,030
they not be out of the HIV and the bleeding disorder and that they were really in a bad way.

513
00:59:20,030 --> 00:59:26,690
Did it become less frequent with time or was it just they were being siphoned off into a special unit?

514
00:59:26,690 --> 00:59:32,770
I don't think it became any less true, but I think the incidence has increased or decreased during.

515
00:59:32,770 --> 00:59:36,890
What should I have asked you about? What would you like to say?

516
00:59:36,890 --> 00:59:42,370
I don't know whether the university wants to know anything about what I did, the GFC or not.

517
00:59:42,370 --> 00:59:51,140
Is this it? Well, I did a decade on the GFC and I did a variety of posts that I found it very interesting.

518
00:59:51,140 --> 00:59:56,690
I was on the education committee and I found it particularly interesting to have

519
00:59:56,690 --> 01:00:02,280
the privilege of getting around several other medical schools as an inspector.

520
01:00:02,280 --> 01:00:10,050
And seeing how they handled problems and situations that we were only too familiar with, because, you know, that common diseases,

521
01:00:10,050 --> 01:00:18,660
these sort of issues occur across the board, so that that was an interesting aspect of the work that I did with them.

522
01:00:18,660 --> 01:00:22,680
And this was by this stage, I had given up my inpatient practise.

523
01:00:22,680 --> 01:00:34,960
But as an active member of the GMC, I was also invited fairly soon after I joined actually to become a primary screener for Complaint's.

524
01:00:34,960 --> 01:00:47,590
And I must have looked at about 5000 complaints over the decade that I was on the GMC and our job was really merely to say whether this was an issue,

525
01:00:47,590 --> 01:00:53,410
which prima facie it looked as if there might be a problem that needed to be looked at further.

526
01:00:53,410 --> 01:01:03,400
Um, we probably closed something like four fifths of the complaints we looked at and then they would go all through a process.

527
01:01:03,400 --> 01:01:08,080
I did that job through the first three years. I was there three or four years.

528
01:01:08,080 --> 01:01:19,220
And then when the council was reconstituted and I was part of the working group that devised the governance for the new much smaller agency.

529
01:01:19,220 --> 01:01:25,820
I had we had abolished the idea of appointed members by that I had to stand for election,

530
01:01:25,820 --> 01:01:30,020
but I was elected, I think I'd become notorious enough by that.

531
01:01:30,020 --> 01:01:40,190
And that was very interesting because it was during the period that the medical profession was under a lot of media criticism

532
01:01:40,190 --> 01:01:52,400
and really around the period of the problem with the neonatal paediatric surgery in Bristol and how Shipman's problems.

533
01:01:52,400 --> 01:02:00,440
And almost every day they would be very anti medical newspaper cuttings, I'm sure you remember it,

534
01:02:00,440 --> 01:02:05,210
and we were under close scrutiny as counsel and had to, I think,

535
01:02:05,210 --> 01:02:10,310
think fairly fast about our own fitness to practise processes and what they were about.

536
01:02:10,310 --> 01:02:16,190
And I think a certain amount of the sort of intellectual and academic rigour that I had been trained in.

537
01:02:16,190 --> 01:02:23,660
It was very helpful there in trying to look at really what we were there for and what the purpose of the organisation was.

538
01:02:23,660 --> 01:02:32,630
And in working towards rebuilding the respect of the medical profession and public confidence in the medical profession,

539
01:02:32,630 --> 01:02:36,380
one has to look at patient safety and the issue of colleagues who,

540
01:02:36,380 --> 01:02:43,700
for whatever reason, are perhaps falling below the standards that we would regard as generally profession that required,

541
01:02:43,700 --> 01:02:50,780
um, it enabled us to completely rewrite a new set of fitness practise processes.

542
01:02:50,780 --> 01:03:01,340
And I think I had never expected when I qualified as a doctor, to spend as much time with barristers and politicians as I spent with patients.

543
01:03:01,340 --> 01:03:10,430
But it was an interesting insight into how one draughted acts of parliament generally change statutes around professional governance.

544
01:03:10,430 --> 01:03:14,990
And I chaired the first practise committee that that brought all that into being.

545
01:03:14,990 --> 01:03:20,630
And we were really of a race against time because we managed to not only devise it,

546
01:03:20,630 --> 01:03:27,560
but get it through parliament and implemented in practise a good two months before then,

547
01:03:27,560 --> 01:03:32,750
John Smith produced her voluminous reports on the shipment limits.

548
01:03:32,750 --> 01:03:43,040
So it at least, I think, allowed us the credibility of say, we realise there have been problems, but they've been very actively addressed.

549
01:03:43,040 --> 01:03:49,910
I think the world is not a perfect place, and as long as we have a profession,

550
01:03:49,910 --> 01:03:56,360
we're going to have people in the profession who probably shouldn't be there. Just as you know, as an academic,

551
01:03:56,360 --> 01:04:06,560
we have historically always weeded people out for academic reasons who couldn't cope with with the level of the academic requirements.

552
01:04:06,560 --> 01:04:09,770
I think we have to look at their personality requirements and whether they're

553
01:04:09,770 --> 01:04:14,930
able to maintain the personal standards that are required of doctors as well.

554
01:04:14,930 --> 01:04:24,170
Do you think the smaller Jamesy is an advantage? It allowed it to operate much more as a.

555
01:04:24,170 --> 01:04:37,920
Structure board and sort of governance terms, the bigger GMC didn't really do it in the in the in the policy making sense.

556
01:04:37,920 --> 01:04:43,110
The if it had a plethora of small subcommittees,

557
01:04:43,110 --> 01:04:53,130
but the main function of GNC members was to sit on fitness to practise hearings as the sort of judge and jury, as an expert panel.

558
01:04:53,130 --> 01:04:58,830
And I've done a certain amount of that during my time there. And it's quite interesting.

559
01:04:58,830 --> 01:05:09,150
And I was based on what we call the conduct hearings, which were the people whose behaviour had been publicly a disgrace to the profession.

560
01:05:09,150 --> 01:05:14,220
But I was also on the performance panels,

561
01:05:14,220 --> 01:05:22,460
which looked at whether people are kept up to date and whether their standards of professional practise were acceptable to the rest of us.

562
01:05:22,460 --> 01:05:28,020
And that was a very complex set of assessments that were devised for the GMC,

563
01:05:28,020 --> 01:05:35,130
looking at people whose practise standards were poor and believe you me, the ones that came to us were very poor.

564
01:05:35,130 --> 01:05:41,340
I mean, you know, there's no doubt at all that the shock horror element was really quite strong and that

565
01:05:41,340 --> 01:05:46,350
I was peripherally also involved with the health committee with six doctors who also,

566
01:05:46,350 --> 01:05:53,550
particularly if they're addicted to drugs or alcohol or have mental health problems, can become a risk to patients.

567
01:05:53,550 --> 01:05:59,930
And we have to incorporate all of those in our new hearings and structures.

568
01:05:59,930 --> 01:06:09,200
So I think that the GMC had functioned really as a source for panel members and the new GMC has become very much more

569
01:06:09,200 --> 01:06:19,640
attractive sort of board with a combined role as trustees of a charity and also the board over at a public order.

570
01:06:19,640 --> 01:06:30,080
Yes. Which would you leave the GMC? I left roughly when I left when I was very nearly 60,

571
01:06:30,080 --> 01:06:40,100
some said would be 90 at 2008 and which year to do so up in Oxford Hospital, I had I had stopped in the September.

572
01:06:40,100 --> 01:06:47,300
My academic appointment came to a conclusion in September of the year that I retired from the GMC at the end of December.

573
01:06:47,300 --> 01:06:53,180
Yes. So I only did three months after I had completed stopped to person.

574
01:06:53,180 --> 01:07:00,650
Inquisitive questions. Yes. Which you don't have the answer. You mentioned Stan show that when I was a medical student at the middle.

575
01:07:00,650 --> 01:07:09,230
Yes. And I mean, what did you think of him? And do you think he was hard done by or did he get what he deserved?

576
01:07:09,230 --> 01:07:13,430
He was a difficult case. Yes, he was a very difficult character.

577
01:07:13,430 --> 01:07:24,680
But ironically, at the time that he was introducing his renal dialysis, he did initially meet a lot of opposition.

578
01:07:24,680 --> 01:07:27,710
And ironically, like a number of difficult,

579
01:07:27,710 --> 01:07:36,860
difficult characters I've encountered throughout my career and what they were standing up for is now accepted as the norm.

580
01:07:36,860 --> 01:07:46,030
You know, and in a way, one wonders whether people who weren't difficult characters would have made those pioneering.

581
01:07:46,030 --> 01:07:53,020
Processes. But he was at and I was in I mean, I was a student, I was incredibly junior at that stage,

582
01:07:53,020 --> 01:08:01,960
so I was very much just an observer of the political machinations, but a bit like one or two characters who I'm sure you could name here.

583
01:08:01,960 --> 01:08:07,160
You know, they get preferred lives by their colleagues just because they're too hot to handle, too difficult.

584
01:08:07,160 --> 01:08:15,140
And for the gym and I of it, then I get to.

585
01:08:15,140 --> 01:08:25,920
Jim. I think was somebody who was a very sound academic and whose work I think has stood the test of time.

586
01:08:25,920 --> 01:08:31,890
I think he found finding a clinical role and a clinical niche very much harder.

587
01:08:31,890 --> 01:08:36,480
And I think he never felt the Oxford had given him the credibility.

588
01:08:36,480 --> 01:08:43,460
He deserved it. Robert, I think.

589
01:08:43,460 --> 01:08:49,060
Was also somebody whose academic work has stood the test of time and again,

590
01:08:49,060 --> 01:08:58,220
I found it very difficult both to involve himself with the patient end of things and.

591
01:08:58,220 --> 01:09:04,700
Had very few students or colleagues, probably perhaps you didn't find that because you were working closely with it,

592
01:09:04,700 --> 01:09:09,800
but he was much more interested in the physiology and biochemistry.

593
01:09:09,800 --> 01:09:17,180
I suspect the patient and these people have that place in that unit and make very real contributions.

594
01:09:17,180 --> 01:09:26,810
One of the skills of the Oxford faculty has been to actually contain them somehow and find the muscle to.

595
01:09:26,810 --> 01:09:34,070
I'm not sure what would Robert have gone to do if he hadn't died so tragically and suddenly, I don't know, um,

596
01:09:34,070 --> 01:09:43,910
he'd have gone on mainly with the epidemiology of diabetes and management trials, comparing one man with another, I think.

597
01:09:43,910 --> 01:09:52,160
And he would go on doing clinical medicine for which every now and then he, I thought, had real involvement and flair.

598
01:09:52,160 --> 01:09:57,500
You see, he was the the right hand man to David whether when he first came.

599
01:09:57,500 --> 01:10:06,500
And I'm sure he handled that pretty well. I've always felt that whatever I take it, that I'm sure he was a capable clinician.

600
01:10:06,500 --> 01:10:10,640
Yes, I know that. Not in any way. I had questioning that.

601
01:10:10,640 --> 01:10:14,870
I'm just trying to think of interest in this case.

602
01:10:14,870 --> 01:10:23,390
Where is. No. And I think Jim would have welcomed a more general clinical trial in Oxford and never got into it.

603
01:10:23,390 --> 01:10:34,010
Had perhaps, you know, got a bit more of that. And you see anything and anything else, because otherwise, I mean, at the end of the top of my head,

604
01:10:34,010 --> 01:10:41,200
I think you've covered most of the things that I would that I would like to have talked about.

605
01:10:41,200 --> 01:10:48,760
I've been very lucky, I think, looking back to have had the role I've had and a career that's progressed and

606
01:10:48,760 --> 01:10:53,200
been so diverse and has given me so many expanding and different interests,

607
01:10:53,200 --> 01:11:00,340
I suppose what I should just mention is that, of course, it's just at the time I retired and was the leaving the GMC,

608
01:11:00,340 --> 01:11:07,240
I took on for six years chairing the trustees for the Royal Medical Benevolent Retirement, and I've just handed that over.

609
01:11:07,240 --> 01:11:10,450
I actually have just become a lady of leisure.

610
01:11:10,450 --> 01:11:23,630
And that has been fascinating and in a strange way has has built on both my professional interests clinically and the work I did with the GMC.

611
01:11:23,630 --> 01:11:29,120
Because the Dramatical Benevolent Fund over, gosh, what is it now?

612
01:11:29,120 --> 01:11:37,700
One hundred and seventy seven years has provided Stocklands for doctors who get into financial difficulties and has been

613
01:11:37,700 --> 01:11:45,020
largely supported by doctors and their families and looks after doctors and their families who get into difficulties.

614
01:11:45,020 --> 01:11:45,350
I mean,

615
01:11:45,350 --> 01:11:57,860
last year we looked after we gave money to something over 350 individuals and we had an age range that went from the neonatal to one hundred one.

616
01:11:57,860 --> 01:12:03,320
Now, initially, it was doctors who became ill and didn't have pensions before the NHS.

617
01:12:03,320 --> 01:12:12,500
Now, rather sadly, it is much younger doctors who come to us because with the fragmentation of the health service and the fact that people

618
01:12:12,500 --> 01:12:18,170
have gone back to having the very short contracts of employment that perhaps we recognised from our early years,

619
01:12:18,170 --> 01:12:25,440
and we thought that somehow it got out of the health service and come back again and people can be ill while working for one trust.

620
01:12:25,440 --> 01:12:34,810
And when that rotation takes them to another trust, find themselves unemployed because the other trust won't take the form of.

621
01:12:34,810 --> 01:12:43,270
It's a it's a it's a fund that has, over the nearly two centuries it's been in existence, got substantial financial resources.

622
01:12:43,270 --> 01:12:57,330
I mean. Nearly 70 percent of the money we give away and it has a budget of well over a million pounds a year and more than 60 percent of that is from,

623
01:12:57,330 --> 01:13:03,620
uh, interest on our investments, even with the low interest rates at the present time.

624
01:13:03,620 --> 01:13:12,800
And to have that resource, I think, is something that the profession should be kept aware of because the great many groups have got it as well,

625
01:13:12,800 --> 01:13:16,790
set up and organised, and it's a lovely bunch of people.

626
01:13:16,790 --> 01:13:20,240
Again, it's taken me working with people all over the country.

627
01:13:20,240 --> 01:13:28,130
And when I started as chairman, Barry Jackson, who would be president of the College of Surgeons, was the president.

628
01:13:28,130 --> 01:13:34,760
And more latterly, Dave Detriot has been our president.

629
01:13:34,760 --> 01:13:42,500
It's an organisation which, again, had to dig itself out of the past because the charity commission got interested in the

630
01:13:42,500 --> 01:13:46,490
structure of the National Benevolent Funds and wanted to abolish all charitable status,

631
01:13:46,490 --> 01:13:53,270
which we didn't think was a very good idea. So we had to very rapidly dig out our legal credentials.

632
01:13:53,270 --> 01:13:59,790
And I discovered that we were operating in 2010 on.

633
01:13:59,790 --> 01:14:11,070
Legal documents that have been devised in my team and which had terms like pecuniary necessity for supporting people,

634
01:14:11,070 --> 01:14:16,110
we've got the SEC having redraughted acts of parliament for the GMC.

635
01:14:16,110 --> 01:14:21,360
We draughted all the articles that would be in your hand.

636
01:14:21,360 --> 01:14:25,500
Well, we give away just short of a million pounds. Yes.

637
01:14:25,500 --> 01:14:32,790
So it's a significant sum of money. And about a third of this is still collected and donated.

638
01:14:32,790 --> 01:14:35,920
You know, quite a lot of it comes to standing orders and things.

639
01:14:35,920 --> 01:14:41,070
That's what we'd like people to do, because that's in the contemporary world, how those people give to charity.

640
01:14:41,070 --> 01:14:51,270
But we also have an annual appeal at a number of parts of the country, still run social events where the support comes due.

641
01:14:51,270 --> 01:15:01,890
And I got the impression that if you'd formed a considered opinion, you were never loath to declare it in a discussion.

642
01:15:01,890 --> 01:15:06,090
And where how far back in your life do you think?

643
01:15:06,090 --> 01:15:09,880
I've always been outspoken. So I said certainly considered in there.

644
01:15:09,880 --> 01:15:19,870
You didn't hide it under a bushel, I think, but I.

645
01:15:19,870 --> 01:15:29,140
I think from being quite a young schoolgirl, I learnt that if I could.

646
01:15:29,140 --> 01:15:37,700
The reason something. And it had any sort of logic behind it and was not.

647
01:15:37,700 --> 01:15:44,310
Immoral, illegal, or totally off the wall? It was worth expressing at.

648
01:15:44,310 --> 01:15:55,110
I think that I've had the opportunity of working in fairly liberal academic environments where to be somewhat of a

649
01:15:55,110 --> 01:16:03,700
nonconformist over things or being prepared to express a contrary point of view wasn't a reason for ostracise against it.

650
01:16:03,700 --> 01:16:10,470
And I suppose that may have encouraged me to continue to express my views.

651
01:16:10,470 --> 01:16:14,680
And that's a super interview. Thank you very much indeed for that. Thank you.

652
01:16:14,680 --> 01:16:15,320
Because coming.