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John, we're recording interview on what is it,

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the 20th is the 20th of November one three about you and your experiences with the Oxford Medical School.

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What led you to come to Oxford, would you say? Oh, job, yes.

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But were you advised to apply? Were you invited to apply?

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Did you see the advert? No, I was I saw the advert because those days you saw what was coming up in the BMJ, of course.

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But I wanted to come to the Oxford Neurology Department as opposed to having to go into the London system,

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which would almost certainly have meant going to the National.

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And Oxford had a very good department.

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It was headed by Richard Russell and it had a very good while Richard Russell was there.

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They just appointment at that time, I think.

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But anyway, there were other NHS consultants who were of good reputation and it had a very good neurosurgical department,

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which in some senses had been spawned from the London hospital,

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which is where I did my clinical training and where I did my first two years of post qualification jobs, because Pennebaker,

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who was the senior neurosurgeon in Oxford, had come to Oxford from the London and indeed, uh, Professor Cairns had come to Oxford from London.

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Although by 1965, when I came to Oxford, of course, Professor Cairns had been dead for a number of years.

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So, yeah, Oxford looked very nice to me.

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And I also wanted to stay in the UK for family reasons.

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And if I hadn't come to Oxford,

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I would very probably have gone to Boston because I had a U.S. Public Health Service Fellowship that I could have take it up.

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And there were plans for me to go to the Boston VA where Norman Gershman was, but I opted for Oxford instead.

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That's interesting. I mean, you use public fellowship. You did you ever take it up as well?

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Did you ever start it? Did you do anything to them or had you applied for it or was it dropped from the skies?

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Well, I can't remember, but I presume I must have applied for I mean, I don't think you know, I don't think these things dropped from the skies.

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That was in case you didn't get a job in England that suited you. You know, it was.

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Because at the time of that, I applied for, I thought that that would be the best thing for me to do.

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And you know Gershwin. Yes, yes, yes. I knew no engagement.

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And he had said, come. And I said, okay.

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But time passes, of course, from between deciding that that was the thing to do and applying for the fellowship and take months before.

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Exactly. Actually know that is possible. What did you just like about the London system?

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Well, I was in a slightly unusual beast, I suppose, because I did my clinical training at the London after I had got a Ph.D. in Cambridge.

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And I knew when I went on to clinical training that I wanted to be a neurologist because I was particularly interested in the brain.

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And I before the U.S. Public Health Service thing arose,

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I already had a mental health research fund travelling fellowship which had been awarded to me on the basis of some competition that I entered.

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And although I got this fellowship, I didn't know exactly how I wanted to use it.

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So I went to Oliver Zango, who was the professor of psychology in Cambridge,

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who had sort of pointed me in the various directions that I had gone in up until then.

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And I said, what would your advice be on where to spend this fellowship?

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And he advised me to go and seek the advice of Roger Gillet, who was the professor of neurology at the time.

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So I sought an appointment with Roger It and duly saw him.

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And he was very disparaging, really. He told me that I should contemplate taking up this fellowship until I had gained the experience

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of admitting some enormous number of patients as an essay which was certain the national.

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And I thought that was rather boring, I guess.

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And so you have membership at this stage.

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You should have membership. No, no. I was only about 18 months qualified.

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Yeah, I, um, I was actually doing a as a job in cardiology at the London time, but I, you know, I was getting old.

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I didn't see a great point in hanging around too long.

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And you came to Oxford and of course Richard was very conscious that he was different from Green Square.

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And, you know, I was quite proud of it. But after, say, three or six months, did you regret your choice?

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No, no, I never have. I never said the nursing in Oxford compared to the nursing in London was right up to scratch, would you say?

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Oh, yeah, the nursing was very good.

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And I'm in the Oxford Department at that time, had what basically, I suppose, two systems of nursing because it had the ordinary,

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the inverted commas, neurology, ward, nursing of all the various forms of neurological patients.

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But in addition, on the other side of the corridor, it had its own respiratory unit for the care of patients with friends, was killed very soon.

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Myasthenia gravis in a severe state or tetanus who?

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Needed respiratory assistance, it had this research unit, so it took in a very wide range of neurology patients.

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I know that you got very involved at times with the respiratory unit.

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We'll talk about that. But equally, A, your interest of yours was epilepsy.

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When did that begin to develop? Well,

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it had the germs of it had been sewn while I was still an undergraduate student in

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Cambridge before I had done a clinical training because it was in the second half

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of the 1950s that a lot of work was coming out of the Montreal Geological Institute

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on the relationship between the cerebral localisation and cognitive function.

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And in particular, in the late 1950s, there had been this realisation that the medial temporal lobe structures,

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particularly the campus of the amygdala,

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were extremely important for memory, that without these structures intact, um, one was highly likely to have a very deficient memory system.

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And prior to the mid 1950s, that would be a very little inkling of that at all.

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Um, you know, it was well recognised that the that the thalamus was very important in causing severe amnesia,

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but the hippocampus and the amygdala had not really been recognised.

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And that recognition, of course, came out of work that was related to the surgical treatment of epilepsy.

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And so even before I went on to medical school, and certainly long before I was in Oxford, I had had an interest in focal epilepsy particularly.

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And did that continue early in Oxford? Because I remember when this woman who was interested in epilepsy was always linking up

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with Charles withi Yat-Sen there was it with Charles that we went down with Charles,

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but also received calls that, um,

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Charles had edited a book of his own on which is sitting somewhere else anyway on memory function and epilepsy and such.

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And initially, you have been doing general neurology time on the respiratory unit.

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And that was particularly Joan Spalding, I would guess.

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Yeah. And that experiments with. Right. As the anaesthetist who integrated with them and I mean, they did tremendous things.

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Yeah. They improved the treatment of the people with failure of breathing because they improved the swallowing angle didn't they.

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They stopped people taking on their own saliva. Well, you know, they certainly stopped people through saliva.

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But of course, um, the, uh.

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Well, in some of these conditions, such as myasthenia, um, and also to some extent we working on very similar, but particularly myasthenia,

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one of the major deficits is that the respiratory muscles aren't functioning, so the breathing becomes deficient because of that.

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There is also in some of some condition.

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Such as testimonies or even status epilepticus, the need to paralyse the patient and to breathe for them mechanically pump,

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so it is partly the swallowing deficit, but also the weakness of the respiratory muscles, whether induced,

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as with corollary, to try to control the disease process or whether the cause of the disease process has been much thinner with

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the tetanus people that came the introduction of the beta blockers to help against those annoying storms.

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That must have been a tremendous development. And how long did it take, really?

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Oh, I don't know that I can answer that question.

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I mean, they used to be enormous discussion as to what medication should be introduced to control blood pressure fluctuations.

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One of the major problems is and the beta blockers really worked extremely well.

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Is that right? Yes. Yeah. Yeah, that was great.

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Now, I know that involved the whole working together, John Spaulding and Alex Cramton Smith.

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And at one time, I gather John Spaulding put in for the chair of Anaesthetics of companies with it.

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Was that a wise move, Derek?

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I don't know. That's before my time. Right.

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But did you know about that at the time that he'd put in for it?

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And and the first I've heard about that.

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But anyhow, what you do have feelings about are the various professors of neurology, which was the first professor in the chair, the Maxwell job.

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Yeah, well, yeah, the actual research is I think you're right.

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But and Ritchie, what would you say was Richard's great strength of imagination?

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I would say is an observation. Yes. And observation.

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But he was incredibly imaginative and he was not frightened of following an idea that he had had.

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He he had some I mean, his major contribution was, of course,

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getting proper respiratory care for people with polio and out of that developed the proper respiratory care for people with at that time,

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less common diseases like John Burris syndrome, senior tetanus, respiratory care, them.

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And that was a very major development in some areas.

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His imagination possibly ran away with him a little.

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He had, but now seem like slightly curious ideas about how to manage multiple sclerosis, for instance,

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in which he was a firm believer in the idea that two hours rest on the bed each afternoon

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was very important and that various sorts of exercise programme were very important.

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And I think he felt that they were important not only to help muscles that were already weak,

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but also to somehow or other diminish the pathological process by increasing the blood supply to the spinal cord.

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And I think that would just relieve the tendency to spasm in muscles the rest.

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But I mean, I don't know. They might have done well, possibly, but not very effective.

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Mean. But anyhow, he didn't believe in tuberculin people, derivative and personally.

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That was you probably know more about it than I do.

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But did you work with on it or not? No, you don't.

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I mean, when you've worked with on a peripherally occasionally as a registrar or call, one might have to do something about.

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Patient on the department's meningitis unit,

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but that would be very rare and occasional the as the registrar called the a consultant opinion one might need

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to ask all because none of the main urology consultants happen to be around for all that would be covering,

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but otherwise made contact with all that was at the Friday morning meetings were

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all those opinion was always very interesting and very well worth listening to.

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So that time you were working at the church, I guess, and honours unit was at the pavilion?

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Yeah. Yeah. You had to travel over there. Yeah. And the other professors after Ritchie retired, which would have been, what,

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three or four years after you went off to about 69, I guess you would ride over as late as that ride.

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Okay. Okay. And who succeeded him then? Brian Matthews.

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Was that a good appointment? Yes, it was. I mean, the whole yeah, it was.

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Brian was a superb the experienced clinician.

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And he was appointed at a time when Oxford professors were mostly very good clinicians.

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And I mean, I don't know.

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But yeah. Well, what philosophy and was Henry Miller involved in that appointment?

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And he was certainly reputed to have been while he was on the appointments committee.

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He was. Yeah, he was the external assessment. And of course, Joe Matthews.

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Matthews was John Knox rather a.

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Yes. I don't know how important that was, but he certainly had been a Henry Miller protege and his days in urology in the north.

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And he had written a very influential book, I think. Yes.

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Mhm. I mean did you think well of the book. I mean what was it.

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Was. Yeah it. Yes.

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Mm hmm. And then when I was succeeded by John Newsome.

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Davis. Matthew Matthew. Yes. Yes, yes.

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And at one time you thought John Spalding's should have been appointed professor.

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Which action was that. Uh, that was when Brian Matthews was appointed.

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I'm not sure I ever said that. I thought that I have a knack for paraphrase.

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Yeah. Now,

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I know you told me before it was a lovely interview and I'm sorry it was lost

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was that Richard would pass all the students to John Spaulding to supervise.

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In other words, he wouldn't take them on. And John was a very good academic supervisor.

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John was a very good academic supervisor.

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He had a number of people who he had supervised, who went on to very senior positions in neurology with an accent on the autonomic nervous system.

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Um, he published a large ish for those days, a number of.

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Papers mostly related to autonomic nervous system and physiology.

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And. He had a flourishing autonomic nervous system laboratory at the Churchill, which he did in addition to his routine NHS work,

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and it should be remembered that he was not only one of the small number of NHS consultant neurologists,

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sort of Brossette, the vast number that there are these days for Oxford.

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But he also provided the neurology for Northamptonshire.

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So this he was doing in addition to his academic work.

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And as far as the respiration unit was concerned, that was a 24 hours a day, seven days a week activity.

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And from the point of view of neurological cover,

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it was really entirely dependent upon him and the two NHS registrars who were in the department at that time and all that.

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But for the neurology and John had a very heavy, critical node.

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Yeah, I mean, it wasn't done in a sense, Northamptonshire,

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because the department was linked up with the Mandaville to or was it linked up to a lot of other places back then, say, in the 60s?

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Yeah, it was linked up to Buckinghamshire and to Berkshire and apart from Slough, which was linked up to one of the London teaching hospitals.

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Um, and, um, I mean, if we are on the John Spaulding part of the system, there was what was called the respiration unit flying squad.

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And the way that this worked was that if a patient with a neurological condition or believed bad or logical condition got

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into respiratory difficulties anywhere in Oxfordshire or Buckinghamshire or Northamptonshire and and bits of Berkshire,

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the respiratory unit flying squad could be called a part of this flying squad

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consisted of one of the two neurology registrars and anaesthetics registrar.

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And the neurology registrar would drive the anaesthetics registrar to wherever it was the patient in difficulties happened to be.

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It could be in some remote farmstead in Northamptonshire. And so I remember going to one of those or to some remote place near Newbury.

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And on one occasion actually the Chalfont epilepsy Kalakala.

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Yeah. Where they would be met by an ambulance.

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And the job of the neurology registrar was to assess the condition from the point of view of the neurology and the job of the anaesthetic

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registrar was to intubate the patient if necessary and to maintain respiration until the patient got back to the respiration unit in Oxford.

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Yeah, well, I mean, you know, this was amazing experience from the point of view of the oldest.

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I remember there was one summer when because the senior registrar was away on a three week,

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three month secondment to learn some aspects of neurosciences.

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I was on call continuously for three months and I actually collected in that time seven patients with tetanus where you get that experience.

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I hope you got some sleep, too.

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But do you know at the end that ambulance service, emergency service come before sorbets, upset Trick Flying Squad or after it?

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I don't. I don't. I don't know. No, ma'am, it's worth trying right now.

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This time you would have been doing some written work. I mean, observation papers.

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Were you submitting papers, doing research or up to your neck in clinical work?

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Well, we started with we started actually submitting papers that were patient based.

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So, I mean, one of the one of the papers that we submitted to and I submitted it was accepted,

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was published in Brain was on a rather rarified condition called Cholerae Noemia.

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Now, this was of enormous interest to Norman Cashman, which is partly perhaps why I had the opportunity of working with him,

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because he had observed possibly had been observed previously, but he worked out that you could get this curious condition of colour.

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I know. And dyslexia in a brain condition where there was a right hand to the left hemisphere dominant patient,

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where there was a infarction of the back of the left hemisphere so that all the visual to the right hemisphere and in addition,

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there was an infarction of the posterior part of the corpus callosum.

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So that visual information had difficulty getting from the back of the right hemisphere to the language areas in the left hemisphere.

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And as I say, one feature of this condition was Coleraine, Namu and dyslexia.

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Well, soon I got out of two patients in the sixties.

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Late sixties. Yeah. Yeah, great. Got hold of two patients,

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one of whom had Cholerae Namir as a result of a smallish lesion in the left hemisphere or the other who

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had died as a result of a bigger lesion in the left where there was involvement of the corpus callosum.

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And we showed that there were various different features between these two patients,

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which made it to the locus of the cerebral damage on this, bear in mind,

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was in the days before CT scans of the brain or MRI scans of the brain or MRI functional imaging or all of that,

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and was of the sort of thing that interested the clinical neurologists who were interested in the brain.

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Indeed, we were greatly honoured because we got a letter from Charles Simons,

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who was one of the doyennes British neurology at that time, telling us how interesting this was.

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Had you localised that pathologic that death or by electrochromic, indeed.

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No, no, we didn't. How did you recognise it? How did you know what was.

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Well, how did we know in those days? We knew largely on the basis of what the various clinical signs were.

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But how did you know the corpus callosum in the first page?

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Well, we I suppose it have to be said he assumed it.

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And then, of course, you never you never got the proper localisations or while your patient was still alive,

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because even if you had angiography, you was a very sort of gross method of trying to decide whether a lesion was but neurology and.

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Those days had to localise the presence of calls, horrible damage on the basis of what is found by examination period.

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That's how I did. Now, let's just think when did you today on membership?

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Well, I did my membership, but I'm probably about two years after coming to Oxford.

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And did you find it difficult to get the non neurological stuff up to speed on not I mean, did you go do any courses or group treatment?

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Group support? Probably. What didn't exist then? No, it didn't exist.

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That famous person whose name I forget in London is who ran courses.

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And I never went to any of them.

220
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Yeah, there was a well, but I meant in Oxford really.

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Nobody was helping in Oxford. Oh yeah.

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There were people, there were people who did membership runs that were usually senior registrars in general medicine.

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And one went and attended them and they produced patients with sort of typical type conditions.

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And they have they're great, you know, I felt at the first time and passed at the second time.

225
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Yes. Like many a good man, really. And then how much more were you writing?

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I mean, did you feel you had a theme that you were getting interested in or was it a bit of a bit of that?

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Well, whether it was with Charles, which we were very interested in status epilepticus and Charles was particularly interested in,

228
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says Epilepticus, and he interested me in status epilepticus.

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And we took out all the notes of patients in Oxford who had been admitted with epilepsy over a large number of years.

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And we picked out from that sample the patients who had presented with or had developed whilst in status.

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And we analysed the presumed underlying cause of the status.

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And we showed that there was a very high incidence of frontal lobe pathology in people whose epilepsy presented as status.

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And that got published in Brain and also in some slightly different aspects of it,

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or published in the Journal of Neurology, Neurosurgery and Psychiatry.

235
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So there was that. And then when Brian Matthews came along,

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I became his first assistant and he but there was an NHS past or university press and the university and I had to

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pay five pounds to have an Oxford AMA because nobody could have a university post without the honour per page.

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And it's university. Brown Matthews was interested in the treatment of acute cerebral infarction,

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and in particular he was interested in whether or not treatment with dextran intravenous dextrose improved the outcome from certain function,

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the accused phase. So that was a prelude to that bit when we analysed all the patients who had been admitted

241
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to the Oxford hospitals with acute stroke of the previous some number of years.

242
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Involves examining innumerable piles of notes and having done that, I'm not quite sure why we did that first, but we did do it first.

243
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And having done that, we then set out on doing this trial of patients admitted with stroke to the general medical wards,

244
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almost invariably at the request.

245
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And so over a period of, I suppose, about two years, I or we sometimes had a registrar working with us on the research money.

246
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And at one time it was Greenhaw.

247
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And one time it was something called Keith Granger, the Australian, who then went off and became a consultant urologist in Perth, Perth, Australia.

248
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We saw between us all or as many as possible of patients with acute cerebral

249
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infarction admitted to the Radcliffe Infirmary the next day or that night.

250
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Well, from that night. Yeah, that was pretty demanding and that was very demanding.

251
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Yeah, that was very demanding.

252
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Um, and it was during that period that Sue and I bought a house in some part of the road, which is of course just behind the factory.

253
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So I didn't have to drive in from country to did all of this kind of thing.

254
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Um, and that went on for a while.

255
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And ultimately it was published again in the brain.

256
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It showed the dextran was really very much good.

257
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But it also, more importantly than that, I think showed the problem for the first time,

258
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although it's always difficult to say that anything is for the first time

259
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because you really sort it out and somebody else knew it a long time previously

260
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or what that you could predict virtually on the day of admission what the outcome was going to be according to what you found on the examination,

261
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because, again, you didn't have CT scans of that ilk, although he was just beginning to come in then.

262
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But it was all right for excluding haemorrhage, but it wasn't very much good for localising precisely where the infarction was in anyway.

263
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In the acute phase of cerebral infarction, you often don't get any abnormality on CT.

264
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It's not until four or five days later that the abnormality appears so that we sort of have to do.

265
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A series of publications came out of that.

266
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And, uh, um, but textiles really weren't very good.

267
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And I was followed into that post as Brian Matthews's read up by Charles Warlow,

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who subsequently became really the the king of UK cerebral vascular disease and

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remained so until his retirement from the chair of neurology in Edinburgh.

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And he developed an enormous contingent of cerebral vascular disease and neurologists, some of whom have become very famous.

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But and I don't think that he thought very much this trial had gone on before he arrived on the scene.

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But I did notice in one of his writings fairly recently that he cited this trial as one of the first such trials in the treatment of Cerebrovascular.

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And now presumably when he came, that was when you were appointed consultant.

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Yeah, but before we get one thing he said, because just on the organisation of the Orleans Department,

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you said when I was working for Charles withI so did you, as it were,

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a take between consultants or were you just the registrar, one of the registrars to the.

277
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Well, there were two the two there was a scene in which John myself was sceneries trying to register and there were three NHS consultants.

278
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And what happened was that, yeah, we rotated.

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I think I'm so irritated between when you were working for in the leadership post, you know, did you see any epilepsy in those days, those years?

280
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Well, yeah, because I hope I was then became an honorary consultant.

281
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Yeah. Once you did that, I was an honorary honouree and I had my own clinic and I got sent out to Britain as well.

282
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And so I had mean, I was doing general neurology as part of the review.

283
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It was called First Assistant way back in the 60s.

284
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Which consultant had read under that umbrella? Well, no, that's what it's all about.

285
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None, because there was John Kid, who was a general physician and interested in neurology,

286
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and he provided the neurology for reading and also for Amersham and high Weyco.

287
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And, um, but at some point or other, when I was the first assistant, he called for help and because he had too much work to do.

288
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And so I used to go down to Redding.

289
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He called to Mathieu's for help. What are you. Well, not to me. No, no.

290
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I just wanted to show you a message. Yeah. And you were sent.

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And I was sent. And you continued that right to your retirement, is that correct?

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No, no, no. When he retired, which would have been when he John Kidd retired when which would have been two or three years, I suppose.

293
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After I started going down to the clinic, the system was reorganised.

294
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So Richard Greenhaw was appointed to be a consultant in Oxford, but with more sessions in ridding of me.

295
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And I then shifted over to doing I wouldn't.

296
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Right. I saw peripatetic. You know, I got shifted.

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Now you've been an honorary consultant, then you became an NHS consultant.

298
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And what difference do you feel that made your working habits and practises?

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Well, I think that I could only answer that by observing what happened to successes in my university post,

300
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but I think what happened really was that as an NHS consultant from that time,

301
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one got progressively less and less facility to do other than clinical work.

302
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Mm hmm. And even if one was working in a rather specialised form of neurology, because by from about the mid 1970s,

303
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on until the time that I retired in 2000, I was increasingly involved in the assessment of people for possible epilepsy surgery.

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And I think progressively throughout that time, one had less and less time medication to do one's specialist neurology work.

305
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Well, I think before that, being in the university post, that would not have been so.

306
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I noticed that some of my successes in university posts were quite successful

307
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at dropping and NHS commitments that had been imposed upon them by I mean,

308
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I think very wisely. But but now you were very instrumental in epilepsy surgery story and did the impetus from that come from you?

309
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Because I think you were going down to London a bit before Chris Adams came.

310
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Why is that wrong? I was going down to London to discuss things with people who were moving.

311
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But Chris Adams started it with you? Yeah, well, I mean,

312
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I think Chris Adams would have to be said to have started it because Chris Adams had been my Faulkner's senior

313
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registrar at Kings and Murray was the epilepsy surgery king of the UK at the time that Chris was his senior registrar.

314
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And so, um, Chris brought this facility, particularly the temporal lobe.

315
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She said to Oxford with him, Chris also, who developed hemispherectomy, which was not, I think, one of my forclose particular operations.

316
00:50:14,750 --> 00:50:28,220
But Chris made it very much his own. And I mean, in terms of success, it probably has the highest success rate now.

317
00:50:28,220 --> 00:50:36,680
People always sort of fall over backwards when they hear this suggestion of taking away one hemisphere and curing something.

318
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But it has to be remembered that the hemisphere that is being taken away is extremely damaged

319
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and that the person from whom it is being taken away already has a heavy Plager and very

320
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possibly has a heavy knife being on the same side and has appallingly frequent epileptic

321
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seizures several a day and very often has severe behavioural disturbance going with it,

322
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presumably because of the more or less continuously ongoing abnormal electrical discharges in the brain.

323
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And when the operation is being done, they have no more weakness hemiplegic side than they had before it was done.

324
00:51:38,600 --> 00:51:44,570
And they have virtually always no further loss of.

325
00:51:44,570 --> 00:52:00,970
Is your function and the behaviour often resolves to normal, just like that, Mark, like switching off attack and they were having an anaesthetic, too.

326
00:52:00,970 --> 00:52:07,310
Yes. Yeah. Yeah. Um, I mean, use that tremendous development.

327
00:52:07,310 --> 00:52:13,250
How dependent was it on improved imaging or would it have happened without that?

328
00:52:13,250 --> 00:52:27,200
Um. Well, the, uh, the temporal lobe work became extremely heavily dependent on good imaging because the, uh,

329
00:52:27,200 --> 00:52:39,170
temporal lobe, temporal back to work and ultimately not total temporal lobe, but medial excisions lateral.

330
00:52:39,170 --> 00:52:49,880
Um, they were heavily dependent upon you being able to demonstrate that there really was pathology in one hippocampus,

331
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the one that you were not the one that you were going to take out,

332
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and that there was little or no damage in the hippocampus that you're going to live in.

333
00:53:01,220 --> 00:53:17,150
Because if you took out a good hippocampus, you were left with a patient who was severely amnesic and also you didn't use the epilepsy.

334
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So you had to develop sophisticated techniques for determining as far as possible

335
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that the hippocampus that you were not to operate on was more or less normal.

336
00:53:37,730 --> 00:53:45,330
And of course, the one that you wanted to take out was well, when the MRI came in.

337
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And that was a fantastic advance because you could image the size of the two hippocampi.

338
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But before him came in, one indulged in a certain amount of sort of physical activity with CTE, but it wasn't really anything like.

339
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So the more I became the falsity, you had to do it on the basis of, uh, psychological function, essentially.

340
00:54:18,950 --> 00:54:27,780
And what happened in carotid amatol testing.

341
00:54:27,780 --> 00:54:38,090
And if you got it wrong, the patient got a very severe disturbance of memory.

342
00:54:38,090 --> 00:54:41,660
And fortunately, we never had this happen to us.

343
00:54:41,660 --> 00:54:52,150
But people did that to some university and I guess we were lucky.

344
00:54:52,150 --> 00:54:55,940
Uh, so imaging I've made a big difference.

345
00:54:55,940 --> 00:55:03,100
How much help with the Aegean? What was your experience with the guys in Oxford?

346
00:55:03,100 --> 00:55:16,280
Um, well, Chris Christie's great dictum as a surgeon was you've got to remove pathology and if you don't remove pathology,

347
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you're going to get into difficulties. And he didn't much like EEG is a method for localising pathology.

348
00:55:32,420 --> 00:55:45,860
Um, but of course, there are other epilepsy surgery centres, particularly nowadays, who are extremely heavily EEG dominated.

349
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But Oxford never was. And, uh, so we got on without it.

350
00:55:54,890 --> 00:56:01,550
Was there for the Energy Department interested in other things then, or what was the problem?

351
00:56:01,550 --> 00:56:12,440
Um, well, I don't think that the Oxford EEG Department was particularly interested in that surgery.

352
00:56:12,440 --> 00:56:27,230
And indeed, what EEG or a lot of the e.g. that we obtained was obtained from outside Oxford, particularly some Thomas's patients were good.

353
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And yes, indeed, we got funding from the regional board to send patients down there.

354
00:56:34,500 --> 00:56:43,880
And now you'd have been saying all this time tremendous development in the drug therapy of oral therapy, of epilepsy.

355
00:56:43,880 --> 00:56:50,070
Did that. Change life or not? There was that added stone thing, I don't think that was a great change.

356
00:56:50,070 --> 00:57:11,100
And as you know, phenytoin had been available since the late 1930s and carbamazepine had come in a bit later than that.

357
00:57:11,100 --> 00:57:23,970
And from that point of view, treating focal epilepsy, the next development really was LaMotte's gene.

358
00:57:23,970 --> 00:57:39,000
And our impression very much then, and I think it was a correct impression, was that the changes in medication,

359
00:57:39,000 --> 00:57:44,520
the developments in medication are very important from the point of view of reducing side effects of medication.

360
00:57:44,520 --> 00:57:52,230
But they're not actually terribly important from the point of view of improving seizure control.

361
00:57:52,230 --> 00:58:14,460
So you got I mean, phenytoin, of course, produced a good antiepileptic drug for stopping seizures, but it had a lot of very undesirable side effects.

362
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The arrival of Lumosity at the scene was particularly good because it didn't give any better seizure control,

363
00:58:24,000 --> 00:58:30,540
but it gave a much better side effect profile.

364
00:58:30,540 --> 00:58:40,080
And Petit Mal, was that a therapeutic challenge of our diagnostic challenge while Petie.

365
00:58:40,080 --> 00:58:50,340
Now, of course, surgery had no place in the treatment that it.

366
00:58:50,340 --> 00:59:03,070
Yeah, I mean, it could be a diagnostic challenge, but it shouldn't be because the seizure pattern is pretty typical.

367
00:59:03,070 --> 00:59:10,290
The age pattern is pretty typical and the characteristics are pretty typical.

368
00:59:10,290 --> 00:59:18,690
The thing that really causes the problem is not pediment as such,

369
00:59:18,690 --> 00:59:42,870
but seizures arising from very small areas of of malformation with the brain because they seem to produce

370
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rather weird seizure patterns and weird EGFR abnormalities and extraordinarily difficult to control.

371
00:59:54,390 --> 01:00:02,250
But of course and so everybody prayed that surgery would have some place in their treatment.

372
01:00:02,250 --> 01:00:15,180
But on the whole, it didn't, because the these displays, as they're called, tended to be distributed rather widely through the brain.

373
01:00:15,180 --> 01:00:28,080
You take one out, you left with elsewhere. How much were you getting involved with sort of national meetings and national organisations?

374
01:00:28,080 --> 01:00:35,700
I've never been involved with national organisations. It's not the way to any extent.

375
01:00:35,700 --> 01:00:46,310
Of course, we went to national meetings that we had students who obviously know as well.

376
01:00:46,310 --> 01:00:57,670
I mean, I think the answer's the same, but neither of us has ever been much involved in national organisations.

377
01:00:57,670 --> 01:01:05,520
We become sort of committee members on this sort of organisation or that.

378
01:01:05,520 --> 01:01:16,290
But we went to the majority rather than the national meetings, and we went to a lot of the international meetings.

379
01:01:16,290 --> 01:01:23,010
We went to the American epilepsy almost virtually every year.

380
01:01:23,010 --> 01:01:32,010
And we went to we both members of the International Neuropsychology Symposium,

381
01:01:32,010 --> 01:01:44,530
which was a very interesting group, um, and we used to go to that every year or two and.

382
01:01:44,530 --> 01:01:59,880
We would go to the occasional international epilepsy meeting, but usually the we went to the American role and how often are you presenting papers?

383
01:01:59,880 --> 01:02:05,400
And one in two. And when I was said, at least one in two.

384
01:02:05,400 --> 01:02:20,110
Yes. I mean, we we went to the the international epilepsy in Sydney in 1995.

385
01:02:20,110 --> 01:02:29,620
We I think we and the people with us presented something like 10 papers that was a little

386
01:02:29,620 --> 01:02:43,900
exhausted and we had a similar number that would have been at the American epilepsy.

387
01:02:43,900 --> 01:02:52,030
And well, they both actually in San Diego and in in Florida,

388
01:02:52,030 --> 01:03:04,960
which would have been two of the years in the last five years of the last century, we presented about the same number papers.

389
01:03:04,960 --> 01:03:10,960
Do you think Medicare nowadays work as hard as you used to?

390
01:03:10,960 --> 01:03:13,300
Well, I think the health service ones do.

391
01:03:13,300 --> 01:03:29,620
I mean, the the one that the I mean, I'm in contact with two NHS consultants who are very much concerned with epilepsy and neurologists,

392
01:03:29,620 --> 01:03:40,870
physicians who are very much concerned with providing epilepsy services in epilepsy surgery services.

393
01:03:40,870 --> 01:03:51,490
One of them in Oxford, Jane, that cop and the other one in Bristol.

394
01:03:51,490 --> 01:03:57,220
And they strike me as working amazingly, amazingly hard.

395
01:03:57,220 --> 01:04:03,970
They they work just as hard as we used to.

396
01:04:03,970 --> 01:04:15,730
What I think the advantage that I have to so they have to some extent, is that they don't seem to have to fit in quite so much.

397
01:04:15,730 --> 01:04:25,120
General neurology around all of this. When I was doing it, I used to get criticised.

398
01:04:25,120 --> 01:04:33,820
I was supposed to be devoting four sessions a week to neurology in High Wycombe.

399
01:04:33,820 --> 01:04:45,580
And from the point of view of High Wycombe physicians, that should have meant that I sat in High Wycombe for two whole days a week.

400
01:04:45,580 --> 01:04:53,950
And then what happened to the patients that came to Oxford with the wards in High Wycombe?

401
01:04:53,950 --> 01:05:00,010
I have no idea. But the attitude was that that's what you should be doing.

402
01:05:00,010 --> 01:05:08,470
So one had to somehow rather resist that, because in addition to that,

403
01:05:08,470 --> 01:05:23,830
one had to be doing on call in Oxford and the general neurology in Oxford and this rather specialised epilepsy stuff.

404
01:05:23,830 --> 01:05:38,960
No, I don't think that the modern NHS physicians get labelled with quite that amount around the specialist area in your time.

405
01:05:38,960 --> 01:05:44,740
Were you got to stroke patients as a neurologist acutely,

406
01:05:44,740 --> 01:05:52,630
or would that only be a sort of later referral to stroke patients admitted to general, you know?

407
01:05:52,630 --> 01:06:07,660
Yeah, not much, because in in my time in Oxford, there was a move to get as much neurology as possible,

408
01:06:07,660 --> 01:06:16,500
admitted to neurology beds, and that that worked quite well.

409
01:06:16,500 --> 01:06:21,000
And a lot of strokes are going to neurology. Quite a number.

410
01:06:21,000 --> 01:06:27,260
Yeah. Yeah, quite a number. Of course, the neurologists then became selective.

411
01:06:27,260 --> 01:06:32,530
Inevitably, I'm criticised for doing so because they said, well,

412
01:06:32,530 --> 01:06:46,440
we will admit strokes under the age of 65 or 70, and that wasn't thought to be terribly acceptable to.

413
01:06:46,440 --> 01:06:51,170
I mean, it depends on the number of beds that you have.

414
01:06:51,170 --> 01:07:01,840
And do you feel that the neurology people or the patients were being advanced by that you mean that the physicians would be advanced?

415
01:07:01,840 --> 01:07:07,630
Yes. Yeah, I think they were being advanced.

416
01:07:07,630 --> 01:07:17,000
And neurology has always been a slightly sort of curious, slightly curious relationship.

417
01:07:17,000 --> 01:07:26,500
I think, General, it's, uh, and I think that the neurologists have been seen by general physicians,

418
01:07:26,500 --> 01:07:36,610
probably quite rightly, as being a little standoffish and, uh,

419
01:07:36,610 --> 01:07:43,330
but at the same time have been arguing that all neurologists should be seen by neurologists,

420
01:07:43,330 --> 01:07:49,960
but they don't actually really have the facilities to do all of this.

421
01:07:49,960 --> 01:07:58,000
And I don't know. It's it's very, very tricky, isn't it?

422
01:07:58,000 --> 01:08:06,610
I mean, the Association of British Urologists is still arguing about all this, but things are changing now, I think, in various ways.

423
01:08:06,610 --> 01:08:15,130
But go back to the now you have written, Ed, distinguish textbooks and massive encyclopaedias, as it were.

424
01:08:15,130 --> 01:08:18,820
When did you do that? Before you retired after he time. No, no, no.

425
01:08:18,820 --> 01:08:30,340
I haven't done anything since after I retired the end of June 2000, supercharging at same time.

426
01:08:30,340 --> 01:08:51,920
And the, uh, the big epilepsy book that was edited by myself and Charles Pocky and I go to Charnley that was published about May 2000.

427
01:08:51,920 --> 01:08:57,850
Yeah, I've done it since then. But you've done a textbook of neurology before that.

428
01:08:57,850 --> 01:09:01,450
Yeah. Yeah. OK, so that was while you were working. I mean. Yeah.

429
01:09:01,450 --> 01:09:05,230
And then actually I mean you must have been busy Gemalto.

430
01:09:05,230 --> 01:09:11,800
I mean now you mentioned more than once. When did you start working with her.

431
01:09:11,800 --> 01:09:18,630
Well so I came to I came to the neurology department in Oxford in.

432
01:09:18,630 --> 01:09:26,500
June 65 and Sue came to Oxford with me.

433
01:09:26,500 --> 01:09:35,520
At the time, she was working at Meadowvale and you'd met in London or in Cambridge?

434
01:09:35,520 --> 01:09:44,700
In Cambridge, we introduced by all of the English and French, German, French woman.

435
01:09:44,700 --> 01:10:06,360
And so anybody who came came to Oxford in June 65 and used to commute up to fail, used to meet Jellinek on the train from Oxford,

436
01:10:06,360 --> 01:10:16,950
and he knew the quickest way to get from Paddington Station to avail with two bus change.

437
01:10:16,950 --> 01:10:28,290
And anybody she knew was working as a neuropsychologist with Ritchie at that time.

438
01:10:28,290 --> 01:10:40,410
Charlie Research. And it was a good day as he went along to Ritchie and she said, oh, she said, you know, have you got a job that I could do?

439
01:10:40,410 --> 01:10:48,550
He said, Oh, well, I think I'd like to have a health service psychologist in the neurology department.

440
01:10:48,550 --> 01:10:55,170
And I've got a little bit of money and I can take you on for a year.

441
01:10:55,170 --> 01:11:08,190
So she was taken on for a year. And in that year, you know, towards the end of that year,

442
01:11:08,190 --> 01:11:17,040
we went on our tour of North America and she went and sat with Brenda Milner for three weeks in Montreal.

443
01:11:17,040 --> 01:11:20,790
And I went and visited Northern Ireland and all of that.

444
01:11:20,790 --> 01:11:29,460
Very nice. And at the end of the year, she said to Ritchie, Well, what about it now?

445
01:11:29,460 --> 01:11:41,670
He said, I think he said, well, it's been extremely useful having you working with us all now till the regional board or the

446
01:11:41,670 --> 01:11:49,830
health authority or whoever it was who controls the purse strings that we want full time person.

447
01:11:49,830 --> 01:12:06,000
And May Davidson was the controller of clinical psychology at that time, and Sue had been trained by May and May said, oh, no.

448
01:12:06,000 --> 01:12:15,210
She said we must have this job jointly between psychiatry and neurology.

449
01:12:15,210 --> 01:12:21,480
And Ritchie, I think, said, oh, no, no, that's not part of that.

450
01:12:21,480 --> 01:12:38,430
Anyway, Ritchie got her this job and and that's how the NHS and clinical psychology in neurology actually commenced.

451
01:12:38,430 --> 01:12:52,940
And so we would have been working with each other, really, I suppose, since about September, October 65.

452
01:12:52,940 --> 01:12:57,960
Right, right. I mean, every neurologist does a bit of mental testing.

453
01:12:57,960 --> 01:13:03,360
And is it fair to say that clinical psychologist just do a whole lot more?

454
01:13:03,360 --> 01:13:13,740
I mean, it's still a clinical observation, clinical enquiry, but obviously much more detailed than any bedside neurologist as well.

455
01:13:13,740 --> 01:13:29,640
What they do now is very different. They do a whole lot of things now that they didn't do back in the 1960s.

456
01:13:29,640 --> 01:13:36,300
No. One, they'd be outraged if I suggested that they only do what we did then.

457
01:13:36,300 --> 01:13:48,480
But no, no, but you didn't do it. But what I mean is it's an extension of that sort of activity observation enquiry, probing or with words.

458
01:13:48,480 --> 01:13:52,830
The clinical psychologist now would say that they're involved in treatment.

459
01:13:52,830 --> 01:14:07,530
Right. They would say that if you have a clinical psychologist attached to epilepsy surgery,

460
01:14:07,530 --> 01:14:20,880
that the function of clinical psychologist is not simply to tell you whether or not they think that the.

461
01:14:20,880 --> 01:14:28,080
Their examination shows that what you are about to do is the right thing to do or is not the right thing to do.

462
01:14:28,080 --> 01:14:40,720
They would think that there should be big involvement in rehabilitation and in social management that they have to say and that sort of thing.

463
01:14:40,720 --> 01:14:49,190
What happened last year about that? I should have. Well, I can't say no.

464
01:14:49,190 --> 01:14:55,250
There's nothing on the tip of your tongue that you're burning to declare.

465
01:14:55,250 --> 01:15:12,290
No, I don't. I don't think so. I mean, if I was forced into the confessional, I think I would have to say that they agreed to pay tribute,

466
01:15:12,290 --> 01:15:17,440
I think, to the people who have influenced me and all of his anguish.

467
01:15:17,440 --> 01:15:27,980
I really do put it at the top of this list or the reason he was not a urologist,

468
01:15:27,980 --> 01:15:40,790
but he was much involved in neuropsychology and was ran the neuro psychology

469
01:15:40,790 --> 01:15:49,430
department at National for several years while he was still a professor of neurology,

470
01:15:49,430 --> 01:16:01,730
a professor of psychology in Cambridge. I was being greatly influenced by two neurosurgeons, one of whom was Douglas Northfield,

471
01:16:01,730 --> 01:16:15,200
for whom I worked for six months with her surgeon at the London at the London, and also by Joe Pennypacker.

472
01:16:15,200 --> 01:16:23,150
And I think in neurology, I was, um.

473
01:16:23,150 --> 01:16:34,700
Well, I was equally influenced in different ways by Richie Charles and John Spaulding.

474
01:16:34,700 --> 01:16:49,430
I mean, Charles, which he was not really a very hands on neurologist in the way that John Spalding was very much a hands on neurologist.

475
01:16:49,430 --> 01:17:06,500
But Charles was a very astute clinician and he was very influential in terms of the sort of ethos,

476
01:17:06,500 --> 01:17:15,830
philosophy and all the rest of it of managing, well, neurological patients, particularly epilepsy patients.

477
01:17:15,830 --> 01:17:31,270
And Richie, as I said, already was very imaginative and very inventive and very special in a very broad sense.

478
01:17:31,270 --> 01:17:39,680
And so those who what did you get from Japan of South Korea and Japan?

479
01:17:39,680 --> 01:17:46,440
Remarkable. Absolutely marvellous. From Joe Pennypacker.

480
01:17:46,440 --> 01:18:03,410
I got the extreme care that you must take in examining patients and listening to the history and

481
01:18:03,410 --> 01:18:09,770
making a decision as to whether what you're thinking of doing is clinically right for the patient.

482
01:18:09,770 --> 01:18:22,220
I mean, Joe would appear in the neurology wards at the Churchill late in the evening to see some patients that had been you'd referred to him.

483
01:18:22,220 --> 01:18:29,570
He would come in his Macintosh would sit on the patient's bed making talk,

484
01:18:29,570 --> 01:18:46,310
and he would take the history in a very small number of words that he would get it all exactly the same as that was Moorfield, actually, possibly.

485
01:18:46,310 --> 01:18:50,130
I think he actually had more words than he.

486
01:18:50,130 --> 01:18:58,280
He was very sparse with his words and the examination was exquisite from both of them.

487
01:18:58,280 --> 01:19:06,950
And they would they wouldn't usually explain precisely what it was that they were doing,

488
01:19:06,950 --> 01:19:12,230
because they would expect that by then you would know what they were doing. But just watching them.

489
01:19:12,230 --> 01:19:17,580
But they would tell you exactly what they were.

490
01:19:17,580 --> 01:19:34,890
Looting from it, and I don't think I ever saw that actually from any perspective on Spaulding, not close to it, but I mean,

491
01:19:34,890 --> 01:19:43,410
so then and you have to bear in mind that these days is very much just, you know,

492
01:19:43,410 --> 01:19:51,490
showing me the images showing you and the Washington, you know, and you think that attitude is justified.

493
01:19:51,490 --> 01:19:55,110
Mean the image in the sense that it's so good. It tells you everything.

494
01:19:55,110 --> 01:20:10,800
A careful examination. But I mustn't make any criticism about the the current practise of neurology or neurosurgery.

495
01:20:10,800 --> 01:20:17,070
I don't know anything about it. But Chris Adams merged the two.

496
01:20:17,070 --> 01:20:30,630
He merged the sort of Joe PennyMac Douglas Law failed by Fogler approach with the imaging, and he merged them superbly.

497
01:20:30,630 --> 01:20:35,040
So it has to be both, I think.

498
01:20:35,040 --> 01:20:42,090
But they and I have actually seen it recently.

499
01:20:42,090 --> 01:21:00,990
I seen David Jones in action examining a patient, and I thought that his was a masterclass in who exactly this.

500
01:21:00,990 --> 01:21:10,560
So it still exists, whether it's hard to find now.

501
01:21:10,560 --> 01:21:17,130
Did you come to regret not staying in London or not going to Boston?

502
01:21:17,130 --> 01:21:25,110
Well, I've never regretted not staying in London, not in the slightest.

503
01:21:25,110 --> 01:21:40,110
Uh, I think that I mean, London is still the sort of centre of him very much.

504
01:21:40,110 --> 01:21:53,440
But I don't regret not being there or I Boston, of course, I've been back to Boston many times since.

505
01:21:53,440 --> 01:21:58,650
Um, but I don't regret it. No, not at all.

506
01:21:58,650 --> 01:22:02,880
And I did have another. Oh, I know the medical students.

507
01:22:02,880 --> 01:22:10,140
How much did you have to do with the medical students. Well I think.

508
01:22:10,140 --> 01:22:17,610
The same amount as everybody else in those days of the medical students were largely taught by,

509
01:22:17,610 --> 01:22:22,680
well, Brown Matthews was extremely good teacher of the medical students.

510
01:22:22,680 --> 01:22:32,900
Jonathan Davis was a very good teacher. The medical students I don't have experience of subsequent professor of neurology teaching medical students.

511
01:22:32,900 --> 01:22:44,940
I can't comment on that. But because of the weight of the system, the health service consultants have to teach them as well.

512
01:22:44,940 --> 01:22:50,730
And did you enjoy that? Oh, yeah, that's great, John.

513
01:22:50,730 --> 01:22:54,420
That's been an extremely interesting interview. Anything else you want to say?

514
01:22:54,420 --> 01:23:00,207
Nothing else. Well, many, many thanks for the pleasure that that's recorded.