John, talking about the Oxford Medical School now, as I remember, you must have done Latin and Greek in the entrance exam.
I did, yeah. Well, I did Latin and Greek till I was 18 at Rampy and into the new college or the new college entry.
As an aspiring classicist, I don't remember that I had any particular hurdle.
I sat in the hall and wrote a series of essays and met the warden or general English.
As I said, I didn't have a severe examination of Latin, Greek at all.
But the place was offered. Yes. Did you? Right. Yeah. So then you confronted them with your ways to do medicine?
I did. I, I was fortunate enough to to go to Hong Kong for my national service as a second lieutenant for months.
And as I lay in a tent in the new territories, there was really nothing to do.
You know, you you drilled the men in the morning and you'd come back for breakfast and
there really wasn't much else to do except to organise sports in the afternoon.
So you lay in your tent and wondered what you want to do in life at 18 and gradually wandered really with it.
You wouldn't want to do medicine after all. So then I. I bought textbooks.
I can remember steads electricity and magnetism and somebody else's biology revenue.
Yes. You remember, as I do in a bookshop in Hong Kong.
Good though. Right. And I started reading this and then went back to new college in the April of 1950.
I went up to see the warden in April 1950, and he allowed me to change the medicine, believe it or not.
And I remember him saying that I'd have to pass the preliminary examination of the natural sciences by March of 51, and that that was quite a thing.
And he recommended me to go and see Dr. Creedon staircase, one who would offer me advice about a cram school in Eccleston Square,
which is where I went for people who couldn't do high school, sat for six days a week right through to October, then grade with a manual tutor.
He was, what, for all three years? Absolutely. And then and the old fashioned way, he was my duty for everything.
And that's. No, that's true of I did my biochemistry at Queen's right.
And they were both very old fashioned about it and told me what to read very wisely.
I don't know what Creed really did any very useful work in context of how you employ people, but he's a very good tutor in terms of guiding you.
He's my moral tutor as well. And did you have to rely on him?
No, no. He just gave me the sort of advice that doesn't exist now and probably is beyond the pale.
And I hope this is not irrelevant.
But Crede, when I first started, said Oxford is an experience that you want for the rest of your life, and medicine is hard taskmaster.
And it takes time. But there are so many other things to do in Oxford.
But you must do it can be spoilt. It could be Artec to be debating what's been going on a bicycle ride, but don't chain yourself to work.
And I remember him saying, you know, nobody can do useful academic work for more than four or conceivably five hours a day at the outside.
So if you get up early in the morning, there's never any reason to work after lunch.
And he has a glass of Sherry Rehman and tutorials was absolutely it was.
And actually right at the beginning of the tutorials.
And he obviously was an educated chap broadly because he'd say, do you mind if we do physiology for the first three quarters of the church?
And then what? You like Olvido or Levere? I think it was for the last quarter an hour.
All right. And what about Surakarta?
Because he was pretty dry as he was very dry, as far as I can see him now in what I think my right to Donegal Tweed suit to the West Coast.
Yes, I had the pipe. Yes. Sitting in the corner. And my vivid memory of him was in my last year when I was doing doing my biochemistry Jutes.
He said, letting because you didn't use John in Nottingham.
He said, how is the hockey going?
Are you going to get your blue? And I said, Well, I don't know, but I hope so.
He said, Well, it's more important than your degree, so no need to write an essay if you don't want to write.
So I went against that of him.
Now, your first two years, then your schools. Yeah. How did you read?
They enjoy those, too. I enjoyed it, I think you should enjoy anatomy, was I alone in that?
Yes, and and I loved physiology. And in my final year, I tell you, there were bits I didn't like.
I did not like the squid taxon and I didn't like what I regard still with the overemphasis on neurophysiology.
I thought there were other aspects of physiology you want to know.
And I was very lucky with Crete because I had read a book called Homer Smith on Comparative Physiology of the Kidney.
And that entranced me.
And I said to him, you know, all this stuff on your own, I will be right that two of our papers were one year old and one anyway.
There was one pioneering and but I was allowed to sort of neglect neurophysiology
a little bit to the the advancement of spending a lot of time on kidney.
Right. Which served me and great purpose later in life, which is.
And who are the lecturers you enjoyed or who appreciated those?
Did you think of those? Uh, yes.
Impressive. Yeah. Frightening in a sort of way. Yes. Yes.
Who else was you know, you've got me on this. You got me on the spot there.
No, I don't remember anybody very vividly. Remember in physiology, Dan Cunningham, of course, um, with the respiratory physiology.
Was it Victor Cochrane who did with the kidney? I think he was Carson's.
Carson's of. Oh possibly. Oh well. Passenger worshipped or I guess anyway.
Yes, yeah. Absolutely. No, you got them. You know, you're reminding me people who did and was it little who is a professor.
He was. And who gave those awful dry lectures on a Saturday morning.
Yes. Yes. And actually and looking back and I remember wishing that Florida was a better lecturer to say, what did you make of those two terms?
Oh, I enjoyed the I enjoyed the what was it called path and back path and back.
And I got one thing which might be good for the reminiscence.
And what really turned me on in Oxford from start to finish compared with school was the emphasis on you thinking
for yourself and not believing dogma and not not taking facts as well as anything that we're at all sound.
And one of the things that really inspired me was Rob Smith in the path and back course, who had a morning on blood coagulation.
And I remember it very well because he started at the beginning and said the first part of the morning,
we're going to teach you about the dogma of blood coagulation, how you would act as a clinician and how you would answer exam questions.
And then we'll have coffee. And then for the second half, I get to tell you what's likely all of that is wrong.
And I thought this is teaching of the sublime is the great.
And one of the things I thought about Oxford was that it really did it treated it as well.
You know, this is what they say. But in your tutorial, just try and poke a hole in it.
Yes. Then the scores. What did you think of all the practicals?
Because erm there's, there's a lot of practical as well as chemistry, practical all day help.
And the cat we did cat experiments, the inside ganglion cats and things.
I enjoyed that and enjoy the squid. I can't remember why though I did.
I enjoyed it all very much actually.
I had left school I think rather rather flat and uninteresting and very lucky to have gone to Oxford at the age of 21
because I was a bit older and it just turned me on actually it of salvation from a kind of medical mental nemesis,
which I'd had as a schoolboy. Yes. Then we went up to the Middlesex to do your clinical.
Yeah, we went strictly to talk about that. I know you enjoyed it hugely, but did you ever.
And probably not. But looking back, comparing Oxford people with London people, did you feel you were better educated?
Yes, I shouldn't say so. Well, with a mother who taught in London and had a wife who was educated.
And and I go further actually, and not for publication in Cambridge.
I think it was better than Cambridge. I had a sort of a view that the old anecdote that I was brought up on that in medicine in Oxford,
they ask you what you think and in Cambridge about, you know.
And in London, what you don't know, and even further than that in in the Scottish Medical School, what does the professor say?
I think there was a bit of concern.
And I find I find that highly talented graduates from Cambridge in my year at Middlesex were much more inclined to take the dogma without criticism.
And they also knew much more. And I remember when Morgan Campbell was teaching us in the preliminary exam, had to examine the abdomen,
making very rude remarks about Oxford and saying, oh, Oxford, think you know it all and don't know anything.
Least the Cambridge chaps know something.
And I remember he said, I don't suppose you even know, since we're examining abdomen, which side of the abdomen the spleen is on.
So we would have missed that area and replied, You must.
I went out to do it.
Geoffrey O'Riordan, later, professor of technology at the Middlesex, saying, My dear Campbell, isn't that what you're here to take?
Is there a certain arrogance about arrogance of graduates which Elaine would tell you?
It's my wife as a as a as a London girl looking at Oxford and Cambridge echoes my view, actually, that the Oxford plot were much more enquiring.
All right. But she did say where they were.
You have words unspeakably arrogant.
Then you went on with the various clinical levels in London for quite a time and then got an award through America.
Yes. A lot of travelling scholarship. Yes, British. I think it was British Medical Federation or something like that.
Yeah. And you were in New York. In New York at College of P.A. Columbia.
And that's Presbyterian Hospital with a man called John Alara. And they are HGH, who is a very leading light in the in the hypertension world.
How much clinical did you do then? I know quite a lot.
I did a clinic once a week and I did what's the equivalent of one take with the American medical students?
And that was horrendous, I find, because I don't know what you had the similar experience in Boston,
but I found that the students would have clocked the case that they were lost later, going to be brought on by me.
And I spent two hours in the library reading about it before I got there.
And I found that the American medical student was much more competitive and
hardworking than the laid back British who'd like a pint of beer and a game of rugby.
And I find it very testing during that.
Yes. So you go, yeah, that's fine.
I mean, so I didn't do any more work other than teaching on people that came in, but I did do our patients once a week.
So when you came to Oxford and we'll go back into that a bit more,
how did you feel the functioning of the racket compared with Presbyterian, Columbia Presbyterian or compared with London's schools?
Well, actually, I thought the Radclyffe was an eye opener.
I mean, if you take the London schools, first of all, I think you had quite a busy day if you had a couple of emergencies a day or a bit more.
And when they were admitted, my memory was that they were admitted by the high staff and the registrar and the consultant
really didn't need to know that they'd come in and would find out later about it.
And the same was true. No.
Well, Columbia Presbyterian, the senior resident, was the dominant figure, of course.
And and they had tremendously good sessions in the morning when you had to present the case overnight that you may remember.
Well, they call that it had a name to it or something. But when I came to Oxford, the thing that shattered me about it didn't show to me.
What surprised me was the immediate involvement of the consultant as a teaching weapon right from the first moment.
So it was that something you and other people then originated or had it been happening in Oxford, have been happening in Oxford before?
I think because my memory was that when I arrived and was Elaine was selling a house in London and I was in in oh,
a room somewhere across the road near the pub.
Anyway, the phone rang and Ron Prout, who was the senior registrar of the day, rang me and said, Did I realise that?
Expected to do what he called a take rod, which I'd never heard of, and that he was particularly worried about a patient with hepatic coma.
I remember that. And I had spent the last year and a half trying to assess angiotensin rats with smoke
drums and had a certain feeling that I didn't remember much about hepatic failure.
And then after that, I was in the bath would be another half an hour so I could look things up if I could.
I found myself tested enormously when I came to Oxford.
I thought this is a place where they really want to know whether you're any good and you.
I felt exposed and actually quite anxious to begin with.
But do you think Pat Malam did take grounds and then. I wouldn't know.
I mean, I think my own guess now is that the professorial firms figuring out with probably were right and maybe some of the others were,
but I don't think it was and it cooked well. He's the one I'm not sure about.
I don't think Teddy bothered with it. But, you know, well, that's very interesting because they were more like the London patent.
But as soon as I got into the tech runs, you really were all right.
You're the consultant. You're the public, but you were much less protected out of your senior registrar than you ever were in London.
But now what about the standard sort of nursing care? What did you think of that in comparison?
Oh, well, of course, Middlesex Nursing Care was fantastic. Yes. I think I've never seen anything quite like it.
Was that different from the Westminster? No, Westminster was equally good, I would say.
And it was also very good. Pianists were actually mostly I was working on the metabolic ward.
So, you know, it was all very quiet. I think the nursing was pretty good also when we had our own wards, Rodney and Alex, in my case,
and yours too, with their particular nursing staff and I can't remember the name of Mr Harris.
Thank you. Yes. No, they were extremely good.
You know, I think the nursing then was as good as it was anywhere else.
Tell me about your appointment in Oxford, because it ended up with that amazing two days in which they made the three appointments.
And you've been called over to the Middlesex, I think. Oh, yes, I had.
It's a very long story and not pertinent to this. But I had been I didn't particularly want to go to the Middlesex,
but I was told I should go to an interview for a job in technology chronology that really Slater eventually took.
And I went on to I think it was a Friday and a Monday.
There were two interviews at the Middlesex and that gave me a week long a man, a nice man called Buckley,
who'd I mentioned before I left the Westminster saying that if he could keep his eye on what was happening,
Alan and I would I'd pay the money to come back for jobs in I think I said Oxford, Edinburgh and Bristol or something.
And I didn't want to be in London. And there I was in London.
Anyway, he basically told me by luck, you know what, there's a job advertised in Oxford.
Why don't you go up there on the Saturday, which I did, and found George Pickering in,
can you imagine on a Saturday morning and had a very good session with him.
And of course, I was very lucky because I hadn't realised I mean, I knew he was a hypertensive king and that was my principal research at the time.
I didn't realise he thought the brightest light in the hypertension world was that my then boss in in in the States.
That was a great bit of luck. And you hit it off with Baker very well.
Yes. Yes, yeah. And then when you go again, because you would have been appointed as an endocrinologist.
Now let's you and I had the same I think we ought to look it up.
But I think it said once you a general physician with an interest outside endocrinology, metabolic medicine, diabetes, nephrology.
Right. And possibly something else, I don't think it even mentioned the probability you.
I don't think it did. But then what did you feel about being shunted into nephrology?
You were delighted. Oh, well, I had been sort of mythologically orientated.
I got tremendously interested in salt and water balance in the kidney and handling of salt and water when actually when surgical thermoplasty, McCain,
who wrote a remarkable monograph on fluid balance postoperatively and the metabolic response to injury and things, and I got interested in that.
I've been interested in the kidney in front of the schools, and when nephrology began,
people began to do kidney biopsies and rather and think that was when I was with John Nabarro at the Middlesex when he said,
well, you'd better do the nephrology, John. Right. And you better learn to do renal biopsy.
And I learnt how to do renal failure. Michael Dukakis at the Merrison Hammersmith.
Yes. And then I had carried on because when I was with Dick Bellison at Westminster,
I also did sessions in nephrology with Living in Africa and Malcolm Milne.
So I was, you know, orientated towards the kidney. And so it was certainly nice when that came up.
And I remember Paul Vision saying we're going to be given the renal unit because the government are going to do this everywhere,
1966, and that's going to be dialysis and mechanics.
And I remember what you said. You don't want to be bothered with all that, do you?
Why don't you find someone who would like to do that?
And then you couldn't get on with the wider aspects of anthropology and not too bogged down with connecting people to machines.
And so that's what I did. And that's why that's all I ever took on the record.
Yeah, because he'd been in Pickering's unit. Yes.
And again, he was a stalwart, but not really a typical peccary.
I know he was a very sound chap who wasn't interested in anything at all.
Floury. He was he was immensely interested in what was practically has to be done today, which he did supremely well.
And you were out with the Churchill doing that. Yes. In Ward one. And you find that difficult moving between the two.
You know, now, you know, the traffic wasn't bad, was it?
And we had that extraordinary session on Ward one where all the consultants had beds.
You, I think to but that's the renal unit sort of started infiltrating that and ultimately took it over.
Yes. Yes. And it had it when it began to just desert me and two nurses, I think was quite extraordinary.
Yes. Because I can remember one or two dialysis.
PAPANTONIOU That is done in the RADCLYFFE. Yes. The people, they were waiting, as it were, for the real set up there.
Oh, yes. I mean, if you're really thinking back to medicine then and now,
I've got a vivid recollection of Christmas Day and a child with haemolytic uraemic syndrome under the age of one in Liow one or whatever it was.
Ward, I think that's what it was. And I can remember going in where the consultant staff was Christmas morning.
So everybody's dressed up and there was this child and we thought we'd better try and do some peritoneal dialysis.
And when Williams was then my senior registrar and we set up a Heath Robinson effect,
we found an oesophageal tube which we could put into the abdomen, and that was connected to a bit of plastic.
We could find that which round in circles we put that into a basin of hot water.
And we we had a bag from water.
It wasn't as bad as we're having and we just did it and the child survived.
I forgotten it, actually.
And it's astonishing when you think back to how primitive things were then and then you went down to your old Christmas lunch, did you?
Yes. Oh, yes, absolutely. Because I couldn't have that well, carving the turkey, but and it didn't come off along, did one,
because it then came from a central kitchen and came all you did, but you still were there.
And your children with you have now I have patience, time and have patience.
Would you be doing a week to. Yes. And how did you enjoy that very much.
It's rather sad to find that my daughter, now a physician, says, oh my God, I want to do our patients, all those complaining people.
I look forward to it. I thought it was the highlight of the week in a way,
because you never knew what was going to become what you get referrals when we were wrong
and it really was general medicine you didn't know know anything from anorexia nervosa to,
I don't know, acuteness. I remember acute tetanus actually one morning.
Right. And then you were going out doing a centre is not too many.
But initially, I think when one was first there, I think the GP's wanted to know whether you were going to actually ah,
since you mentioned Ballymun cocain, perhaps not relevant.
I remember one of the GP's saying to me, well, thank God it was the people at Abingdon where you drank beer before you went to see the patient.
And they sat down, had a beer, I said, well, thank God you seem to be somebody we can refer to because we really thought the end had come because,
you know, we wouldn't dream of sending anything to the academics because we don't think they're medically sound.
And a cook was arrogant. And the only physician whom we thought was any good was malem and now he's gone.
Well, that's a lesson that and then you do a teaching round to the students.
Yes. And they go on your clinical programmes. Yes, we did.
You're doing also sort of on one case with them on how to do.
You know, I think we just went round. I had a reputation for going on too long.
I think you did too much and you just went until it was finished and now you kept me going round and round me to obey.
Well, no, I went around by myself. Actually, that was a tiresome thing with all great respect for Brian.
He had a view that he used this word sit here all the time.
He may remember and he thought we should have a sensitive or firm, which I went round with all his patients.
He went or I was always I found that impossible and said, look, I can't I'm sorry,
but we can't have argument about what we do or competition at the end of the bed, which is very much what I'm afraid he did.
And it was it was slightly difficult eight years that I had with him.
And what happened after that? You went into the into the pub?
Yes, the May readership came up. And I don't know whether it should be something.
I was right.
I was very dubious about that because I rarely saw myself in the primaries and the nature physician and clinician and thought that if I ever
had a really weak spot because in in fundamental basic research and therefore to take a university appointment was stretching it a little.
But I was persuaded by David Wetherall. Very interesting thing.
That ought to be that I, I can't it the letter precisely.
But when he invited me to take the May readership, he wrote a letter and said, I have a vision of how to run the Nuffield Department of Medicine,
which is firstly that it should be the department which had the highest reputation for clinical skills.
Secondly, that it was had the highest reputation in the hospital for teaching and only then when I consider the needs of research.
And he went on to say, I am a humble laboratory haematologist who knows little general medicine in my room.
The rumour has it is you're a computer technician and I hope you would join me to do the other side, which actually effectively we did.
Except, of course, he was a better clinician than I was when he was at one time,
but he was a very good patient, is extremely good with a very modest man show.
But he had this vision actually, though, that that developed later that academic departments could have a twin, the head,
which the orientation was teaching clinical medicine versus research, both doing both, but one really dominating the other.
Then I say it myself. I think it worked very well. But in the first years, you can be appointments.
Yes, we're doing a bit of university research. Oh, yes. So you're sitting on.
Oh, I was working on the on the kidney and hypertension, angiotensin aldosterone know reading in particular,
who was a whole field of the origin of hypertension and the kidney and renin, which was a big field in those days.
I think it's probably all gone now. And I had, of course, luckily enough, ended up with a whole series of difficult students,
all of whom were highly, highly talented, to whom I was nominally supervised.
You know, I was supervising, which, you know, people like Martyn Gregory or Gwen Thomas or Wayne Williams or whatever.
Let's think about it before that. I mean, was this based in Pickering?
Yes. Now, Pickering gave me and you had a South African up there, very leery Apkarian area.
And then what about Mike Lee was him and Mike Lee was no was one of George espec was in the same field.
So there was a lot of hypertension interest in that time. Mike Lee also on renin.
And I think that, yes, Perry Leary was the first film student who looked at actually interestingly about the rather than the rate of formation,
the rate of destruction of angiotensin by various organs.
And he used Brian Ross exactly to produce kidney, which a lot of us used that for a long time.
So there wasn't. Yeah.
A good deal of lab work going on, very much animal work, although we did some research at Holwell on the distribution of blood pressure and,
you know, how many patients might have primary austerities or whatever it was going to almost hit, a lot of that would already be nice.
Yes, we know. We know. God, I wish it would be. No was the old with the old ganglion block rat.
All right. Well, another virus, not a virus. A ground.
You think it was out at town? Oh, wouldn't know that. How was how was where we got the patients that we were measuring reading in a normal population.
So cool and so and went out there and got sort of 300 or so they were.
And yes, they were a very, very bright lot of people.
Martyn Gregory, perhaps the brightest in the room. Yes. And it was certainly a great privilege to be given them, actually.
Funnily enough, George Pickering, when I'd been there for a long time,
said those young back young chap back from from America who I think ought to do a deal and he ought to do it.
You ought to interest him in hypertension. His name's George Oberti and George George appeared in my room and I said,
I'm beginning to think this story of attention and reading and aldosterone, they've gone off almost as far as they're going to go.
And I don't think the gold dust. And he said he'd been measuring insulin and things.
And I said, well, I think why don't you go and see Derek Hockaday, do you remember?
Well, I do remember coming to see me. I didn't know that bit there because I thought, well, I.
I wasn't too sure, actually. I hadn't started in the field I was in anyway.
And the E.M.S. revenge attention was pretty difficult at that time.
And the essay you were using in the racket, was that the same one as the last.
Yes. Oh yes. I took it really last. I took it back from there.
Yes. Great. And copied down the mayor as he shunted the Edinburgh Group off or even went for the rest of army.
And I said, yeah, well, he was the first chap to discover that.
Was it the structure of education that he got for it. And then he had Brown, Beaver and Robertson,
the great what we call lever brothers who actually quarrel with with with with quarrel but wanted freedom from Stand Pat and went to the MRC.
And I think that was fundamentally they wanted to stick with the virus and he wanted the rate of interest.
That's why I didn't want to spend time on it. That's right.
Now, John, when did you begin to have to go to London for various committees and colleges and things?
Oh, well, I suppose one became a membership examiner quite early on.
Um, did you spend much time in London or not?
No, not initially, but I would later. I mean, much later.
I was a sense at the college in the early 80s with when Bill Hofburg was running it.
And that was an interesting experience. But I know I didn't go to London terribly much.
And, you know, and I when I went to I went to erm if if they were the most am I talking.
Of course I did. I went to the Medical Research Society. Yes.
Endlessly where you were looking for young to hide you about when it was when it was in London and.
Yes. So we went for that and contributed quite a lot of stuff to clinical science which was a paper that in general,
that sort of thought was quite frightful. Did say, oh, yes, he thought it was, you know, people what he called it,
crawling over the frontiers of science because he relied on the quarterly Journal of Medicine.
Yes. He thought political science was sort of people doing stupid research on animals with no practical use.
But how much interaction did you have with Alec? Well, you know, social.
Yes, very, very strongly social. He'd actually examined me in membership.
He'd remembered that time and he'd known my family.
So, you know, we know him very well. And I looked after his wife when she was unwell.
Things for their kids. When did you start publishing things?
Papers? Oh, well, I'd published a little bit before I came. And then I suppose there was a trickle.
Funnily enough, having said, I had a lousy research note, but there are something like 140 in my career, published papers in decent journals.
I do think an awful lot of them. No, um, I would not have done on my own without very talented young people with me.
But I think it's one of the things that I look back on and said.
George Pickering, when he was looking on that task of an academic and.
I think if I were to contrast George Pickering with Hans, for instance, if you look back at what George achieved research wise,
actually there's a marvellous book on high blood pressure, which was, well,
juiced, but it was a book and it reviewed other people's work as well as his own.
If you said what were the what were the startling features of his work?
Actually, it doesn't add up to all that much compared with Nobel laureate people that we're now familiar with in Oxford.
And yet, if you if you were to look at what George did for Oxford as Regius professor versus Crib's as professor back in history,
the one was a great research man of his own. The other was a nutritionist of of the young.
And I think that's a real one can play in research even if you're not the most gifted bloke.
Yes. And John, I know. Did you come across all the time?
All the time. Every day, right? Oh, yeah. When I was when I said yes.
But something was going on in the. What did you do have every day.
Yes. No, no, I did because it was in the lab. But, you know, it was up there and the the deep field chap would be doing his stuff.
And John, all that would be wouldn't be providing the kids or telling me that he hasn't watched the bench properly at all.
You wanted to actually interesting with John,
you wanted a bit of apparatus that could do something to get into the vein of the of the rat or something,
and he would be delighted and make it for you, remember?
Yes, I do. So we had a very tiring job.
I mean, very Leary was my first film student who had these awful vision, isolated perfused rat kidney was actually quite a set up of, you know,
getting the catheter into the vein and the operator collecting all the stuff and
making it produce urine and seeing what happens when you put renin angiotensin.
That required an awful lot of technical apparatus and set up, which John also just was.
Yes. You know, terrific, because using ground rules for that had really come out of the cribs.
Yes. Yes. I do think they were using everything. Yes, absolutely.
As isolated organs. Yes. And then the clinical field.
Now, when you got to the end, erm you'd had just the two of you as consultants, correct.
I had it already know. Shadow Sheila Canada. Yes.
But the other people had gone, Sydney Truelove and John Badenoch disseminated elsewhere.
Yes. So it was David and me. When you were selling the NHS, had you been joined by more before you went up to India or was it just and.
Oh, just me and Grant.
Yes, because there was the time when it all blossomed out was when there were always grants different students in my business, you know.
I mean, the consultants on offer. Oh, no, they were just the two of us.
Yeah. Because the work came the time when we went up to three and then I had up to four and we were just two.
And do you think that made a change, that sort of closing out because you had be been and then the arm with yourself and David,
whether or the calendar and more not for a bit until David Graham Smith appeared right.
When David thought, well, we must give David's family space when I was difficult, actually, I said, well, look, you know, I enjoy my work.
I got my half. I like my team.
I don't like this idea of that and had of rotating people ONTAKE and running things so that you had four months when you weren't on the boards,
very American set up. I disliked it greatly.
I thought I was there to do clinical medicine and I didn't. I thought so.
David Gravies, clinical pharmacology that will do clinical pharmacology,
but reluctantly, I, I well actually what happened is David Wetherall such a nice man.
David started sharing with with David Graham Smith.
And I kept my health actually. But now David Smith went after our firm after a bit.
Yes. Was that of any reason? I don't think there was any bad that we got on extremely well.
They were very well.
I think it was just a feeling that David Weatherill had that we ought to have a greater distribution of the so-called academic services,
the so-called non-academic. Yes, of course.
You know, I know there was very little difference. Yes.
I remember Peter Slight when you and I and he started doing A plus B appointments, and I think he wanted money.
Remember what we weren't allowed to. Weren't allowed to keep any money for private practise.
Remember, we had that dinner with Picaridin and I think in which Peter said, well, if you think by doing private practise, we'll neglect our research.
And I just point out to you that Hockaday, Ledingham and Slight have published in the last year rather more than the full time academics.
Yes. Said we were competitive. Yes. Yes. And so later on, Amanda, did you see the ending or maybe just the war faction changing up your retirement?
No, not fundamentally. We still actually the thing that I like most of the SDM, actually, funnily enough, I had started Begi Grantly,
and I thought we ought to have a session once a week with the students in which we discussed cases in detail.
That was Thursday morning at 8:00 till 10:00. And you had your visiting?
We had John Spaulding coming from and we had a lecture in psychiatry who went on to be a professor of psychiatry at Glasgow,
who his name has just forgotten, just escaped me. So he had a psychiatrist.
We had Alan Sharp doing haematology and Joe Smith the bugs right there.
Yes, we all came on the ward run together.
But on Thursday morning, we had two cases that would be presented by the students and then discussed with all of us having a good go now.
I thought this was great. And we carried that on with David in the Indian and I gather it still exists.
Peter Radcliffe does it. And it was an admirable session.
No, we only had one on one case. I absolutely agree.
It was a very important part of the week. Oh, yeah. Did you have a pathologist, Bill?
It said Michael Dunning. Yeah. Well, yes.
Now, he was very important in the renal. Yes, he was bit you know, that's well, that's an old story.
But when I arrived in Oxford to do renal stuff, I went to Rob Smith's running back and said, who is going to do the renal histology?
Because it's a very expert area in which people don't agree and people got proper equipment.
And he said it would be the frozen section registrar of the week.
And I thought, oh, God. And then very enquiry.
And somebody told me that there was a man called Daniel who was one of the world's greatest pathologists of the lung,
and that he indicated that he was tired and wanted to do something else.
And if I took him out to lunch and gave him a decent claret, he might be right.
We could within two years. Michael have written a very good book about renal histology here is very quantitative.
And there he was. He was obsessional. And so quite I mean, if you're doing a real biopsy for Michael Cunningham,
you had to remap say you were doing it and he would appear in the theatre and he would make sure that he would be a bit came his way.
He wouldn't send anybody else. Then he'd ring you up and say, come and look at it.
Oh, boy, I would get and look at it with him. It was great fun.
Yes. But now you rather glad the nursing, etc. went on the same.
But gradually the takes became more and more. Yeah, no, no.
It became more. And by the time I retired, I really wanted to retire from general medicine.
I think one of the things that happened was we all did it and enjoyed it.
And as it got tougher, there was an increasing tendency which you and I didn't do, but others did, to say, I don't want to do this.
I'm going to be a young man or a kidney man or a heart man.
And I won't do Ontake to the detriment, I think.
But they were driven to it because Ontake, when we started, was enormous fun,
because you never knew what was going to come and find out if I had the enormous privilege
of of getting all the haematology and quite a lot of the oncology of when I started,
because they probably know this. There was a great Routt original and haematologists is whether they were allowed to look after patients.
Alan Sharp and poor, he never said, were not allowed to look after patients.
And Alan came to me one day and said, look, I'm getting all these bloods and I know how to handle them.
And because I'm not allowed to because I have to send them all to Sheila Calendar and I perfectly well can we
have an arrangement that they're admitted under you and you're looking after them and I'll tell you what to do.
So we had that for four or five years. So my general medicine was incredibly generous in the old Radcliffe because I had our own and Pauline was.
Patients as well, and the lymphomas unit. Yes.
So I suppose somebody would say now you must have been very dangerous because it was so widely spread, but I don't know about that.
If you if you had a small team of people and if there wasn't if somebody come in with septicaemia or meningitis,
Joe, the bug space would come on the wall, run with you, you know.
So in a sense, how did you keep up to date? And I was there at National Regional Society.
Yes, it was. Yes. Yes, there was the renal association, which I was officer of for a long time, used to meet every two months.
Really? Yes. And that would move around the country?
No, it was in London largely. But people came down from Newcastle and places David Carr and people like that.
So this was sort of the beginning of nephrology, really in the 60s and 70s.
A lot of young people. No, that's right. You did keep up, I suppose.
What about journals? I read. What did I read?
Well, I read The Lancet, The New England Journal, a kidney thing called Nephron, which you won't have read watch and the quarterly journal, I suppose.
But I always thought The New England Journal was really the thing you had to read and your suspicions were, oh, no, that's interesting.
There were. He wasn't attending.
Well, I think he's great virtue was to give people their ahead and encourage them and not act as the Lord high panjandrums,
but assume that his colleagues knew as much medicine as he did, would listen to the House officer's opinion,
would certainly listen to one's opinion or even ask one's opinion.
You I admired him enormously for his quiet knowledge when you asked him to see somebody that trouble
he took and the care with which he and the way he talked to people patients was it was an example,
of course, I had actually, as you know, because I also had to cover his life for the Dictionary of National Biography.
And when I look back at his origins, it is interesting the reasons that he came to Oxford, which he said which choice?
Right. He came to Oxford in order to escape the trends that were going on in America, which he thought were deleterious,
namely increasing specialisation and increasing administration and increasing emphasis on research to the detriment of clinical medicine.
So that he came for those views. And of course, he held them and and pervade them.
So I think he was quite different leading figure from Pickering and I think probably did slightly less but than George,
because I think George was just he was a man who was determined that Oxford was going to be on the map.
And, you know, anything I didn't like about, about and was the feeling that the junior very American, the junior staff could do that.
They couldn't come for advice if it was wanted, but otherwise leave it to them.
Um, and the other was that, you know, the way he ran Badenoch and Truelove and other sorts of people, was that this rotating on the walls or.
Ralph, I did better any any anybody in his department could do it.
And I think there were a few no names, no pack drill of people who took on consultant work in the admin business time,
who were inexperienced clinicians who read on the backs of their senior registrars.
Frankly, I you probably know whom I mean. I've got to guess.
Yes. Yes. And the Ontake physicians group that was useful.
I did. It was a mafia, I suppose. I mean, where was it?
Once a month we mentioned something to discuss.
Well, it did bring us all together. And in a way that I I sensed that before I came.
And you were there before that there was some kind of enmity between or not rivalry between the academic departments and the NHS ones,
which really was completely when we did really treat the whole thing as one what George Becquerels creation was.
Yes. So that you don't take positions included always poor and always Tony Mitchell or somebody erm George apartment.
And of course the agenda was an interesting one because what to do about geriatrics remember.
Yes. If you know all geriatricians really physicians, are we going to allow them to do amazing back around the text.
I know, absolutely. And what was your feeling about surgery and the Oxford hospitals.
Oh well no, I didn't think it was as good as medicine, frankly.
I think when you know that the NDIS was well, it wasn't good.
I think our funding was terrific. But Intesa morale was a funny go.
But on the whole, that wasn't good. And then I think there were other people, Tim, too.
It was marvellous. But I thought the surgical side, well, it needed the injection injection of Joe Smith and Malcolm.
They did a good job. And then Peter Morris was the changes were, well, tremendously.
Of course. I remember when that chair was up there was there I sat on the advisory committee of description for the Nuffield
professor of surgery because it was going to be transplantation and they actually offered the job first,
a chap called Meiburg from America, from us, from South Africa,
who had been a Rhodes Scholar at Oxford before and a very formidable transplant figure.
And Meiburg insisted that he had to have a primate lab to do his research and he needed monkeys and that the rest of it.
And so the university said, we're not going to do that. Right. And so in a sense, he doesn't know it.
Peter Morici was a second choice, but.
They are in the desert, Larry Moffett's. Yes, exactly.
I mean, gosh, what a what a what an injection. And here would have affected you through getting transplantation.
Oh, yes. And that's actually in the light of what you hear about medicine, about looking at central performance.
I remember Peter coming when there's Oliver with me a little bit in the background,
had established one of the best dialysis units in the country, I think, in hospital.
So home, home, dialysis, peritoneal dialysis, three days a week on the machine, whereas with an enormous number of people,
beds occupied eight hours by somebody, anaesthetised by somebody and everybody surviving.
But because we hadn't transplantation in those early years, sometimes there was a need to offload.
Desmond's view was we would offload people who really were not doing well on dialysis.
That actually meant people who were irresponsible and, you know, at things they shouldn't get in, came in potassium was off the map and things.
And the term came out amongst the patients that Dr. Ornish was going to offer as a punitive
transplant because we sent them to Cambridge and to and to Bristol and then never came back.
I don't know whether when you came from another place, it didn't sit well with other icons.
You it wasn't doing all that well.
But when Peter Morris arrived, there was a very strong view amongst the patients that were frightened of transplantation.
We think it'll kill us. We're very happy with dialysis. Thank you, Desmond Oliver.
Officers say if they had told me that my quality of life is going to be a lot better on a transplant,
but we know of X and Y and Z who went here and they're not here.
So Peter entered into this field and said, well, look, I can't afford to lose anybody.
So I'm only going to transplant people with a young fit with an absolutely perfect tissue match.
And in context of you, I don't remember whether you were involved.
A girl who late 20s, diabetes, kidney, went right off the map in the course of an ill advised pregnancy,
ended up in the post natal period requiring dialysis, not given dialysis by Peter Bye Bye Des Oliver,
on grounds that diabetics didn't survive the scandal and refuse to transplantation
by Morris for the same reason and given sedation and died because that is.
When did you change your view about diabetes, diabetics, or was that from the 2000s?
I am sorry to say I had the view that the risks and diabetes were ever overrated.
I spent I have battled against both, however, and but I got nowhere.
And until, as you say, Victor Parsons, it king started showing that he could be done.
Um, no. I always thought that was a there was a certain rigidity about both those chips,
whether it was cause of Australia, New Zealand and not Oxbridge upbringing.
But there was a there was a very black and white view about how you manage people with Alzheimer's.
And what about the hypertension? Because a lot of these people must have been hypertensive.
Oh, yes. And how easy it to look after was that? Oh, very difficult.
I mean, the renal hypertension was really a very big problem.
And that's one of the things I got really quite interested in hypertension and chronic renal failure.
Um, and sometimes you did abide by nephrectomy to cure hypertension occasionally.
And then you would then you then you could control blood pressure better when
the kidneys were out and I was wanting to know what the [INAUDIBLE] it was, whether it was rated and then never still don't know.
I don't think so. No. There was an enormous field for hypertension.
And of course, I ran when George left, there was a hypertension clinic that was run by him in New Orleans.
And then me and I then put aside it a bit and then really for the rest of my time, I had a hypertension clinic twice at once a week as well.
What was the evolution of drugs to treat hypertension in your time?
I don't know. What you see is the mileposts. Oh, well.
Started, didn't we, with with adding and things like this.
I think the advent of the. Beta blockers?
Well, beta blockers, yes, missile dopa, yes, not really very effective.
And until you can get the converting enzyme inhibitors right end, it was very difficult to control some people that you really simply couldn't do it.
And but the advent of of Captopril and those drugs have been enormous difference.
And with the receptor blockers a real advance, or is that really the same?
No, same thing. I think very little difference, funnily enough, because of the of the hypertension, like hypertension interest.
So I did serve on the Cardiovascular Advisory Committee for Squibb and Merck in America, which was quite fun, basically,
because I remember being invited to Squibb saying we have we about to develop a drug which would inhibit the angiotensin voting enzyme, we think.
Do you think there's any future in it?
And remember that the two British representatives, Bob Robertson from Glasgow and me and and actually Barry Blumberg.
Mm. Yeah. I was on that committee and we said, go ahead and do it.
And there and we were of course persona grassa with, with the pharmaceutical industry there, which you know,
nothing was too much until about five years later they invited me along to say that
they thought they had a new agent that would inhibit the synthesis of cholesterol.
What did we think about those meetings of standing up to a man?
All six of us said don't. It's an essential part of cell membranes.
We've had one that made dogs go blind. If I were you, I wouldn't do it.
But it wasn't long that I wasn't getting any more. I started to focus on the renal failure, but as these people live, it became quieter.
Oh, yes, I did. Yes, Barry Jim Barry McGrath did an entire day filled with me on lipids and, um, and hypertension in the stage.
Yeah, I was involved in that. So, no, I knew about Jim and Barry would talk to him.
And Barry probably don't remember Barry McGrath, who I had a series of Australian detailers with.
Barry was now a professor of medicine at Flinders.
Was was doing that. Yeah, we didn't.
But we didn't have statins that we had an absolute no no John.
Interaction or the new college. How much to that bulk up?
Well, I of course, nuclear should be where I've been undergraduates. And I have to say that one of the reasons I want to call whatever it is the
May got interested in my readership is carried a fellowship at new college,
and that seemed to me a great privilege. And then I did find that when I was director of clinical studies or before I was there,
when I was read studies first we were beginning to get people to come from Cambridge and George Picaridin.
And I went over once a year in December.
Usually, I think, well, that was not December at the end of that Michaelmas term to Cambridge,
to the Cambridge University Medical Society to tell them to come to Oxford.
And I then liaised with all the clinical preclinical tutors in Cambridge, including your brother in law.
And I used to be invited to dine with one college after another.
And it was very nice.
And we started persuading Cambridge people and with Arthur Cork as the warden of New College, we started trying to pinch the best ones right there.
And I think, in fact, we did become the most popular college for Cambridge graduates to come to.
Yes. Whether that's still so, I think Peggy Fritz is still doing that now.
I think they do pretty well. Sir, when you went Denver, how long would you have to talk at the medical centre?
Oh, I'd have to give a lecture. Lecture on the kidney lecture on why come to Oxford.
Gosh. And now. Yes. Followed by dinner. No. And then I would drive home.
Yeah. I mean a long, long time. Oh yes. But it wasn't.
Yes. No there was an aha. Sorry. There was an hour between Theo Chalmers who was trying to persuade them to stay in Cambridge,
has really tried to persuade them to come in also and an assorted London did occasionally.
But the London boys thought they were so impregnable they didn't bother to come to their own detriment.
What were the things you really said for Oxford?
I said it was small, that it was personal, that you would have on the grounds that you would be involved, that you would be your opinion would be one.
And to be honest, tonight, with all the things I went to and said, you know, Cambridge hasn't yet,
we've just started that school and they can't keep anybody out and they have to farm them all out all over the place.
We don't do that in Oxford, I said, because we're small enough.
And that means you're going to get tutored by people like Wetherall or Maurice or whatever it might be.
And so I thought it was very important, actually. What did your family and friends of the emergency service was in London?
Well, if you want to put up a prime example of that, it was awful.
The emergency bed service prevented well, it stopped the students being rather than that much run of the Mill Med.
I got a very good example of that straight up your street, because I don't think you were that.
But I once admitted to my cardio informed as as deputy premier at the middle at the Middlesex was admitted into evidence,
was a 23 year old with a myocardial infarction.
And I got a phone call from Bedford, which remember Ledingham, you put a myocardial infarction patient in my bed.
I don't have patients like you have till tomorrow to move in.
And I moved him to the academic unit with Hepcat Quick, who I think John Dickens was preferred to take him on.
So there was this view that, you know,
eradicate congenital heart disease or murmurs some other things that I'm not interested in and in this case, make heart disease.
I have a cardiologist. I was here, D'Ovidio hyperlipidaemia.
I had an abnormal coronary arteries, right? Yes.
Yes. No. So and of course, I knew about the obvious because Angus Robson and I, their, uh, regulated admissions show.
So if it sounded interesting, you said, yes, we've gone a bed.
And if it didn't sound interesting, I said terribly sorry was so incredible, that would be done with Dinosaurus.
And what would you like to talk about? We haven't I haven't danced. Oh, I don't know really.
I think when have we I talked to Peggy Frith about George Pickering and the A plus B,
but I think I would like to say that that my abiding memory of the development of
Oxford from 66 to was the unification of everybody and George Pickering's vision that
there was no difference between the academics and the and the and that with all the
research that we do do some teaching and that we'd be paid by different paymasters,
but mostly we'd be a team. Yes.
And I think that's exactly what happened. Yes.
And of course, he has ascended in a most extraordinary way and wouldn't have if George hadn't got asked to do that.
Would the reputation have been coming? Would we have got whether or we have got Morris, we have got whoever it was.
I forgot. Alec Turnbull, Michael Gallagher, a series of extraordinary stars.
Is this lifted the place? Yes. How important do you think it is to have a clinical Regitze and keep in the hospital?
Well, I think we have an example of of how difficult that was.
And that really was. I think that when David Weatherall became Regius,
he didn't want to really he wanted to stay in clinical medicine and he didn't want the administration
side and the interaction between the university and raising funds and all the rest of it.
He wants to be on the wards or in the lab. And it was for that reluctance, I think, he took to the Regents professorship.
And quite honestly, I don't think he enjoyed it and I'm not sure he did it terribly well.
He wasn't a politician. And you need a bit of politics for the region's job.
Equally, I think when David went to be Regius, we had John Beller's and I feel that was my view, a disaster.
It was young. Mel wasn't interested in either teaching or and nor did he know any clinical medicine and he was in the wrong job.
He's now absolutely in the right job. Yeah, he's a supreme medical politician and he's in the right job.
So I think the Regius does need to be a medical politician and I think the clinical side can be looked after by the Nuffield profession is frankly,
what I haven't asked is what about the administrators, your interactions with the administrators as well?
John Barrow with John Barrow. We go back to Robyn Engineering.
They were good, Robyn. Engineering was a bit of a lawyer, but, you know, good in a few.
And they were there. No, it was the evolution of Imit administer.
What can I do to help you to I'm a chief executive officer. How can I spike your guns?
When do you think that occurred?
Well, I think funnily enough, not till after we had gone really in any big way, because when I left and when you left,
Nigel Crisp, who's running the place later, Lord Crisp, now at the House of Lords, running the whole of the NHS.
And I remember Nigel Crisp coming to talk to me about some problem about what actually was on Take the Money.
People had said we don't want physicians or surgeons in any way.
We can do it all and we will send them what they like.
But we don't want Hockaday already coming. And I said, well, I think this is thoroughly dangerous.
But Chris did come and ask what we thought we should do.
And we did run a programme of trying it to see what was wrong with it. But no and more importantly, Chris said, look, you're a busy man.
Can I come and see you when it's convenient? And I have a daughter now who tells me the chief executive officer summons
her and tells her what she has to do is a completely different relationship.
And Chris had a relationship of serving still in 1995.
Yes. And I think that's gone now. I don't know that.
And what about the public officers of health or whatever they were called?
Well, I gather I don't know. But I tell you, the Rosemary Roug of Davis,
people in the regional health authority enormously helpful and promoting women in medicine and really trying to help.
No antagonism. Just all of us working very well together. I think it got really good.
It got because I never quite understood Alex's role.
Now, how would you define the job description? Well, I don't know either.
And there were theorists like Muir Grey who thought, you know, we'll tell you how to run the health service.
Dare I say it, without any real knowledge of what's going on.
So I think one of the things that happened is that the people more and more divorced, divorced from the frontline people instead of sitting down.
And you and I used to be invited to strategic planning committees or Coquille or how do we involve doctors in the administration.
And it also kind of emerged. And then I think it became a them and us, because for two years you would have been on that committee.
Yes. And the place. Yes. Representing the sector in medicine. Yes, I was well, I was chairman of staff council.
Yes, I was. And we had a chair. But that was when McKinsey knew how to run the hospital as a maxford.
Yes. Whose son is now Regius at Cambridge. He said he thought Maxwell.
Yes. Oh, yes. Yes, it is also went through the regional unit here isn't any of that.
Yeah, no. They shadowed Gwen Williams as a senior registrar for a year or two.
And then we had this executive committee, which they said, well, the only way to run the hospital is a small committee.
Any committee over eight or ten can't decide anything.
You've got the Medical Advisory Council of 50. That's disastrous. Everybody planning their own thing.
You want to have people like members of parliament representing other groups.
So if you're representing medicine, for instance, and you're representing endocrinology or cardiology or anything else,
and you want and we've got to decide which one you're going to balance.
And you had surgery and medicine and labs and the chairman and you had then the treasurer and John Boehner and the president and Tara and the matron.
And, you know, of course, there's the days when Tyler would find that there was a world class that was difficult.
He would say, get me the minister when teaching hospitals had privileged dollar here.
We've got a problem. You know, straight to the minister is amazing.
Yes. Oh, that thing was they had you for two years when you were just beginning to know the ropes.
Well, that's true.
One of the things that was interesting that McKinsey had was that nobody should serve on the executive committee over the age of 45 right now,
that you must make decisions which you live with is the view they had.
And if you made decisions when you were under and you don't have to live with them when you have no stuck so high.
And so that's why you have chairman and staff counsel the first to, if you dislike me, hardly out of the egg.
I mean, I know that you were short trousers and tried to handle people like Stalwartly or George Pickering,
for instance, as supposedly Jablin Stopcock.
When you were in their 40s and a miserable NHS physician.
Yeah, okay, John. Well, that's a wonderful. Well, thank you very much.
I bet you think. You hope. I hope. Yes. Yeah.
OK, all the best. And thank you for, you know, organising it because you.