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You were just mentioning about the guy's son. Yes, that was the reason he went back.

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He went back to be dean of the Sydney Medical School, stop neurosurgery and.

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And he had a technique of tripping aneurysms which required me to do a sternotomy and clamp the carotid arteries going up to the brain,

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having cooled the patient. It would take this all day, whereas I had been used to using hypertension and doing an aneurysm in about two hours.

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But and Dick would operate furiously and then had to go away.

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And I don't think he actually understood in those days.

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And neurosurgeons had to know how to treat neurologists.

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Yes, they did. Having spent a year at Queen's Square with some of the time with MacArdle, who's a wonderful neurologist and various others,

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I mean, if you were asked to see a patient, you were expected to give him the opinion.

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Mm hmm. And then the neurologist would decide whether or not he wanted you to operate or not.

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And I've been well trained well both up to do that, whereas Dick would go along and before Brian Matthews knew where he was,

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the patient was in the operating theatre, which did not go down.

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Just to backtrack, who said her Cambridge Anatomy, was that Jeffrey Harris, was he then had he come to Oxford?

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No, Jeff. Jeffrey Harris. He wasn't there when I was there as Chacko Boyd, who's professor of anatomy related to Richard.

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And I might have been I think he was interesting. I never realised that Connexion is thinking about it.

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They look similar. Right. But at one time, Pam Harris was Jeffrey Harris's daughter, who was my secretary.

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Right. And so, yeah, I, I was a bit busy the first few years.

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So who else was a consultant then? You must do a fantastic guy myself.

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Yeah, but when he went to appointed, Mike Briggs was appointed and his interest was head injuries and stereotactic surgery.

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Um, and to be honest I don't I was probably quite a difficult colleague.

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Forceful. Well you need to be a surgeon. And I used to insist on basically running the department and I would do wardrobe.

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And I see the patients at least every day.

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And but it meant we were very efficient because if the patient needed to go, they went back to the same hospital, so few beds.

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We managed to run quite a tight ship. How many did you have?

25
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Roughly 50 in Central Park? No, I think we had enough in one ward.

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Yes. And then there was one which was 21 beds, I think planned.

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And then the head injury lot were downstairs and Cronshaw.

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But the whole the AXTON service was really good.

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Yes. And we supplied neurosurgery to it and we would see the patients and it it was a [INAUDIBLE] of a world winner in a way.

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Yes. And very sadly, when the new hospital was built, that was destroyed.

31
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That was one of the great arguments, wasn't it?

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Well, I was very much involved with the with that argument because, I mean, initially we were destined to go up there.

33
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And then Peter Morris came and said he wanted to go up there.

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So we were left back at directive, which basically destroyed the accidents.

35
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Yes. And I remember writing several documents and giving them to to double richardo,

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saying the only logical way was that all the acute work within one hospital, you can have one eye to you and that should be the new hospital.

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And then people would have to get used to doing the rescue work on a different side.

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Not ideal, but it seemed to be logical.

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The argument against that was that the university had supplied Cordura because they knew John Radcliffe Hospital.

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Therefore they wanted a course hospital because they didn't want beds, but they would have the office space.

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So they had a stranglehold of who went in and who didn't.

42
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And basically, it wasn't good for Oxford Medicine.

43
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That was a that was a huge argument and a lot of weeping about it.

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It was, as I remember, David Hodgson coming into my office and he was white with anger because I what I thought,

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which didn't agree with what he thought, but in a way, he was really suggesting that he said.

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But his role was to to sort out who went up to the what the new hospitals didn't because we stayed and essentially had some patients up there.

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And I was actually quite glad we had been, you know, reasonably cold.

48
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Yes. And it was great, actually, in a way. It's a great hospital.

49
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Yes. I really enjoyed the, um. It was a pretty though the ambulance service got this destroyed.

50
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Yes. No, indeed. Then this summer, Akhmad haemorrhage. Am I right?

51
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You did some work with Germana on clotting of fire at.

52
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That's right. It wasn't you Joan on.

53
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It was with another chap in the pharmacology department.

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What what's very interesting about subarachnoid haemorrhage is the.

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One of the really bad effects of a subarachnoid haemorrhage is after about three or four days,

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the vessels in the head go into spasm and this is a very specific thing for intracranial vessels.

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And the patients would just infarct off.

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And I had one patient who I remember very well who had a subarachnoid haemorrhage.

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She had an A. communicating artery aneurysm, a terrible spasm on the angiogram.

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And I waited six weeks for that chap's spasm to clear.

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And then I operated and found that that aneurysm had not ruptured and the culprit was one

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in the posterior vertical or partially because it didn't do routine vertebral angiography.

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We couldn't do it easily. So he had terrible spasm.

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I really operated he developed even worse spasm and died.

65
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Yeah, because, Jonathan, I was fascinated because one of Pickering's dicta was that you didn't get vascular spasm.

66
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You knew that. But Pickering was always saying this. If I don't get it outside the blood, the head.

67
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Yes, but it was incredible. You do an angiogram, there'd be no spasm.

68
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And then just where the carotid goes through the dura.

69
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Yeah. And we did a lot of work on that. We got it.

70
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We used to do emergency RPM's and get the Basler artery and it would bust the arteries, continue to contract for several days after death.

71
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So you can use it as a preparation. And we tried all kinds of things to counteract spasm.

72
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We put on CSF from patients and watch a spasm and try and come through it.

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And in fact, in those days I used to during surgery,

74
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I used to canula the superficial temporal artery to feed a catheter down into the carotid so we could do serial angiograms in just in the ICU,

75
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just one picture just to try and follow how this happened.

76
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And then we could inject substances to try and stop it. We injected everyth everything we could conceive, prepare for it.

77
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Didn't work. Nothing? No, nothing. Nothing worked.

78
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I mean, there are some very powerful ways of doing it.

79
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So I didn't touch who was the pharmacologist. Well, it.

80
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David. Oh, yes, I know. With it's been there with Graeme Smith is.

81
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Yeah. We did this work with David Boon who sat in a way lost interest.

82
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And we still don't know the cause.

83
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But there is something that takes about three days to develop in this blood CSF and some breakdown haemoglobin molecules.

84
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But it doesn't happen to three days and then can what's the DNA at Queen's Kwabena Rosatom?

85
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So so I know it was on the cervical spine.

86
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Right. Which I still think people haven't got.

87
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Right. Because the cervical spine is an amazingly mobile structure.

88
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If you X-ray infection and extension, the range of movement is a hundred and fifty degrees or something like that.

89
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And what I did was to put X-ray markers on the dura in the civil code and the nerve roots and took X-rays in the basement of the hospital.

90
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Right. With that radiology radiographer, if you mention her name, I'll remember I went well, she was wonderful.

91
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I mean, most people thought this was pretty bizarre. But how did you get inside the middle through Vallentine?

92
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Of course, as I write it down. Yes. And I still think the biomechanics of cervical spine and what happens to the cord and the roots

93
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when you move from flexion extension terribly important in the genesis of cervical Allopathy.

94
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Yeah, because no movement, no more Allopathy right.

95
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But nobody was doing flexion extension views before they, while they were trying to assess patients.

96
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Extraordinary. And the other thing which was very relevant was that people were doing laminectomy and there

97
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was a group of patients who after about 18 months would deteriorate and get further allopathy.

98
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And this is always said we've got the diagnosis wrong. It's Hamas or some other reason.

99
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But actually I am convinced what they did was they did the laminectomy.

100
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They open the dura, expose the spinal cord.

101
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And in those days it was considered a very good idea to cut the dentate ligaments on either side of the spinal cord to sort of free it off.

102
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But actually, after about a year, you get a scar from cervical muscles, which would be attached to the spinal cord.

103
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Right. OK, with that, with the dura left open sometimes, who would have been left?

104
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So when they started regaining movement,

105
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they were just tugging on this spinal cord because the jury was fixed for them and fixed where the surgery had taken place.

106
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So there was a attraction on the spinal cord with flexion.

107
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And I'm still think this explains.

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Deterioration, and if that patient has a very mobile neck, then you shouldn't be doing a laminate and if you do a laminectomy,

109
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certainly you should not be opening the door and cutting the dentist. So that was really the basis of my thesis.

110
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And it's actually been a lifelong interest to me because nobody has accepted or thought about the importance of the biomechanics.

111
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They began to do X-rays, infection and engineered at the.

112
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Well, I did. Yeah, I know every patient.

113
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It just in the logical. Yeah.

114
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I mean if you're going to do an A. fusion which is open, which is often the better option, why not know what the movement has not.

115
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And of course sometimes there's an natural slippage of one bone on the other, which is of course a one by Allopathy.

116
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And you have to uh do flexion extension used often to see and I when I resigned

117
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from the British Cervical Spine Society because I got so fed up with it.

118
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Well, just about everyone else, but certainly the orthopod to belong to it, they just looked at an X-ray and that was it then.

119
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No spinal troubles, lumbago that caused a lot of debate.

120
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Always rage on. Lots of it. Yes, I did a lot of lumbar spine surgeries and I kept saying that you do back operations,

121
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but like pain, not back pain from a can of cure, wear and tear in the back by operating on it.

122
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Just very occasionally, there's some people with a slip of a four or five or three or four where you can

123
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cure that pain by perfusing but basically do back operations for like pain.

124
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And then away from the spondylolisthesis. Was was nature's way of doing a fusion?

125
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Mm hmm. Mm hmm. Which meant you didn't have to put in lots of metal, which, of course, is the current trend.

126
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People can't operate now on the neck or the back would not putting in schools and roads and engineers.

127
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So it makes it a much bigger operation. I mean, sometimes it was vindication for that, but it's not.

128
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Right. And then, Peter, today you got appointed Peter got appointed again, um, very difficult to get additional consultants appointed.

129
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I think I had to threaten to resign before getting anyone.

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But Peter got appointed and his interest is very much in the spine.

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And he had two sessions at Stoke Mandeville and started producing stimulators in the spinal cord and this sort of thing.

132
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Um. And I desperately wanted to get some sort of academic aspect to neurosurgery because I felt that it was a subject worthy of academic input.

133
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Yeah, well, you were an investigator, obviously, in what you've been saying.

134
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Yes. But when you were in that job, you couldn't have had that amount of time.

135
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No. As a matter of encouraging others to do that sort of work and career, Hudson, as best he investigated a bit who had to had.

136
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OK, the Hudson. Yes.

137
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I mean, we did I saw the fraught relationships with the university, but I think it might be fair to say that, Professor, what is the real lesson?

138
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So the neurosurgery was not an academic subject. And it is funny you didn't think the tribalism was.

139
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And I apparently mortally upset him by saying I just did not have time to write a chapter for his book.

140
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And I think he felt that it was a massive honour.

141
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What I've just done, one for Peter Morris's yes book, that I was busy and I said I felt I could do a good job doing it.

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And John Ledingham, who I thought was just wonderful, I just loved let him he said, oh, don't worry.

143
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He doesn't understand that surgeons have to spend most of their time operating.

144
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But Peter Morris there, to be honest, I felt Oxford was good for Peter,

145
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but I'm not sure Peter is good for Oxford surgery because it was very much confined to his

146
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particular renal transplantation and there wasn't any encouragement to develop academic,

147
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uh, people in other parts of the world.

148
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That's right. And I felt that was a real shame.

149
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But eventually I did manage to get Richard Kerr appointed as a reader of neurosurgery,

150
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and he was going to do some work on the effects of transplants in the ventricles

151
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in relation particularly to treating Parkinson's disease with implants.

152
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And unfortunately, Richard spent all his time doing clinical work and that upset Peter, understandably.

153
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But that really put the kibosh on further development of academic neurosurgery till deposes arrived.

154
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It was and is an absolute jewel in the neurosurgical arena, I think.

155
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Incredible man, and then you must have been very gratified at the paternity results with Chris Burke.

156
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Yeah, I was very lucky. The two big areas of my work was the pituitary side and the epilepsy side.

157
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And I had John Kerry, who assessed the epilepsy patients and Chris Burke who assessed the pituitary.

158
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And actually, there's absolutely no doubt in my mind that surgeons should not assess their own results.

159
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Right. Um, I think lots of studies have shown that.

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So I had John Oxburgh, who was very good at assessing patients who are candidates for epilepsy surgery, and Chris Burke,

161
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who was obviously very good at it, was quite difficult as a surgeon to to get used to being criticised by positionally colleagues.

162
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But it was the right thing. And he Chris Burke, was very rigorous in his assessment.

163
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And it was right. It was good. And then John Ross took it on.

164
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But the history of epilepsy surgery is quite interesting because I had seen quite a lot of epilepsy surgery.

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The Murray, Faulkner and the guys with the unit and Kit Anstead was here when I came in the back.

166
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Yes, he lived involved in it and he ran the Park Hospital.

167
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And Kit always had a cigarette in his mouth, of course, but it was a wonderful man.

168
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Yeah. He was really treated the children as a whole person and was very shrewd.

169
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And I remember one patient that must have been very soon after I arrived here,

170
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Murray Faulkner had been asked to see this boy who lived in Manchester and was destroying the family develop fits around 10 or 12,

171
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beating up persisted, knocking doors down Morris and turned him down for surgery because he had by temporal independent sports and said,

172
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You can't operate a kit USPI. He can't see Kit Anstead and Kit asked me to see it and I had to look at him and saw

173
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the X-ray and I could see a very tiny speck of calcium in the right temporal lobe,

174
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which I don't think Murray could have seen. But I said to Kate, well, there's the pathology.

175
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And I was convinced that epilepsy surgery should be like any other form of surgery.

176
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You find the pathology and remove it at Montreal, which was a form to epilepsy surgery.

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They indulge in what I called Spike Chase.

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They would do these massive operations on the local with young kids and do egs on the brain electrical topography,

179
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find the spots and suck away the brain to the spikes could cause a lot of pathology went on suckler.

180
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So anyway, I said to Kate, I thought we ought to do a temporal lobectomy on this boy.

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And he agreed. So I did a right temporal lobectomy. I found a little calcified sort of astrocytoma.

182
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Haematoma took it out and that boy never had another fit.

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And the interesting thing to me was that the spikes on the other side, the left temporal lobe, completely disappeared.

184
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Yeah. So I was absolutely convinced that you had to find pathology and remove it, rather, don't worry about the spikes.

185
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But in those days, kids were going to Great Ormond Street and they would refuse to recommend people for surgery.

186
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And I would often get them via Kit instead and we would operate on them.

187
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But that that was the official line.

188
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Epilepsy surgery was a no go area and the two paediatric neurologists great on the street would not recommend patients for it.

189
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But I know it's all changed now. Yes,

190
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but I made myself very unpopular going to some meeting in Palm Springs saying that it was a matter of finding pathology and forget about the spikes.

191
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And of course, all the electroencephalography is, but.

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I think in a subsequent events have shown that that's right. So how much did you use our pool?

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And they looked very expensive. I mean, about other colleagues say compared to London, what did you think of the nursing directive?

194
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Fantastic. Good. Really good. And the nice thing was we were a family.

195
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We were a team for neurosurgery on Nafie one.

196
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We all work together. We never, hardly ever cancel the patient now.

197
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And if we ever had to, the ward sister and I, we would really sort of meet together and really think about it.

198
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And it was so rare. And there was a there was a fantastic sort of family feel.

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Right. And then the pathologists well, there was, of course, Trevor Hughes and David Oppenheimer, and they were very nice.

200
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We had pathology sessions with them. David was David Oppenheimer was a delight, but he was much more academic, I think.

201
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And my my memory of David would be if we sent off a biopsy during surgery,

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he would poke his head around the operating room door and he would always say, could it be a meningioma?

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And so anxious, not as a massive meningioma, which, of course, it benign, incurable.

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And glioma is not basically but sometimes curable.

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It's just not to draw.

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I mean, sometimes most of course, on but on.

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The very last patients I operated on was a young girl of 23 who had a Glomar which I took out and the centre of the radiotherapy.

208
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And I said, ignore the radiotherapy.

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So say you have six months to live, which in fact it did say and I said, I'm pretty confident I've taken this out.

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And actually, she she was a lawyer and she went back to work.

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She subsequently got married to a Frenchman and had three children. And I still have a problem from time to time.

212
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And if that isn't to say that it's against the orthodoxy. Yes, no.

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Well, I used to say statistics are meaningless to the individual. And, you know, so I mean, you said how you enjoyed Skylake and felt so good.

214
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Did you feel like that after a big operation? I felt drained.

215
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Yeah. I mean, acoustic neuromas. I always felt used to age me.

216
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They're very difficult. Well, the patient is always worse because they may not have completely lost their hearing.

217
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They usually didn't have a facial weakness. And you were incredibly pleased that you could take up what in those days were fairly

218
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big acoustics and still preserve the facial and which was stretched as a tumour.

219
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Yeah, and they were long, stressful operations in general.

220
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I loved operating. I found it relaxing and.

221
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You I, I suppose I found the operating room not difficult.

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Mm hmm. And it was I was away from the telephone, away from my patients, and I was just there.

223
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And I think it's a bit like being an athlete.

224
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You get in the zone. Yeah. Yeah. And you're just totally concentrating on a microscope.

225
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One my new area and nothing else impinges on you.

226
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So, I mean, in your leisure time, what percentage of operations would have the dissecting microscope, the operating microscope, the majority?

227
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You are sort of 90 percent in the head.

228
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Yes, not in the not so well, occasionally in the spine.

229
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If you were doing removing a tumour from the spinal cord.

230
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And that was pretty rare. Um, I suppose my other area of interest, which is quite amusing story, really.

231
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I got very interested in Trudgen around you.

232
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And the theory developed that this was all due to compression of the fifth, the act where it enters the brainstem by an artery or a vein.

233
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Uh, and the more I thought about that theory, the more it did not up.

234
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Because one of the things about general neurology is that it's it's episodic.

235
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People can go for months without it. Yeah. Uh, I wrote an article which I sent to the American Journal of Neurosurgery, which they they rejected.

236
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And the reason was that it wasn't.

237
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Everybody in America believed the cross compression of the test.

238
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And I produced a lot of reasons why this couldn't be. And they're very unhappy about accepting it.

239
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And I learnt a lot from this. The so-called science is full of emotion and very, very little to do with facts.

240
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And eventually they published it and there was a huge outcry saying how unfair I'd be to genetics.

241
00:32:03,480 --> 00:32:12,850
This American neurosurgeon whose theory criticised I pointed out some interesting facts are black Africans never get traditional neurology,

242
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but they get hypertension early and that the vessels become torturous.

243
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And you'd expect more often in people with dementia because of the atrophy in the brain and so on and so forth.

244
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But about three months ago, I got an email from an American neurosurgeon who's always taken an interest in Trojan on the Rajha.

245
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He said, I've been thinking about writing the project for the last 40 years and I think your paper is right.

246
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What did that mean for therapy? Because they used to inject the game then?

247
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Well, I said it doesn't. If you want to stop changing the neuralgia, you just have to damage the nerve prepared.

248
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And Walter, daddy used to rub it, you know, expose the nerve and with a blunt hook, just rub it.

249
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And his results were just as good as the microvascular decompression.

250
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Um, you can use the gamma knife.

251
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Uh, yes. Which is quite good. But the insulting it and the less you insult it, the more preservation of sensation you get.

252
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But the higher recurrence rate. So it's a it's a sort of swings and roundabouts.

253
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Does anybody know the pathogenesis? No, we don't.

254
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And I'm sure that I'm sure there must be a genetic factor and I'm sure they'll find there's a biochemical effect.

255
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I mean, if it does occur, people with their.

256
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Of course, that's not uncommon.

257
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Uh. And it may well be that some sort of mechanical disturbance of the nerve root is a factor, but it isn't in the majority.

258
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I think the important thing is to to keep an open mind.

259
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I was asked to go to the World Congress of Neurosurgery and to give a paper on trigeminal neuralgia.

260
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And Ginetta, who was this American neurosurgeon, was asked to get the paper, said we were encouraging the debate.

261
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So he gave his paper and then I got up to give mine.

262
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And Janetta and a Japanese neurosurgeon called Fukushima stood at the back and barracked.

263
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Well, I gave my paper, which is also slightly unusual.

264
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And at the end, Fukushima came up and he bowed very low and he said, Mr. Adams, I'm very sorry.

265
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That was a very Japanese thing to do. And we became very good friends after that.

266
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If you see, uh, Tegretol is a great treatment.

267
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But, you know, how does that suddenly work if it's a mechanical.

268
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Yes. Compression. Yeah. So how many articles did you write for medical scientific journals?

269
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Oh, quite a lot. Yeah. My Fusion 80.

270
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I like to think that the sort of contributions I made with the cervical spine,

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which I have to say I don't think my contributions have yet been appreciated.

272
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But that's right. I tried to arrange.

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I wrote a lot about and obviously epilepsy surgery.

274
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I mean, I know one interesting story I went to.

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I was asked to give a lecture in the Aether Dome at Mass General out on sabbatical, my Allopathy.

276
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So I went along and I showed my research on movement and how that affects the dura and so on and so forth,

277
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and explained that I like to analyse the mechanics of the spine and then decide what

278
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sort of surgery should be done on the decompression or effusion from in front of.

279
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So I gave my talk and the neurosurgeons there were pretty scathing, you can say, and they said, oh, we get very good results.

280
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Just doing a decompressive laminectomy. Uh, I, we don't need infusions from from we don't need to analyse all this nonsense.

281
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So I said, okay, well, we are. At the end of a lecture, Professor Raymond Adams came around to professor of neurology at Mass General and he said,

282
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Mr. Adams, that was a very interesting talk. Thank you.

283
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He said, you know, the results for surgery for survival lot correspondent allopathy here.

284
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So by stop referring patients to that, surgeons are obviously, you know,

285
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the surgeons were operating on a small group of people with very narrow and immobile cervical spine.

286
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So there is a group where they're just they're born narrow and they get narrower and they can't move as far as well.

287
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Those are absolutely ideal patients for doing a decompressive laminectomy because you open

288
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up a canal and they're not moving much so that they can't cause the injury to the skull.

289
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But all the others they weren't getting. So it's just an interesting illustration of how selection influences search results.

290
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You've got to be so careful about making sort of sweeping statements and then of, they say, subarachnoid haemorrhage.

291
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But other things do depend on the emergency medical people to an extent.

292
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Well, not satisfactory. Did you find that in there? That I think people can pretty well trained in any sudden, unusual headache coming on.

293
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Whatever, you know, which lasts for more than 24 hours, is a subarachnoid haemorrhage to prove otherwise.

294
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One of the problems is getting people to do lumbar punches. Right.

295
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Because in the old days, everyone did lumbar punches.

296
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But you then the CT scan came along and people thought, well, we can get out of doing a lumbar puncture,

297
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we'll do a scan, which because it couldn't, I had to wait till the next morning.

298
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And this sort of thing used to drive me nuts because as I kept.

299
00:38:55,310 --> 00:38:59,220
I kept quoting on Smith, I do remember. Oh, I do indeed.

300
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But she said, you need 24 hours of life left to cure meningitis.

301
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Right? And which is true. Yes.

302
00:39:08,360 --> 00:39:16,310
And if you've got a fulminating pneumococcal meningitis, which can come on very quickly when they're dead in 24 hours.

303
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So you got to do that lumbar puncture there.

304
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And then and I stood over them as they chose saying I will take full responsibility for this lumbar puncture, but you've got to do that.

305
00:39:31,480 --> 00:39:44,080
And as Trevor Hughes rightly used to say, more people die of late diagnosed meningitis than than people die from coding.

306
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Yes, absolutely. But people became frightened that no punches when the fear of coding.

307
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Yeah. Then after Philip Sheldon, would it have been pandemonium?

308
00:39:57,760 --> 00:40:08,390
Yeah. And it was great. Yes. I think I was on the apartment committee for had and there were several candidates.

309
00:40:08,390 --> 00:40:14,230
But actually what happened was that they appointed somebody who wasn't.

310
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And they and I remember saying, I think we should have a spare in case this chap doesn't take the job.

311
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And they agreed on and all of you being the up or he was right back to Jack.

312
00:40:31,730 --> 00:40:42,800
Yes, he was the back. And the chap that offered the job to, in fact, decided not to take it and went to Manchester.

313
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And I felt that getting and the point was the best thing I ever did for that cliff and third grade, he was he was fantastic.

314
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And he got around to these words. Yes. Just incredible.

315
00:40:56,390 --> 00:41:05,660
I mean, the Russians started this by by learning how to detach balloons and putting them in, and there isn't.

316
00:41:05,660 --> 00:41:14,090
But it was really the French who perfected the technique of putting these wires,

317
00:41:14,090 --> 00:41:22,940
these very fine Cass's just the watch flow directed into the aneurysm and then injecting superglue.

318
00:41:22,940 --> 00:41:28,250
Later it became weaving a basket and are so skilful.

319
00:41:28,250 --> 00:41:35,330
Of course, I thought this if I had an aneurysm,

320
00:41:35,330 --> 00:41:45,050
I'd want I'd want you to do his basketry inside it fairly because of course, you didn't have the problems of spasm.

321
00:41:45,050 --> 00:41:50,900
No. Mm hmm. And I was very key.

322
00:41:50,900 --> 00:41:56,980
In fact, I encouraged Andy to do this big trial.

323
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And because I was about to retire, I got Richard Kerr involved with that.

324
00:42:01,490 --> 00:42:10,880
But that was a real contribution to the management of subarachnoid haemorrhage, doing a controlled trial between surgery and.

325
00:42:10,880 --> 00:42:15,240
Well, that essential. Really? Yeah, great. The Americans did not like it.

326
00:42:15,240 --> 00:42:20,810
No, they don't. Well, the trouble is that you have one operation.

327
00:42:20,810 --> 00:42:29,810
Surgeons said they'd spent their lives learning how to clip aneurysms and any other technique was a real threat.

328
00:42:29,810 --> 00:42:36,200
And they're driven to an extent by private medicine. Oh, I mean, how much private medicine surgery will you do?

329
00:42:36,200 --> 00:42:51,110
Well, I did quite a lot. We got a lot of overseas patients and we were making about a million pounds a year for the hospital.

330
00:42:51,110 --> 00:42:58,290
And I wrote a very I got very cross. But if you remember, the days of were three percent efficiency.

331
00:42:58,290 --> 00:43:09,800
Know that? Well, in the early 80s, 90s, we had to do three percent.

332
00:43:09,800 --> 00:43:14,570
We had to do our work with three percent less money. Right.

333
00:43:14,570 --> 00:43:19,520
And of course, the people that were affected were the most efficient.

334
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If you had fat to spend, three percent was nothing.

335
00:43:24,910 --> 00:43:31,340
Not ran a tight ship, which I like to think we did. Three percent was very difficult.

336
00:43:31,340 --> 00:43:40,490
And the only way you could accommodate this was to reduce your length of stay each year and our length of stay,

337
00:43:40,490 --> 00:43:46,130
which is already much less than the national average, got faster and faster and faster.

338
00:43:46,130 --> 00:43:55,630
We got to the stage of taking out a clot of a patient in North Hampton and putting him back in the waiting ambulance.

339
00:43:55,630 --> 00:44:02,230
But to take him back to Northampton, I a general subject of interest.

340
00:44:02,230 --> 00:44:17,030
OK, I said this was not safe and I wrote to David Wilson and said, we are now hyper efficient, which is not safe.

341
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What are you going to do about it? So I got no reply, just standard administrator.

342
00:44:27,700 --> 00:44:34,130
We try and avoid trouble and bury our head in the sand.

343
00:44:34,130 --> 00:44:45,210
And so I wrote a paper called The Ox Down's Syndrome, the inevitable disease of the National Health Service Reform.

344
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And I sent this to the BMJ and basically I drew pictures of how this sort of wheel of went faster and faster,

345
00:44:55,430 --> 00:45:01,890
meaning the length of stay got shorter and shorter if you added it in three per cent efficiency each year.

346
00:45:01,890 --> 00:45:11,930
And I pointed out that there was no way of making this will go slower in the NHS.

347
00:45:11,930 --> 00:45:17,180
The BMJ liked the article very much. They said it's just the right mixture of passion.

348
00:45:17,180 --> 00:45:23,960
And in fact. And before they published it, they sent it to the Department of Health.

349
00:45:23,960 --> 00:45:27,440
So was like, you know, Wolf, going into a chicken run.

350
00:45:27,440 --> 00:45:31,230
Yeah. Lots of flapping of wings and squawking.

351
00:45:31,230 --> 00:45:39,870
And first of all, that the chairman of the region came down and said, Mr. Adams, this is not you know, you must do this.

352
00:45:39,870 --> 00:45:45,530
You mustn't publish it. And it wouldn't be good for your career. Oh, God, that is so terrible.

353
00:45:45,530 --> 00:45:48,190
Well, this is the truth. I'm sure it's true.

354
00:45:48,190 --> 00:45:59,300
I'm sure if I chose to take no notice, I was fortunately fairly well-known in my career in that sort of thing that bothered me.

355
00:45:59,300 --> 00:46:06,050
And then the regional medical officer came and sat in my kitchen, Barbara Stocking.

356
00:46:06,050 --> 00:46:14,280
Right. And she said, oh, Mr. Adams, this unscrupulous, it's not right.

357
00:46:14,280 --> 00:46:21,110
Surely we cost every patient in the NHS individually.

358
00:46:21,110 --> 00:46:29,880
And I sort of looked at her gobsmacked and said there's not one patient in the NHS that's individually costed,

359
00:46:29,880 --> 00:46:36,050
but you don't even know the cost of a private patient, how much to charge them.

360
00:46:36,050 --> 00:46:39,350
It's all X amount of money divided by Y patients.

361
00:46:39,350 --> 00:46:50,300
So there was the regional medical officer full of the buzz words, management buzzwords had absolutely no idea how costing happened.

362
00:46:50,300 --> 00:47:00,650
Mm hmm. Mm hmm. I was pretty shattered. But she then went on to be head of Oxfam and is now head of Cambridge.

363
00:47:00,650 --> 00:47:09,650
That's right. But I just felt these NHS administrators just didn't understand what it was all about.

364
00:47:09,650 --> 00:47:23,380
No, they don't. I, I used to go around making myself no doubt extremely unpopular by saying no one says.

365
00:47:23,380 --> 00:47:28,660
When I'm young, I wanted to be an NHS administrator.

366
00:47:28,660 --> 00:47:38,530
They've all tried something else and failed and therefore and a girl dead and she left after six months.

367
00:47:38,530 --> 00:47:47,200
Yeah. So they're all failures. I mean, this may have changed now, but I gather that getting more medicks into administration,

368
00:47:47,200 --> 00:47:52,000
which is one thing since school, but the other my other aphorism,

369
00:47:52,000 --> 00:47:58,300
which I'm afraid probably didn't make me many friends, was I used to ask academics, well,

370
00:47:58,300 --> 00:48:04,510
what have you done with your research, which is change clinical practise and nature?

371
00:48:04,510 --> 00:48:09,850
And they didn't like that at all. But actually, I don't think it's an unfair question.

372
00:48:09,850 --> 00:48:20,260
No, I quite agree, because actually, if you're doing research, you know, we all know a lot of on the surgical side,

373
00:48:20,260 --> 00:48:26,890
they all had suntans and they carried their golf clubs and they were away for six months in the year.

374
00:48:26,890 --> 00:48:36,670
But actually, if you're being paid to do research, I think you're entitled to ask, well, how you not how many papers have you written?

375
00:48:36,670 --> 00:48:43,150
But actually, what have you done to change how we do things? And they're absolutely Jane Pennebaker.

376
00:48:43,150 --> 00:48:47,860
Whenever he saw me in the corridor, I would say, well, what have you discovered this week?

377
00:48:47,860 --> 00:48:53,710
And I found that there was a GP out of Bedford who apparently when Joe was young,

378
00:48:53,710 --> 00:49:01,520
would be coming in to see his patients because they did in those days. And he would say to Joe, what do you mean?

379
00:49:01,520 --> 00:49:07,060
That's where they come from? Yeah. And then were there any other consultants?

380
00:49:07,060 --> 00:49:16,270
I mean, the Mike Briggs, Peter Teddy then then those two say, is who?

381
00:49:16,270 --> 00:49:21,010
I think it's fantastic. The Cole.

382
00:49:21,010 --> 00:49:26,950
So many now. Yes. You know, they do proliferate and I don't know most of them.

383
00:49:26,950 --> 00:49:32,240
Tell me about the anaesthetist. And, um, did you have one, as it were?

384
00:49:32,240 --> 00:49:40,420
Who you who is John Edwards? SEAL and John Kerr?

385
00:49:40,420 --> 00:49:44,050
Um, they're both very different.

386
00:49:44,050 --> 00:49:47,500
John, I always found very, very good straight up and down.

387
00:49:47,500 --> 00:50:09,040
He used to get a bit sort of write you on occasions, but. Said, Gosh, I really was full of admiration the way John coped with that and his work,

388
00:50:09,040 --> 00:50:18,010
but he got obsessed by railways and trains and retired to run one of those little railways in Wales.

389
00:50:18,010 --> 00:52:44,070
So. And yeah, I tried to introduce a three session operating, they said we've got these operating theatres and we use them from sort of eight to six,

390
00:52:44,070 --> 00:52:54,290
but that's actually not a good, good use of a bit of capitalism and.

391
00:52:54,290 --> 00:53:02,810
We should have instead of two morning and afternoon, we should have an evening session, and he was furious.

392
00:53:02,810 --> 00:53:08,900
Never been so badly treated. Blah, blah, blah. It's going to be something to discuss.

393
00:53:08,900 --> 00:53:12,380
But it just seemed to me to make sense. Well, absolutely.

394
00:53:12,380 --> 00:53:17,870
But the anaesthetist, I mean, they were they limited surgery, but they don't have the general surgery.

395
00:53:17,870 --> 00:53:26,660
I mean, in my time, because they wouldn't work after five o'clock and another session, I wasn't here know.

396
00:53:26,660 --> 00:53:31,980
And you'd have had more anaesthetists. But I thought on the staff time.

397
00:53:31,980 --> 00:53:39,500
So if you get the anaesthetist with you, you'd run because there are always hundreds of the best chairmen of the Medical Staff Council.

398
00:53:39,500 --> 00:53:44,140
I thought it was Roger. He was an anaesthetist.

399
00:53:44,140 --> 00:53:49,190
Oh, he was so good in those cities.

400
00:53:49,190 --> 00:53:53,700
But he would take time to go around and talk to people before the meetings.

401
00:53:53,700 --> 00:53:57,950
It was good. It was all sorted. Yes. And he was fantastic.

402
00:53:57,950 --> 00:54:01,910
The other day, I was secretary of Medical Staff Council when I first arrived.

403
00:54:01,910 --> 00:54:10,160
And as a consultant. Yes, Alan Sharp was the he was a lovely I was you know, I really was very fond.

404
00:54:10,160 --> 00:54:16,880
Yes. Very sad when he died. But Roger must have been quite late.

405
00:54:16,880 --> 00:54:22,240
Is that right? Yes. I wish I could remember. Been worried because, I mean, I think he's after my time.

406
00:54:22,240 --> 00:54:35,770
Yes, I think he was. It took a lot of time and I suspect only anaesthetise had the time to go around and talk to people, but he was very good.

407
00:54:35,770 --> 00:54:41,630
Yeah, Chris is something I should have asked you about.

408
00:54:41,630 --> 00:54:53,030
Um, no, but I can think of I mean, know I probably being far too outspoken, no, it's very, very interesting and nothing rude at all.

409
00:54:53,030 --> 00:54:57,110
But I think they probably, um, because I think people should say what they think.

410
00:54:57,110 --> 00:55:01,490
You know, how it came about. Yeah.

411
00:55:01,490 --> 00:55:14,810
I mean. I think I had the best time in the NHS to be honest and show, and when I qualified,

412
00:55:14,810 --> 00:55:25,700
I had the choice of medical defence subscription of five pounds a year or fifty pounds for life and took the 50 pounds.

413
00:55:25,700 --> 00:55:35,630
Where did you find the 50 pounds? Well, it was my first paycheque when I was a S.H. House officer, a guy.

414
00:55:35,630 --> 00:55:42,200
So I stayed in for six months, but that was my first pay packet.

415
00:55:42,200 --> 00:55:51,230
And now a neurosurgeon has to find about one hundred thousand pounds a year before he can.

416
00:55:51,230 --> 00:55:55,810
Yeah, I did. Because you were with Joe Pennypacker just as an asset.

417
00:55:55,810 --> 00:56:01,820
Yeah, yeah, yeah. How did he compare with the people in London?

418
00:56:01,820 --> 00:56:13,490
I worked with Murray Faulkner who had been at Oxford and thought the world of Oxford Murray was still using black silk,

419
00:56:13,490 --> 00:56:17,600
which everyone else had given up because it was a pain.

420
00:56:17,600 --> 00:56:21,800
It became infected. You had to do that.

421
00:56:21,800 --> 00:56:30,380
And I pointed out to Murray once that, hey, given that black silk in Oxford, and it was only when he heard that he would give up black silk.

422
00:56:30,380 --> 00:56:37,670
But Murray had this rather sort of disturbing laugh, which was humourless.

423
00:56:37,670 --> 00:56:44,570
But it was when he was in trouble and he was a television programme.

424
00:56:44,570 --> 00:56:51,320
Phil Murray doing an acoustic. And I still cringe at this because there's this awful sort of cackle.

425
00:56:51,320 --> 00:56:55,190
Oh, he was doing it. And it wasn't a great operation.

426
00:56:55,190 --> 00:57:03,170
But then I worked for Valentine Logue, who was a I had great admiration for Valentine.

427
00:57:03,170 --> 00:57:09,380
Um, he was quiet. He was obsessional. Very good neurologist.

428
00:57:09,380 --> 00:57:14,570
Very nice man. He, of course, was the son of the King's Speech.

429
00:57:14,570 --> 00:57:19,010
Yes. He was the little boy reading the book and he was a little boy reading book.

430
00:57:19,010 --> 00:57:24,140
And also making model aeroplanes who try to do is avidly as a boy.

431
00:57:24,140 --> 00:57:36,290
And I liked I suppose the only thing I'd say about Palantine was he really spent a lot of time sort of stopping every capillary bleed,

432
00:57:36,290 --> 00:57:47,810
which is not really necessary. Um, but he would go home and then phone up at eight o'clock in the evening to ask after his patients.

433
00:57:47,810 --> 00:57:53,330
And it was really very caring. I don't think he actually received the credit that was due to him.

434
00:57:53,330 --> 00:58:04,850
Right. The other surgeon at Queen's Square at times one, because it was much more forceful personality and tended to get the sort of limelight.

435
00:58:04,850 --> 00:58:10,300
And was there another at the Middlesex with Valentine, too, because Diana Beck stopped?

436
00:58:10,300 --> 00:58:15,270
That's right. Diana got myasthenia gravis, didn't she?

437
00:58:15,270 --> 00:58:31,380
I didn't know that. And then I think Lindsay Simon took go right, who was at Queen's Square as a sort of lecturer when I was the.

438
00:58:31,380 --> 00:58:38,340
I mean, looking in time is a very general surgeon, I think he was more gentle.

439
00:58:38,340 --> 00:58:50,620
And Joe, I always I remember being struck that Joe I thought was rather rough and everybody said it was a fantastic surgeon.

440
00:58:50,620 --> 00:58:58,020
I think he was. And he probably knew how rough it could be to get away with that speeded up a bit.

441
00:58:58,020 --> 00:59:04,770
Presumably he was fast, whereas John Potter was just rough.

442
00:59:04,770 --> 00:59:12,180
And when he sort of his patience ran out, he it was a disaster.

443
00:59:12,180 --> 00:59:20,290
And, uh, I think, you know, John, John should never have gone in for the research.

444
00:59:20,290 --> 00:59:27,990
He was interested in head injuries. But, of course, that wasn't really bone surgery.

445
00:59:27,990 --> 00:59:32,610
And I mean, his helmet work was the good thing. Yes. Yeah.

446
00:59:32,610 --> 00:59:37,200
Yeah. I'm going to close down then, Chris, if that's all right.

447
00:59:37,200 --> 00:59:41,440
Oh, well, thank you very much. That was really interesting. Thanks a lot.