This is the 11th of February to 015, whom Tchang being interviewed by Derek Hockaday,
whom I guess that the first time you came to Oxford in connexion with opthamologist, be one of the conferences.
That's right. Yes. Yes. We there to be roughly. Oh, I first came, I think, in nineteen sixty seven or eight to the Oxford Congress,
which, as you know, is an annual international Congress held at that time in Balibo.
And although it was started by Doyne, Robert Thorne, who is the founder of the hospital,
the Oxford Hospital actually had very little to do with the Congress other than from from time to time.
The people who work there participated.
Um, but it was a very lively meeting because the location of it was so attractive in the summer for an international meeting.
And we had people from the three continents for more.
So I first got to came to Oxford for that reason.
Who would be chairing the conference? Well, the conference has a master and this rotates every two years.
Right? So usually somebody Eminem is elected into the Mastership and but there is a committee that runs the programme.
And these are the, uh, the committee usually consists of both regional and academic representatives.
So in other words, there would be people interested in the front of the on the back of the eye, people from Ireland, from Scotland, so and so.
It's sort of fairly representative of a national body that is sort of a reputable representative.
And it's very, very good. And of course, because if they at that time, it was limited to only senior registrars and consultants.
It was much later on when we find a bigger venue that we we made it into an open meeting at that time.
We met in the physiology school. But you see how small that is.
Um, and I first came because I wanted to present a case that diabetic Mac Allopathy,
which I treated by Zino, and I got the sense in the next few days to disappear.
I mean, there was no comment on the seizure, but it just this caused and that was a step forward, so to speak.
And that's my first acquaintanceship with Oxford.
You were just telling me about Xenon. Yeah, yeah.
Retinal Vertigo regulation. And it was the Hammersmith or More Fields, the first place to do it.
And Morpheus was the first place to do it.
And because Hammersmith had a big diabetic clinic and they were doing sort of innovative research to do with the treatment of science retinopathy,
it was natural that morphine, which is aiming to introduce this treatment, should be pleased with that.
And this is how I got involved, because I'm saying to you, I mean, as you know well,
at that time, diabetic retinopathy was the commonest cause of blindness.
So I was motivated to get involved with looking into that and see whether or not the regulation was what it came to be.
A professor in Germany, Komachi Karaf, he was a retinal surgeon and he invented this treatment partly to try and, well,
the retina back onto the collar, onto the underlying coat, because initially, before the retina becomes completely detached, you have a tear.
And that was a time when you actually could put it back on before the fluid separated the retina from the core and then they wouldn't have any effect.
And because this is a welding process, in other words, you produce heat, coagulate tissue.
He also applied it to retinopathy, and he claimed in his little booklet about the use of light xenon after further
calculation that this was also effective in the treatment of DABIC diabetic retinopathy.
So up and down the country and in different parts of the world, people bought this gigantic machine, which is called a jumbo,
because it had to house this mechanism to generate an intense xernona, which is then reflected by mirrors onto a Summerskill.
Um, well, when we actually apply this treatment, it wasn't really that as successful as he implied in this book,
but nevertheless, it had some I mean, like old treatment, which sometimes was effective and sometimes not.
There was a lot of doubt. It was natural that it was a sort of prelude to a randomised controlled trial.
And that was what was started in London, spearheaded by the group in London between Morpheus and the Hammersmith.
To you and Niva. Yes, I was the one of the active members who went around the country trying to drum up interest.
And I did some of the treatment in, Um Moorfield where I did most of the treatment of it,
but it was actually very difficult to get people to really put their back into it.
So essentially it became mostly Moorfield and with the simple patient in the hemispheres,
a handful of cases from other places like Bristol, one or two from Ireland.
But, um, and this accounted for the small numbers.
So we are dealing with hundreds of patients as opposed to thousands.
We hope to God. And that would have brought the trial to an earlier to brought some conclusive results earlier.
Um, so when did it change, Joergen, to Argon?
But that was really when the United States, um, I mean, Argan was introduced or early on, but by different people.
And I've forgotten the name of the person who mostly initiated in the United States.
It seemed a much more weird way. And also you could generate more power, so to speak.
Uh, so the American, Marty, Multicenter randomised controlled trial was based on argon,
whereas we started earlier and we had only the xenon, which was a sort of, uh, tool that most people possess in the UK.
And so our our study was based on 094 for the regulation, whereas the American was based on argon laser vertical regulation.
Um, and, um, I mean, as I say to you, these were exciting times because it seemed that this ravaging disease was, um, could be brought under control.
And in fact, we published the first paper in the UK, as you know,
I can't remember the day I think it was 76 in the ER in The Lancet when we published
the results to say that it was effective in the treatment of meritocracy.
Now, we didn't have quite enough cases to analyse subgroups in the way that Americans did,
but overall there was a statistically significant difference in the treated and untreated groups.
And is that provision of visual appearance of provision for this?
This is obviously important because this is MacKillop. This is essentially to do with the macular and vision across the prime indicator of a function.
Uh, a year later, the Americans published a bigger study and they show that it was also effective and delivered.
It was opposite where we then publish in the paper a year later.
Supporting it, but with smaller numbers, um, so, you know, I was very lucky to be involved in such a study and,
you know, to reach positive results as it was the first generation Oxford before you came.
Yes, 35 years. There was a jumbo, you know, um, but and as far as I could tell, some patients were treated,
but there wasn't really, uh, organised effort to to tackle retinopathy.
And when I came already, there was a portable xenon would be much easier to use, which we did.
So we acquired that. And then, um, very shortly afterwards, the organ became available.
And it was, um, then we use that. We converted to that.
What made you decide to come to Oxford? I mean, there you were in London, notable black, you know, doing well.
Well, I was attracted to London to to Oxford for a number of reasons because, um, um, I also had a very nice place and not a lot going on.
And I to tell you, choose the person who's, um, my immediate boss didn't really want me as, um, on his unit as a whole, as a permanent colleague.
So he didn't know if he had his eye on another fellow.
So I really need to find another job. Now, did you were you a consultant in Tunbridge Wells?
Yes. Yes. And while you were working at Moorfield? Yes. Yes, I.
I had so I this is how I, I, I had to, you know, in case I did.
So, as you know, when you become a senior registrar, there was sort of pressure for you to go.
And I could have gone. I mean, I could have applied to the London if I did apply to the London.
And I was hot favourite, according to one of the people who was on the board of selection, you know, but I didn't like the senior surgeon.
Chappell Barry Jr. is dead now, and he was not a very nice person to be working with.
And for me, thinking about it, you know, to spend my next 30 years, 35 years or twenty five years with him was unthinkable.
And, of course, um, there's a very nice unit here headed by Tony Brown, who is very innovative and active.
And so I would be very nice to collaborate with Tony Brown, particularly at a time when he actually had gone from the welcome,
um, um, welcome trust to do to, um, see if they improve glucose control had a beneficial effect on, uh, retinopathy.
Yes. Yeah. As you know, um, the methods for controlling diabetes wasn't refined and therefore you couldn't tell.
Uh, so anyway. But we need but I contributed to that.
And, um, and of course, the other thing is I was lucky in other respect that lends implantation was beginning.
And I, um, um, did some early work, um, when I was in London, Tunbridge Wells, um,
and I because of my work with the randomised controlled trial on diabetic retinopathy,
the head of the NIH, I gave a paper in the United States and he hit one of his associates.
I heard him say, look, why don't you do a randomised controlled trial on Lenzi implantation?
And so I designed something to design that.
And I said, well, if I could come to Oxford, I would be able to find collaborators.
If I was, you know, elsewhere in a provincial hospital, I couldn't possibly attract young talent.
You know, people could assist me in research. And indeed, I did get a big grant from the NIH to do this.
And we published some some papers.
How do they we had we had this grant for five, six years or longer.
And so what I came that I introduce to implantation,
which then subsequently took off in a big way because it was the natural way to go and not I didn't need a randomised controlled trial,
but in the randomised controlled trial,
did stir up some methodological formulae or ways in which they actually subsequently employ to do other studies,
notably one in India where they're trying to.
And I funded a big study in India trying to compare LENZEN implantation with other forms of treatment to see.
But it was a save, but it was cost effective. So so it wasn't completely wasted and it was something that had to be done.
A randomised randomised controlled trial. And then Tonin Institute had people working on the biochemistry of the lens.
Yeah, that's right. Yes. Yeah. Did you get involved with that at all?
Well, I didn't, um, other than as a um.
There was one paper I didn't, I contributed to it.
But you provided some lenses. Oh yes. Yes, yes.
We uh. But the method of lens implantation, uh,
evolved in such a way that they actually lost a lot of material because initially when you wanted cataract surgery, one removed the whole lens.
And then we send the lens to the lab and they looked at the camp biochemistry, what we did about biophysics.
But when we discovered the best way to retain the implant in the space where the lens should be was not to remove the holes,
but to remove the contents of lens, but retained the capsule so that the artificial and goes into the capsule that they lost the materials.
So but I mean, not altogether. There was there was still some there.
So, um, and then later on, the cataract surgery improved the technical aspects and I introduced a fake ID,
which is greatly simplify the way cataract was removed.
So so I mean, this in a way runs up the way I was saying to you that I was involved.
Lucky to be involved in a time of a lot of innovation, important innovation.
And that was my ultrasound was yes. I think most education was instituted by a man called Kelmann, who's a charismatic figure,
uh, who plays the saxophone in New York in a nightclub the night time.
And they did some ophthalmology in the daytime, but he had the vision to persuade the engineer to do it to to make it, uh, ultrasonic probe,
which you could then introduce into the lens space and fragment the lens and then
evacuate the lenticular material as a liquid so that you could then preserve the.
Mm hmm. I mean, obviously, like all innovative surgery, it didn't it had its problems initially, but then he became kind of an adopted method,
which not only revolutionised cataract surgery, but, uh, and enable people to have cataract surgery much earlier on.
So they weren't so desirable.
But it made it a much faster operation, which meant that in a few minutes you could and the patient didn't have the rest for so long after,
you know, did anybody work at all from your memories? How many people got, like, veins on both sides of parliament in but the cataract surgery?
Well, in my time already, people were mobilised very well.
OK, it was only in the very early days before I started ophthalmology that they put sandbags that were on both side of the head.
And they, as you said, quite rightly, there was some other systemic complications.
Yeah. And I mean, obviously, you were doing general upturn, logical practise and the Lansberg.
Yeah, to me, actually, because I came to one day because you came to Oxford as a real diabetic Pontypool.
What you have is that that you can I came in 77. Yes, you see seventy six.
We just started a prospective Oxford study. Yes.
Looking at control against tissue damage and linked up with Audry because before you came in, he was the guy most interested.
And then, of course, a bit later, Rob turned over to his desk.
Did you get involved with the UK? We did. I did get involved.
I help the embassy, the fellow American fellow, although I never got acknowledged when I thought and I never realised that.
On the other hand, I helped him. I gave him a lot of help. And and also I did some of the initial assessment for Robert Turner.
Right. But you know how it is. It's it didn't matter to me in those days anymore because, I mean, other interests.
You now have it. Williams was it Juliet? Her.
William Yes. Is he she did a lot of work on average.
No, there is only with Audrey. Yeah. But she didn't work with you and so you were to have your own little team and Philip would have his.
That's right. Right. Yeah. Yeah.
You know, Philip, um I, he continued to give the medical school a lecture on diabetic retinopathy, retinopathy to the medical students.
Um, and and but I don't think he was involved with the research when Robert Turner had his study.
When you got go initially and he sent all his patients with me to assess the annual I checked.
But then as the study grew, I couldn't possibly accommodate in my room everywhere else.
So so he had to appoint other people where he did it with either and probably several other people he did with other people.
But I think the retinopathy was I can't remember.
Well, I mean, because when the fellow was here, he did it right. But he either was the sort of national speaker, as you can imagine, in the UK.
It is retinopathy. Yeah, but. And where did you eventually come to give the lecture?
Well, as long as I did give lectures on on diabetic retinopathy and I was flattered that they got Professor Glassco whenever he wrote about breast.
And obviously he was quoted the very first paper that I gave to do with the efficacy of treating macular, obviously.
Um, but I mean, I tell you a story which which means you when you asked me to give the rest of the lecture to your cause,
I you said, oh, we got double projection. And so stupidly on my part, I didn't check that you had double projections projection.
We are used to it. So I got to carousels.
I prepare the lecture two cars.
I arrive at yourself only to find that you've got one projector and the other one you did by hand had some blanks.
But because you were down there and I was up there, I, I couldn't communicate with you effectively, said, look, there are some blanks.
So the whole thing was a fiasco because I was it to remember that side.
But it was my fault. I should never have ever since I've checked. Yeah.
Yeah. But you gave it again and I said, well I didn't like it.
I'm sure I'm sure you're aware of that. And now when you came, I mean the hospital is a small place, small building.
And there was the institute behind it. Yes. I mean, what changes did you see in the actual hospital where you were?
You know? Well, huge changes, because when I first arrived, we had this operating theatre with a tiny space adjacent for the needs of anaesthetics.
And from many points of view, from, you know, strictly hygiene point of view,
it wasn't really the ideal solution that we continue to work there until we could move to the top floor.
There's another funny story, which I will tell you, because when I first arrived, Tom Patterson, the plastic surgeon.
And he said, oh, yes, I am,
and I know the hospital because I used to work with Perthes who when I was operating with him one day I heard a pitter patter.
I looked around. There was Matron bringing her little dog to see how we were getting on.
Well, things had changed for that.
And when we moved to the tower block and we did everything the same as the I can't remember what date it was, but we we did away.
And then, of course, the other thing was we modify because numbers grew and we did many more things in the hospital.
So we had to introduce more consulting space.
And we obviously made use of the theatre, the part of the theatre which we converted into the casualty department and so on.
And so things sort of gradually improved.
They built a corridor to it. The linking you to a bit to the to the.
Yes, to the main building. The main building. Yes.
Because I can remember that arrived and it made it much easier to get outside to the aisles, particularly to the lecture theatre.
Yes. Yeah, yeah. And so you were teaching.
I was the clinical student. So you favour teaching teaching technical students?
Well, the time that they were allowed, they were exposed to ophthalmology was very short.
So they they used to come to my clinic and then I would show them cases so that the sort of hands on teaching methods of examination,
some of the material they saw, um, and as far as I can tell, not all the students came.
I mean, I think it was sort of, you know, far left to those who had an interest, those who had other things to do.
So as a handful of them, um, rotated through the Cape because they nearly always hit somebody in the clinic.
So this is how some of it was taught. And then you had house for the surgeons?
We had how surgeons and the team expanded, uh, when, um, when I first came,
there was just one senior registrar, uh, and but with the with the diabetic retinopathy work,
um, we second man was appointed to work with me with a particular emphasis on emphasis
on helping the local diabetic retinopathy and then also on the junior staff.
We got more, um, S.H. out. And also we, um, um, had some technical assistance because one of the nice thing was that Rosebury rule,
it introduced the party part time training scheme for married women.
And we benefited by having, uh, these three in my time who went through the rotation and, uh, and others came.
So we think that the team, the junior staff expanded a bit.
And because of the sort of things that was going on in the lab, Tony's lab and also in the clinical field, we attracted some very good,
um, uh, students from, uh, for for example, I quote the Julian Stevens, who was supposed to be the top, uh, top of the his year.
He became an ophthalmologist. I had a chap, um, Keith Bates, who was a right, a scholar of Orio, I think.
Or Copas, I can't remember. They all had, um, either first or extremely well qualified.
So, um, I there were several of these people.
So full time Oxford University. Can I have some.
Excuse me. They about this, they we had some very good people who's been through and as a matter of fact,
the president, Professor Robert MacLaren, he went through a very, very nice and he's extremely innovative.
And you may have seen him on television and the first person to put a microchip behind the retina, but to simulate a sort of vision.
Oh, yes, I've heard of that because he's blind and he's got other he's got lots of grants.
And so that professorial unit is very active.
So that's certainly broadens readership made in church. Yeah.
Ten years is a person who chair the eye.
As far as I can see that it is a personal chair.
But I think he has the leadership and Margaret Ogleby readership, but he's working in the umbrella of neuroscience.
The professor of the neuroscience department is Russell Foster.
Yes, he is correct.
Yes.
Um, and, um, um, so Robert MacLaren has continued, um, to propagate the name of Oxford after Tony Braun said that the research part is alive and well.
Yes. They got stem cells, gene therapy, all that sort of thing going on, which they move up the hill would be after your time after year after night.
And has the laboratory gone up there as the institute? Yes.
Yes, it was the engineering. Science neuroscience.
Yes. Is, um, so, um, I don't know whether, um, um, the integration is I have to say, I haven't really looked into it closely.
I did go to one of their seminars and I was very impressed by what was going on.
Um, so it seemed to be working well. Yes.
And, um, I mean, when you came, my guess is the facilities were all at least a bit more cramped than all fields when you went into the tower.
Yeah. Was that everything you wanted or. Um, well, the tableau, um, the operating theatres were more modern.
And, uh, as you know, I also worked with Mike Poole in the um, um, craniofacial.
So it was much more, much more convenient. Uh, there were cases where I had operated with him and, uh, there were also cases where he came to us and,
uh, that wouldn't have been possible if we didn't go into the towable.
Um, but I have to say the changing room was left a lot to be desired.
But I like, uh, but I hope things are better than they were.
But so, you know, the hospital hadn't had anything to do with the design of it.
No, that's right. Yeah. Yeah.
Um, no, that was the craniofacial unit was also, um, something which was, um, um, a very interesting development in the right of infirmary.
Uh, and, uh, the eye of the monastery was very glad to be involved because as you know, some of these gross deformities, iPads and Khuza'a,
were attempting to try and correct, uh, to to some extent that deformity is is it accidents or was it a deformity, a congenital deformity?
Uh, mostly congenital rivalries that the craniofacial, um.
And. Oh. And Mike Pool was, um, the, um, uh, she, uh.
Prime mover in that now, obviously, insurgent depends on a lot of people.
How did you find the standard of nursing? Well, the standard of nursing was very good.
I, I, uh, I must say, because they were very when I first came, there were some sisters who were elderly school.
And I, I don't think if you were a nurse, you get away with being sloppy.
So, um, they, uh, they said very good examples.
And, um, they're also the outpatient sister was a big lady and there could be no nonsense with her.
Now I think that was and alcohol, gradually things change, uh, sometimes for the worse.
But I'm glad to see that that changed back to, for example, the discarded their uniforms.
Yeah. And I thought that was a retrograde step because a patient didn't know who they were.
And also, you wonder about, you know, um.
From the on theoretical grounds, it can't be the Kennedy spot is questionable.
So, so, so, um, so, um, I don't know what else, but when you first came,
did you have a nominated number of bids or was it all fused, as are all the fossil fuels?
Yes, it was Allseas. Um, and uh, but of course the hospital being separate the that were largely protected.
Yes. So that's well, we didn't we weren't always looking over the shoulder to see where the medicine might pinch the fan.
So but did you even have a word with, say, one other consultant or was it a complete job?
It was I it was there were two was a male and a female.
I was. And they were there was one one group.
Um, so which was supposed the isolation is or isolation more private.
Um so they felt like they were nearly always enough beds for the people who were on the waiting list,
because more often than not we have some long cases I retinal detachment.
So it's limited by the duration of the list. Mm hmm.
So for the duration of the list, we nearly always had beds available.
I mean, do you remember roughly how long would have been the waiting time for, say, cataract back then?
Oh, um, there was a time when it was maybe I think I, I this is, uh, not something I can vouch for.
No, no. But I think a year or is.
Um, actually it is. So that was a very long wait.
But I wouldn't have any other condition whether as long awaited as that.
Oh well if you had talked you wouldn't have to wait long.
If you had the attachment, you wouldn't have the way that these sorts of, uh, um, detectable more or less an emergency like,
um, glaucoma would have priority because, you know, it wouldn't want wouldn't do so if you left it.
So this is so cataract was because it's a known as an operation.
And to check the progression of cataracts by not slow, uh, but the thing that, um,
perhaps the group that was disadvantaged a little bit was the squinch children misdoings because of the waiting time.
Uh, and I think the waiting time was largely limited by the time available, but also by the sessions,
a number of sessions we have bit of them that you didn't have enough sessions so that you can actually have a much bigger time.
Mm hmm. Um, I think that was my recollection to that sessions in the javadoc as opposed to our own surgery.
You're right. Even even even before. Right before.
Because it was sort of linked to the anaesthetic I this one room available for I say operating for three years for four consultants.
Yeah. Yeah. So now is they're important.
And how did you find that. And I suppose it became quite a lot of it became local.
Yes. Yeah. Progressively. Um I operate all time.
Exergy rely less on gentlemen.
It's easier. Uh and this was became more or less universal I think that um long operations.
Like a detective or complicated retinal detachment.
Well, they they changed much later. But for nearly all the other surgery, apart from death row, just around next to me, uh,
you change over the local, but then because of the age of the patient, we still needed.
And in these cities, uh, so it although, um, a particular surgery, because many of the patients that, oh,
we still needed anaesthetists to be available in case of any sort of emergency like, uh, respiratory distress or some heart problem.
So and then the local anaesthetic, you know, dropping stuff into the air.
And then there are things of injecting. Yeah. Now anaesthetists do that presumably.
Do they did you. Well, in our time, um, we still use Rencher Balbir or Perivale them anaesthesia um and injected IV.
So you inject we did that because on the whole we were more used to doing that.
And the anaesthetist, although they're trained to give local anaesthetic, they're not trained, they'd be less expensive to administer.
We prefer that we take the risk rather than to let you know unsentenced.
But now cataract surgery has evolved so much that, um, more often than not, they only use topical anaesthesia.
In other words, some cocaine and some short acting anaesthetic drops.
And when you arrived, how did anaesthesiology compare with London?
Um, I thought it was much the same. If anything, I think the, um, uh, the anaesthetist were more sort of.
I mean, compared to morphemes, notably, we had, uh,
quite senior people and it seem out of fashion compared to all sorts of sort of progressive of I mean, the school is famous from Lafayette.
Yes. They had a son. And then how much do you work with pathologists and how important is that?
Um, not so much because, uh, we didn't do so much to my work.
I mean, melanoma's. What do you do them melanoma's, of course, local excision.
Uh, but, um, um. And of basal cell carcinoma.
But, um, I personally didn't get a lot of, uh, tumour what passed my way.
Uh, and I think the tendency was, uh, referring to melanomas, to plastic surgery because it require bigger excision and also some reconstruction.
Yeah. Quite often. And then bacteriologists you.
I've been very much yes. Because the one disaster, the one complication with fear after cancer surgery or any intraocular surgery is an optimises.
Yeah. I mean critically depend on working closely with them.
Uh, but we have a case which I'm happy to say happened rarely.
But when we did, it was very critical that we liaise with closely about type, uh, what sort of.
The sensitivity, that type of bacteria and sensitivity, light sensitivity and so on, you know,
when were you busiest in your professional career, would you say, as a consultant or previous fellow?
I would say that as a consultant, because, as you know,
one is given so many sessions and to try and write papers if it has to be done in your spare time.
And it's a question of creating, um, I'm a sort of working myself up to the energy and then creating the time,
you know, to to do things in order to write right up.
So I would say that the middle period when I was particular, when I was travelling, going to report to the NIH,
that was sort of the most demanding period because, you know,
you go there because you're trying to get things ready and get the paper ready to to get to go.
And you suffer from jet lag when you got there and you come back and you have a project and you try and catch up.
Uh, so it wasn't, uh, easy, as it turns out.
So, um, but it's actually salutary because, um, uh, I don't as I don't need to say to you, did you do outpatients outside Oxford?
I did. Banbury, um, once a week arrived at once a week every Friday morning.
And I was always a big rush. Uh, but, um, you know, it's a service fund which, uh, one had to deliver.
And, uh, but it's always a rush trying to get back to the afternoon activity.
So, uh, it was when I, I, I.
I was so I had such a long waiting time for people to get to my clinic that I once said to the,
um, I once wrote to my colleague Unfoldment, but I'm getting many referrals.
And I discovered it from a clinical system that he's thinking of actually cutting down his genius.
So I wrote to the Medical Council committee to say, look, for heaven's sake,
don't let him because your wife is not asking to send me some of your patient,
send more to him because, you know, the waiting time to get to my clinic is over long.
And, you know, I you know, invariably it's five days is a day.
I don't have any lunch because of the sort of the rush.
So apparently this was a bit of a joke because Robert Bell is a paediatrician.
He's all very, very sort of extrovert.
Yeah, loquacious. He said, oh, I see. Yeah.
The man who never has any lunch. But I know, but I mean, at Bamburgh were you just doing outpatient your operation.
I wasn't there, but he was I well I mean he was.
I would do it, but there wasn't a facility and the pressure of the clinic was too great.
Too many patients you couldn't stop there to to operate, so they'd come to Oxford without having to answer it.
And I think and of course, the other thing is that ophthalmic equipment, when it comes to things like lasers and so on, are so expensive.
Yes.
You couldn't really put them in all the outpatient places like Whitney Banbury Stupenda over there, the second to get thrown out, said Mandaville.
Uh, I in the region, it was winzer.
Right, that had a very active chap called Jack Kanaskie.
And he he managed to to get a lot of equipment.
And were you involved in, as it were, educating him or did he come?
No, he was a contemporary of mine, Jack, and he was a year ahead of me in those years.
Um, and, um, the people that we sort of trade up with, nearly all the consultants and Stoke Mandeville now.
Mm hmm. Uh, and, um, but in those days, they weren't, um, they weren't, um, part of.
Did you lecture much in the region. Yes. Regularly because we have, um, regional days.
Right. And um. And well.
He was part of my mission to try and get them to go organise their diabetic.
Well, you remember Charles Fox?
Yes, he was very active and he used to get me to talk to North Hampton is a lot, but not just North Hampton Roads and poverty.
And how much private work really? Um, I was doing, um.
Initially, I didn't do any right, um,
and I might consult my accountant persuaded me to have a room in my house so I could claim that that was right there,
but I didn't do anything for five years.
So, um, but then gradually, the more demanding all the time they retire.
No, no, no. It just doesn't suggest that there was just the demand increase.
And so I didn't share rooms with Philip Audry and on Frieman.
So I did I did two or three 1/2, two 1/2 days.
I did two days. It was Saturday morning.
And and and one of the other days. Yeah.
And then the operations. I did them in the afternoon. Yes.
Um, and that was all well kitted up. Well no they actually um.
I mean I was very um at times uh very uh uh disenchanted with them because they didn't have, um, the sort of, uh, equipment that I need.
I had to bring them from the aisles, but eventually I persuaded them when they saw that there is a potential for them to earn some money.
And there were no nurses trained in.
And I, uh, and one nurse who along with, uh, Hotan, uh, who's predecessor, um, he, um, was, um, um,
she was very cross with me because I, I point out things that she had to do, which she wasn't doing.
So, uh, that she is good enough for Mr. Holtan, but it's not good enough for you.
That's progress. And, uh, and so they act better because, um, you know, as you know, um,
as one stays in the place long enough, uh, people get to know you, they want to to come to you.
And so, um, in a way, I mean, I say I'm not saying this, um, um, out of all the right words to choose,
but I didn't want to make a virtue of it to some extent that the private practise.
But what sort of push on to me, because the particular people in university,
they came and either they had insurance, the colleges ensure that they they want the service.
And I'm there as a clinician. I provided the service. And so to come back to their initial bid, the annual meetings.
Yeah. Were you involved with this? You have to be.
Yes, I was regional advisor for five years and I was college, the college representative of the for the region for for a long time.
And so I was involved with the the regional meetings.
Yes. I was really thinking of the national meetings. The Oxford.
Oh yes. Yes, yes, yes. Oh yes, yes. I mean if I had a paper to give and because when I was doing this, uh, during the, uh, randomised control,
uh, control, uh, study on diabetic retinopathy of almost every every meeting, uh, presented the paper.
Good. Um, and also when I was doing the randomised controlled trial on cataract surgery, it was a lot to talk about.
Yes. I said and also all the people asked me to. And so both the we had two national meeting.
One is the college meeting. A lot of the you know, the O u k before the college to establish the ophthalmology society, the United Kingdom.
Uh, so that was an animal that moved. And then in the summer, there's the Oxford Congress.
Uh, and, um, I from time to time I gave papers.
Were you the master of it? No, I was there. I was the deputy master, but well, there only chose masters from amongst counsel.
Right. And Tony was already. The council member, so so, uh, I was deputy minister for one year, so.
So when you were going to America, that was mostly on the retinopathy, was it?
No, it was mostly on the lens. That lens implant.
Oh, yes. Right. Yes, yes. For cataract.
Cataract. Yeah. And did you keep that up?
I mean. Well, I didn't, because when the lens implantation became mainstream, there wasn't.
And it was largely overtaken by the Americans and then also eventually became commercialised.
And so I didn't go. It was I also I was in Dubai then.
I wasn't doing any innovative work. So I, I stopped there, uh, and, um, but it was a very interesting experience because in England, as you know, the,
uh, the concept of internal implantation was started by a man who had originally in England, he was a Scientologist.
And, um, uh, apparently a student said to him, so you move a lens from an eye to a cataract, so why don't you put one back in?
And he thought about this and that and developed a lens which is very heavy.
But by a great stroke of luck, the first two cases worked.
But after that, there were all sorts of complications which he never really admitted to.
And I said the whole thing went into sort of, uh, you know,
became part and and also later attempts led to all sorts of complications and to a man in Holland, publish a whole series of cases,
more or less honestly, which show that if you did it in a certain way, that the complications were,
quote, acceptable, unquote, and then people took a great deal of interest.
But, um, how original disciple was a tactical choice?
Peter Toys, who was, uh, want a better word, man?
Very economical with the truth. Yeah.
And he and because of that mainstream surgeon, but had gone off as planned implantation and therefore it wasn't done for decades,
really, really until there's been publishing the result in nineteen seventy six.
But then you see Peter Choise went to America and persuaded the Americans because of the commercial angle,
you know, he could do this and they should do it. And for four years the Americans were copying him and there was a whole load of disasters.
And so this is this is what led up to the necessity to do a randomised controlled trial trial and also, you know, to studies, you know,
have sort of, uh, sort of protocols and follow ups and, uh, but then, you know, like things in America, things evolve very quickly.
And it's said that the commercial lobby took over and it became very commercialised.
And we were writing papers up to retirement.
Or did you stop for a bit? I stopped, I'm afraid went not because, um, basically I ran out of things to say and I did.
And, um, but other things to do. But we were doing last paper being, which is magic as well.
Uh, it was um I, I it, it had my name on it.
I contributed to it. It was again a contract study in Southeast Asia and I helped a Norwegian, um,
who got a big grant from the Foreign Office, Norwegian Foreign Office, and he was a Truesdell University.
He did a thesis which is sort of a continuation of the work I was in.
I took my protocol for the U.S. project and he modified it.
And and then I, you know, got involved with his work.
And I visited the places where he had, uh.
To prevent blindness, blindness prevention studies in Nepal, Bangladesh and India.
So I got I wasn't the prime mover, but, you know, I helped, you know.
And so I think there was in the early 90s, I got I, I got to go to India or this is what I ran a workshop in Chittagong and also in Kathmandu.
And so I used to go from time to time.
But India was a I don't I don't know, you know, in India is a very taxing experience.
Yes. And I needed to be tough. I always enjoyed it.
But I. But I know what you mean by that. You mean are you glad you came to Oxford?
Oh, hugely. Hugely. Because, um, people ask me, why don't you if you like France so much, why don't you go to live in France?
I said, well, I like France a lot, but I also like Oxford better.
I now is there something I should have asked you that I haven't?
Well, we, I, I don't think so. I mean, um, we've gone over the um uh what I did was I was involved in the, uh.
I hospital visit a number of changes, I don't I don't I don't think so unless you can do could think of it.
No, I have no idea right now. Impossible to stop them.
Yes. Yes. That was lovely. Thank you very much. That's terrific.