This is Peggy Frith being interviewed by Derek Hockaday, 15th of September, 1915, Peggy.
Well, they were in Cambridge early seventies. What made you want to come to Oxford?
Hmm. Well, I. I just decided fairly late to change the medicine as I went to Cambridge to do natural sciences.
And one of the big problems was I was very squeamish.
So I had to convince myself that I could overcome that which I did by going to the open heart surgery.
Anyway, I decided to change the medicine because it seemed more pragmatic.
And in those days there was no teaching hospital at Addenbrooke's.
So you could either go to London or come to Oxford and Oxford seemed more my cup of tea.
I didn't really want to plunge into the rigours of living in London and I thought Oxford was an appealing place.
Did you listen? I ever hear one of the Oxford ambassadors, I mean, like Pickering or Mike Penhaligon, that erm did you hear any of them in Cambridge?
I didn't actually, although it seemed that there was an interesting crowd of medicks who were going to go over to.
Yes. But I was dislocated from my ear because I spent having done biological natural sciences and a part time in physiology at Cambridge,
working with the likes of Martin and Brindley.
And I remember Hodgkin coming to lecture to us and Adrian and people of that sort and James Fitzsimons and Simons.
Indeed, I was very fond of of James because he was the most human, if I can put it that way, and that I loved it.
And also I thought his work on first was fascinating and there were very good teacher, very clear picture.
So I enjoyed physiology, but I didn't think I would enjoy being a physiologist.
So I had to spend a year doing anatomy, which nearly drove me crazy. So just one year doing all that because I hadn't done any anatomy at all.
And what was the admissions procedure like to Oxford?
It's very interesting, fairly informal, but I think I was the only person because it was an irregular time of year and I rather,
in desperation, contacted probably Messrs Tidey and Messa, and it was towards the end of Michael Daniel's directorship.
And he interviewed me and I can remember we had a very jolly time and laughed a lot.
And again, I can most vividly remember talking about something about the art of Picasso.
So it was not exactly a medically orientated interview,
although perhaps he moved on from medical questions or physiological questions, or if so, there was no written paper,
there was no formal interview by a board, or does the one man know anything about and you know,
roughly how many were coming from Cambridge a year then? I know you at the time, but how many would you think we were?
Twenty eight. And we were the Cambridge intake.
Not all of the 28 came from Cambridge. There were a few people. And Bornhorst from London.
Yes. People like Jim Ritter who'd done a deal here, and a few other assorted people from different premedical schools.
But the majority were from Cambridge and there was a similar number.
I think the total in the year was 52, 54.
Yes. And of course, we were at Cambridge. We were one in ten women.
And I should note also, my students are now aghast at the fact that at Cambridge I could only go to one of three colleges because it was just prior,
about six years prior to the first men's colleges.
Yes. Taking women at Cambridge. So I was at Newnham. Right.
Um, now that slightly got off the subject. Yeah, there were six girls in our half intake, so six of the 28 were women got a fifth the quarter one.
And then when you went on the firms, how many clinical students will there be an affirmative time?
I seem to remember there were five or six. Those were the days and those were the days.
And what did you think of the clinical student period?
For me, it was wonderful.
It was quite daunting because I wasn't sure I could do it in the sense of would I have the technique, would I have the personality?
Would I be it? Would I would I enjoy the actual medical work?
I found it quite taxing. I found it quite upsetting, dealing with people who were really very ill.
But I found that the level of support, although it varied enormously,
some people didn't seem to understand what it was like to be starting as a student all over again.
But there were others beacons of understanding who were very supportive, in particular a young.
Canadian NATO senior house officer whose name I can't remember, sadly, but he was very humane and very understanding,
and I think he prevented me from running further than running off the ward, which was here.
And I was on slight hold and.
Yeah. And of course, there were an ledingham, which I did is my second. I don't think I did now.
Renowned for being an organ. Hockaday I don't think they did well though I,
I remember vividly all of those who taught me and I thought it was the most wonderful apprenticeship system.
I particularly remember when I was a student in my final year of clinical
studies being on tape with John Ledingham and admitting a very unusual thing,
a man with lupus. We really did think he had lupus. We didn't have the sophisticated, serological testing.
Then we had to defibrillate blood with paper clips and look for lupus cells.
I remember doing that, but the man was very ill and he had lots and lots of physical signs.
I remember being completely transfixed by how this systemic disease was creating so many problems in different organs of the body.
So I suppose I was naturally always felt that I was a physician and probably a
specialist because I really enjoyed the detective work of making a diagnosis.
And I was I was too squeamish to be a surgeon, although I think I would have made quite a good surgeon if I hadn't been squeamish,
because I'm quite neat and dextrous in small hands and all that sort of thing.
But I'm rather glad I wasn't a surgeon, actually, because I think I think it's more interesting,
more challenging to be to to think through the twists and turns of medical diagnosis and treatment, which, of course, you would understand.
And what about Furneaux? But what do you think of that? Oh, well, fine.
It was interesting because by then Jim Holt had taken over as director of clinical studies and he called all the Cambridge crew and he said,
and of course, we'll all be doing Oxford finals. And we looked at each other and said, actually, we hadn't thought about this.
So we said, so, Dr. Holt, what's the difference between Oxford and Cambridge finals?
And he said, oh, the Oxford finals are much easier than Cambridge. So the five of us,
because I remember we all piled into Jerry Marston's mini or was it a Hilman
name in order to go to Cambridge to to to sit said exams because we rebelled.
And Peter Millard was brilliant because there wasn't a pathology component of finals at Oxford.
And he drilled us in pathology, having been a but he'd been at Cambridge and he was also he was a rebel as well in that
he thought that what we were doing was quite right and that we should stick to our guns.
So I don't actually think I was ever an undergraduate or clinical student member of a college at Oxford.
I went back to Addenbrooke's to do find I suspected something to do with this odd dates and so on.
But you got your badge, many of them due to my complete ineptitude, because I didn't realise that you had to apply for both of those.
It took a year for me to realise I actually hadn't got my qualification in surgery.
Well, I had, but I hadn't applied for the letters after my name.
So we had to go through another hoop and send another message to the Senate, House or wherever.
But that didn't delay taking over Halstrom. No, no, no.
Fine. I do I do remember finalise surgical finals in Addenbrooke's.
It was that old Addenbrooke's. Yes. He also told Addenbrooke's.
But I remember that we had Harold Ellis and a very large Scottish professor from possibly Glasgow.
I don't know. And I was sitting,
waiting my turn somewhat nervously for my surgical vivir and my the person who'd been over the head of me came out white as a sheet and I said to him,
Are you okay? You look a bit. He said, Gosh, Harold parallelise jumped up and lay on the floor and said, Do something.
I've had a heart attack and lay there pretending to be dead. So I said, well, I hope you gave him a jolly good thump on the chest.
I said, I didn't know what to do anyway. This rather distracted me from feeling nervous,
and I didn't think they'd repeat that particular performance next stewarded, you know, and then and talking to people.
Do you think it was true that the Cambridge exam was more difficult than the Oxford?
It's very difficult to know. It it's very difficult to know because one doesn't get the opportunity to do both
as a sort of let alone the control or the standard of which they're marking here.
I mean, if it was a funny mismatch, because I remember that we did orthopaedics, whereas the.
Didn't seem to do much orthopaedics, and they were terribly impressed.
I remember diptheria got prise in orthopaedics at Cambridge because she'd been well drilled by the all and got an orthopaedic patient in her finals.
So I don't think they specialised in orthopaedics.
It was rather sort of an also ran subject was indeed there was sort of mismatches of that sort, but.
Oh, I think I think we did OK. And Dayna got the prise in surgery.
So did you get the jobs you wanted? I did.
I, I got the SDM job much to my surprise, because there was only one professorial unit there.
And as you will remember and therefore I was Paul Beasley's, one of four housemen lost and Wetherall first one.
So David came in the New Year, I think the calendar year.
So we had August, September, October, November, December with Paul, who was delightful.
Yes, a man of few words, a man of great charm and understanding and a very good clinician.
Yes. And what he do takes in the evening or not, he would appear on the round if asked.
Yes, I was with Roman Gokul, who was out, and he was hugely efficient and effective.
And therefore I know I am distressed. He would be I mean, there was a problem that Roman couldn't sort out.
Indeed. Yeah. And you said and then Wetherall.
Oribe. So how frightened was he?
Well, we were sure it was quite a big change in personality between Beeston and Wetherall, but he was he was very fair and quite strict.
I do remember now this was when I was in S.H. So I remember taking the rap for my
house officers who had not done something that I had suggested should be done.
And I was roundly ticked off, but not for having failed to get this particular test done.
And I rather gallantly, I thought, didn't blame these young chaps afterwards.
I had I had quite a stiff word. Yes.
And I did not burst into tears on the road, although, I mean, you would be ticked off on the ward round in front of the patients.
I mean, I'll come back to that. I will come back to listen to you.
That's very, very interesting. That was still happening. Yes, I actually would have been.
Yes. Because I can remember standing there at the trolley is thinking, well, I don't take the rap here, but I'm going to have words.
Oh, yes. And then you said, Kujo, that was Tim to that I'd been I'd been a student with Tim,
but I actually did the paediatric surgical job with Nick Dudley, who'd be newly appointed, and Malcolm Gough.
Yes. And I actually found surgery fascinating.
I find watching an experienced surgeon, particularly, I remember Malcolm Gough operating on a a chap who was sixteen,
I think, who'd collapsed on the rugby field at Bradley.
And it turned out that he'd had a volvulus of his small intestine because he got some peculiar sort of mental problem.
And this boy would have undoubtedly died if he had not been in the hands of such an experienced and bold and skilled surgeon.
Yes. And I remember Malcolm Gough operated to undo the tangle and he said if he's going to lose as much, God seems to be infected, he won't live.
And therefore, we will put hot I'll stitch his abdomen together.
We'll put towels on his abdomen, send him to intensive care, and I'll operate tomorrow.
I couldn't be there on the following day, but he said that he'd only had to resect a couple of feet of small.
But that's interesting because the arterial supply had got tied up in the volvulus and as he done.
But I remember the moment where he had to make an educated guess as to how much he had to clip of the omentum in order to undo the problem.
And I had huge respect for the ability to keep calm.
He would say, oh, well, this is sort of fairly standard procedure.
But as a junior trainee watching someone with that degree of experience now, you've been in no doubt that you were working very hard.
Did you realise how hard he was working in this in the operating theatre?
Well, know that.
Erm I mean they and yes I think, I think particularly in paediatrics as well as try to think about it and whether it was even more unpredictable,
what you would have to operate on a lot of appendicitis then, of course. But also they had a speciality in I remember a lot of spinal bifida children.
They did a lot of chumped work, right? They didn't actually do primary repairs on the spine that would have been done by neurosurgeons or orthopod.
They think I see there may well have been a urinary diversion work for those children who didn't have bladder control or bladders.
I mean, you know. Yes.
And there was this incredible dilemma as to what the quality of life of those children would be, because if you didn't operate, they would die.
And if you did operate, some of them would do quite well, but others would not have such a good quality of life.
And it was terribly, terribly difficult to know. And that's fascinating because I'd always imagine the neurosurgeons were doing that.
But in fact, the paediatric surgeon now, I didn't even know they had a separate house.
I mean, there wasn't a firm of paediatric surgery in the sense they wouldn't have had separate
beds or that they both did general surgery as well as the paediatric surgery.
And I remember it was as they were building up the service that Nick Dudly came
on board and gradually probably did more of paediatric surgery than others.
But he also took on Tim Taylor's thyroid surgeries. But I mean, yes, they did.
The husband of just a paediatric surgery not to go for it.
All right. I was just the paediatric surgeon and I over the beds, they were on Liow surge.
Right. So the Leopold wards, which were sort of out in one of the wings on the main Picadilly corridor corridor from Picadilly,
Leo made, I think it was on the ground floor and the search was on the first floor.
Presumably it could then get to taller. No, we didn't have dollar theatres or did we?
I remember Tim Tebow operating on the ground floor in the Oval Office is.
But I can't envisage. And did you have another husband?
I mean, you're a pair of people. I seem to remember that as paediatric housemen, I was the only housemen and that we cross covered with the outcome.
Yes, that was made sense. I remember Cross covering. I remember taking over from Alan Spannaus.
So I think there probably was only one paediatric.
So I think they I think Gough and Dudley had to housemen, but one of them was adult and the other was and we swapped overall a bit.
Right. I think we may have swapped a part of the firm. You did?
Yes, because I remember being and now I come to think of it, I remember being in the operating theatres with Malcolm Gough at that juncture.
So then you go back to a on the national parliament.
I went back to the said yes. The weather not forgiven you.
Yes. And we looked up to these really very old leukaemia patients, lymphoma patients as well, even more hair raising.
I occasionally looked up to some of his private patients who were usually
crusty old bachelors from the university who were holed up on the private ward.
And they were which was right at the top above the Indian wards.
Yes. I remember going there at weekends and trying to cheer up these rather well.
They were pretty ill, many of the patients, and finding that quite difficult because they were quite, quite scary.
So now it was very interesting.
And to me then, I mean, it was Wetherall with say,
Jim Hoge was the senior editor because John Ledingham hadn't come in yet, but he buzzed off somewhere else.
He was. He was. Because we had Roger Smith and David Graham Smith during the time.
Was that when I was asked Joe, was that when I was housemen? I remember, but I worked with both of them and we had a lot of fun.
Yeah, cheerful physicians and interesting, interesting cases where today's close to saying, oh, well, I wondered whether I might become a neurologist.
Yes. So I did a year of neurology working with the likes of Charles withI Brian Matthews,
Charles Warlow at the church, at the church, and indeed on the specialist board there.
And Brian Matthews was the most remarkable clinician. I don't have to say.
I remember him walking onto the ward one morning and he said to me,
Whose patient is that p pointing to a young woman who is propped up in a bed with the cot sides up with a nasogastric tube.
I said, Well, not yours, Professor. I know that you haven't got a torch.
Patients got Wilson's disease. Good Lord. And he went to the bedside.
I produced my torch and I had got you of luxury. So he didn't say another word, but I mean, he couldn't have seen the kinds of the rings.
No, I've got courage afterwards to say to him, how did had he made the diagnosis?
Is there anything that causes a spastic Tatra paralysis with nasogastric with all problems?
So are the petina. To me that this was how you might make a spot diagnosis of autism.
But ever a fascinating disease, sorry. Why is neurology?
I then decided I wanted to work part time because we had two sons.
Well, actually, I decided I wanted to work part time before Tom was born.
And I did not think that part time neurology would be feasible in Oxford if you were a woman.
I think I was probably right.
So I said I was or had always been interested in ophthalmology, although I knew I was very unlikely to want to be in isolation.
But if the eye hospital was interested in employing someone who had a physician's background,
I would be very interested to do some homology with a view to becoming a physician with an interest in what I wanted to,
partly because I knew from my neurology that neuro ophthalmology was very interesting.
But equally, there wouldn't have been such characters around whether in fact and what was their response.
Jondaryan was a great hero. He was very, very supportive.
I don't think he quite knew what it was that I was going to do because he hadn't done much theology.
But he realised the fascination of the I use the ophthalmoscope and all sorts of how the I could help in diagnosis.
And he was he sent me to see the censor.
I think it must have been at the Royal College of Physicians involved.
So I put on my best frock and went to it was in the Georgian buildings on the right hand side at the college and is slightly elderly.
Man said. Oh, he said, you've come to see me about was it being an eye physician, he said doesn't exist, you know?
And I said, no, I realise that, but I'm very interested in it. And he said, well, I'm a diabetic allergist.
And he said, You've been sent by John Ledingham. He said, I work for Una Ledingham.
What a formidable lady and what a wonderful clinician. He said.
So I I understand, you know, what he was trying to say was that women could make reasonable physicians.
So he put on his glasses and he said there's no syllabus.
You know, I don't quite know what you have in mind. So of course, I'd gone with this thing in my handbag, which I produced and handed it to him.
And he looked at it. He said, oh, he said, oh, it's obviously going to take a bit of time to have a look at this.
Would you like a cup of tea? I said, thank you. He said, you haven't just come from Oxford to talk to me about this.
How are you? And I said, yes, I have. So he started to leave his way through the syllabus.
We looked over his glasses at me and he said, oh, he said, would you like a chocolate biscuit?
Then I thought to myself, I think I might be in with a chance. Yes.
So in the end, he said he could see what he could do and he realised that it was actually much broader spectrum than he had supposed.
There was not only diabetic eye disease and neural homology as inflammatory disease,
and it's overlapped with rheumatology the and diagnosis with things like Willson's disease and neurofibromatosis, lots of inherited diseases.
I mean, the sky's the limit really. Anyway, I went home and said to Robyn, my husband, hmm, not sure everything's going to happen.
It wasn't real for the plane, but it might have been. You know, I wonder he was a diabetic.
Oh, yes. Yes. Oh, I ought to remember this.
No, no, it doesn't matter. But he was at the vintage that might have been called Wilfred.
Anyway, about a month later, this thing plopped through the letterbox here.
Actually, we were living here and it said Royal College of Physicians.
I opened it thinking it was going to be a no. And it said we have the training committee has decided to award you an ad hominem training post.
I looked at this and I said to Robyn, hold on a minute, shouldn't that be?
And feminism, he said he said, shut up and just write back and say thank you very much.
So that was exactly what happened to me then.
Those days you had to get their registration permission then to go to work because you've got membership already.
I have got membership if it was in order to pursue an accredited training programme.
So it I think it was the training.
They were both accreditation that they had given me and then ticket to let other people should think of following in my tracks.
But that meant it's fascinating because it's the positions extending their orbit into their hospital.
Yes, but what were their hospitals saying? Um, well, I did a rather this is a rather PEGI thing to do.
I wasn't sure whether medical terminology would be a goer and whether anybody would want to follow in my footsteps.
So I had two tasks. One was to conduct a training programme, which I'll come back to later, if I may,
and the other was to find out whether this was a reasonable idea or not.
So I hit on this this idea, which was my idea that I would write to all thirteen of the professor of epidemiology in the United Kingdom.
So it was in pre email days.
So I typed out a letter and did my best to that exact lick stamps and addressed it to all these professors and of the thirteen eleven replied.
I thought was pretty good, but three of them said, what a brilliant idea, go for it.
I don't know how you're going to do it. Three or four of them said this is a really interesting idea and I would fully support it.
But it's very difficult because, of course, there are no jobs, so maybe you'd be foolish to do it.
Three of them said, I like the idea, but there's no way this is going to work.
And two or three of them, too, I think, wrote back and said, What on earth are you talking about?
Stop being so stupid. And one of them said, I shall be nameless where I went, but it was a fairly high ranking institution.
Would I go and see him, which I did.
And when I got rid of him, in a way I was in a way. But when I got back, in essence, I said to Robin said, So how did it go?
I said I was making a case. He simply did not want to hear this.
And so there were those who felt very strongly that I could only be done by an ophthalmologist as I'm breaking up the managers.
Well, that was a very interesting question, because what I had to do was to set out to win my spurs and be a good general opthamologist,
astute at diagnosing and understanding what surgery implied for the patient without hurtfully doing any operating myself because I'm being squeamish.
ISIS, one of the things that really makes it difficult for me and in fact,
it's the only time that I have actually passed out in the operating theatre,
although I think I was pregnant at the time, so that might have had something to do with it.
What I had to try and do is to maintain my credentials as a physician and possibly capitalising on my neurological training.
So I built up links with neurology and set up, in fact, a neuro theology clinic,
which I think was I certainly remember having a succession of neurology, senior registrars.
This was to, as I got more senior with my medical training and I also had to know what I was doing ophthalmological.
Because if you if you if you were foolish or if you didn't know what you were talking about, ophthalmologist didn't think that,
of course, because they felt that you were trespassing into their territory without really understanding what you were talking about.
I mean, you'd have to be able to dive in Stockholm and say exactly, exactly.
Because if you diagnose glaucoma as any old optic neuropathy, you that that was culpable.
There's absolutely no way to do that. But actually, the overlap in the quality was very, very interesting.
And I was quite clear in the end, John Illston came and didn't Hongchang did the diabetic work and therefore I was doing their very work.
You know, I had to train in diabetic work and I had to train in using the laser, which was not my favourite thing,
because I was terrified that I was going to do harm instead of good with the laser,
which, of course, is very difficult to do if if you're if you're trained in a good way.
It's difficult not it's difficult to say exactly.
There's the fixing beam and then there's the firing beam. So I did all of that and I went for part of my training.
I was working under Rosemary Roof scheme, which used to be called the part time married women scheme.
But there were lots of jokes about that. You know, were you part time when you the other part time or whatever?
Yeah. So training flexibly.
One of the great things about the scheme was that they would pay for you to go to get training outside Oxford if you couldn't get it in Oxford.
And neuropathology was an example.
So again, put on the best frock and went to see the wonderful Mike Saunders, who lives under the name of Saunders like Winnie the Pooh.
He was not Saunders, but some years ago. And he was he was quite intimidating when you first met him.
And he was a highly regarded clinician. He was a neuro ophthalmologist at Queen's Square.
And I went with my CV and I knew that he was training Elizabeth Graham, this Graham, who is my exact counterpart at St Thomas's Hospital.
But she was ahead of me in her training because she trained full time and in fact, I think went less than full time.
She she certainly postponed having a family until she had a consultant post in London.
So he had experience of training.
He knew that she was an excellent physician and knew that she'd made an excellent ophthalmologist as well within the neuropathology field.
And I went to him with my CV and he said, I'd love to employ you, but I'm afraid I can't pay you.
And I said, that's fine, Mr Saunders, because I come with my with my funding from Oxford, which he said, oh, well, when can you start?
Yes, but the previous week when I think about, you know, a few weeks time.
So every Friday, every Thursday evening, I would go to London, stay with a friend of ours overnight,
and then go to a full day clinic at Queen's Square on Friday.
Outpatient clinic, outpatient clinic. And he had very little.
Inpatient work, although we would work at patients who had to come in for the neurosurgeons now, I suppose in essence you asked why ophthalmology?
I've always found the I fascinating because it's visual and I'm very visual.
It's detailed and I'm very detailed. It's neat. And I love neat and tidy and orderly things.
I could never made a gut person, although the technique is there tidiness and you didn't have to get out of bed in the middle of the room,
which you did occasionally in neurology. And suddenly you might have to see sick patients in neurology on the ward if they were.
Yes, if there were medical problems that needed to be sorted out.
So it actually combined quite well with with wanting to look after children and helping support Robin in his career.
There was this hectic six years where I was mother to 52 children because we went into the Dragon school.
You ran the house? We ran the house at the Dragon.
Indeed, with fifty 10 to 11 year old boy there expected you to do better because I was the first house master's wife at the Dragon who had worked.
There was only one house that we could take over because it was a big house with
fifty and we had two Matron's and my job was to appoint and support the matrons,
but I didn't have to be there in the day because they would cross with each other and they used to look after our two boys who were little.
Then they were three and five.
When we moved in to the house, when they had things like they said her, the Oxford Hospital reacted because there who was there?
Was it turn on the television was very concerned that I might sort of might not mesh
into the way that the eye department ran because I wasn't a I wasn't a surgeon.
I didn't spend time in the operating theatre.
And I suppose my allegiances were very much to the sort of physician side of whatever it is would have been.
You'd have thought. I mean, I know he operated, but you'd have thought running the academic institute, he would have an hour.
Yes. Yes. I think I think he found it difficult for one reason or another.
He did when he retired. He did write me a delightful letter which said, I admire many things that you have achieved, many of them against.
No, some of them against opposition. And then there is a little sort of, Tony, broad caveat, which I said to him, thank you very much for your letter,
because and it was acknowledging that what I had set out to do had actually brought something to the hospital,
whereas he was worried, I think, that it might take something away from the hospital and take it into the medical domain.
But I enjoyed training juniors. I set up a medical clinic which was mostly uveitis to treat inflammation and infection.
And one of the things that was instrumental in setting up the post because they weren't exactly growing on trees at that time,
was the fact that I was invited by John Brazier,
who was a surgical colleague at University College in London, to set up a new service for HIV patients.
Yes, I remember it started in 93, which was actually almost at the peak of the epidemic of HIV AIDS.
And I had an average of one new patient with cytomegalovirus, retinitis,
which was the main site threatening infection of the highly immunosuppressed end of AIDS patients would get.
And it was a race between them dying and going blind if they had seen the retinitis, which often became bilateral.
So I and we had a rough incidence of one new case every fortnight in Oxford.
This was in London University College, one new case every fortnight and a death every fortnight.
So at any one time I had about 30 patients, three zero patients.
And we it was a battle and we fought it using intravenous drugs with Heckmann lines because there were no oral medications at that time.
So who is putting in the Heckmann and the husband, the HIV team would do that?
Yes. We then started to inject eyes.
And I have to say that we were told that this was crazy because we would detach the retina, there would be bleeding, there would be infection.
If particularly if we did repeated injections of antiviral gansett be forced on it,
there might be uveitis as a result of the injection of the medication. And of course, I was squeamish.
So I had to learn how to give these injections. They came in tiny insulin syringes and they were two drops.
Wow. So I think it's 100 microliters 50 microliters job job.
Got that wrong. I'm not sure. And I had to get my registrar to teach me how to do these injections, but I had to steel myself to do them.
And once at a conference, I was asked, does the patient need a sedative, Dr. Breath?
And I said, no, the doctor needs to know that providing explain to the patient what you're doing.
You're using days apparently know. So it was sort of.
But then who decided to do these injections? You said people were saying you can't do that.
So where did the where did the impetus come from? One of the extraordinary things about CMB retinitis was that we could see the relentless
progress of the retinitis by looking and by photographing and by mapping it.
And it was often the last thing that AIDS patients developed before they died.
So with this race against the virus,
we we the people in the states had injected and they had shown that you could get much higher concentrations of antiviral,
all the static, of course, nothing biocidal,
but that you could halt the retinitis by injecting in a way that you could never achieve with systemic levels of the drug through a human life,
even giving twice daily infusions with big peak levels.
Actually, I remember all the toxicity. I remember from George roaring around London on his motorbike with these sort of the
refrigerated equivalent of a pizza delivery thing in the back of his motorbike with all the.
Clearly a hospital which was tailor made to the weight and real function of each of the patients anyway to see the pharmacologist.
He was a palliative care doctor, but he was a man. He's rather like more grey.
He was a great sort of doer and a great visionary irregularity.
I mean, oh, yes, he would. There was nothing that Robert George couldn't overcome, hence the motorbike to weave through the London traffic.
Anyway, we injected eyes and we showed that it was relatively safe.
And these brave men who died, who had the courage to accept the injections,
paved the way to finding out that they were acceptable and indeed that they were efficacious for macular degeneration patients.
So I think without the pioneering work that these patients accepted,
you see the extraordinary thing in the eyes that the patients could see that they were going blind, literally.
They could see the visual field encroaching week by week, sometimes even day by day.
And they knew when you injected that it would stabilise things for maybe a fortnight.
But I do remember one of the early patients I injected, he was blind in one eye, had some vision in his second eye.
And in those days, 20 years ago, we would say that the worst possible side effects from the injections,
but we perhaps made light of them because we began to realise it was relatively safe.
Anyway, he was German, this patient, and he's lying there on the couch.
And I injected the eye and he said, it's black. I said, What did you say?
He said, it's black. I said, Your vision is black. He said, I can see nothing big intake of breath.
I said, it'll be because the pressure's gone up to a very slight extent and the eye is struggling with the blood supply.
Let's wait and saying a prayer under my breath, almost literally.
And I bet you in a minute or two hoping that this would be right.
It'll come back a minute, went by another half minute.
He said it's back. I said, is that you say it's still black?
He said, no, it's back. My vision has come back. Hmm.
Well, so before you end the AIDS, I mean, how part time were you, six sessions away from the AIDS off.
So this get back to my story, which I had gone off being with,
came before I had a consultant post in Oxford and I was working half time in Oxford, which I mean five, six months.
I think it must have been six sessions. Yes, that's right. So we sort of when you said but I'm off for a day in London, what do they say?
Well, I had some sort of because I was, as it were, supernumerary in our department,
providing I could fit round the arrangements that were made in London that was acceptable to the department.
I made sure that I think the only patients for whom I had nominal responsibility
under Tony Brown's supervision were in the neuro ophthalmology clinic.
But when did I start the inflammatory clinic? I must have majored in inflammatories.
But we always we were always careful to see that other trainees actually had exposure to inflammatory disease as well.
And was that in the hospital or in the Drumright? It was in the old hospital.
Yes, we were the one of the last. Because, I mean, did you run a germ clinic with direct with John Ledingham?
Yes. And that was in order to keep up my physician's credentials because I didn't know whether this wild card was going to come off.
And if it hadn't done, I think I would have gone. Will work as a general physician.
I didn't quite know how that was going to work. I do remember going to talk to Andrew Marcus in time about whether I would be able to qualify as a GP.
And there was this window of opportunity after which I would lose all the training I had ever had in general medicine,
and I'd have to go back to square one to train as a GP. So that was a bit of a wake up call.
Anyway, I did eventually get a job in Oxford, which was crafted on the back of having already set up the London clinic for HIV patients.
And although we never had many HIV patients at any one time, HIV AIDS patients in Oxford proportionately far fewer.
But Tim Pito in particular said, But with this patient choice, Peggie,
we will have to pay for those patients that you're already looking after and future patients with Kotva retinitis because
we wouldn't actually find anybody else who could look after them in the way that you can with your London expertise.
The trust will have to pay for those patients to go all the way to London to see
you regularly so I can make a case to show them that it's not cost effective.
And indeed, that is what happened. And the chief executive asked to see me, David Wilson, I remember he said, who are you and what do you do?
And unbeknown to me, I had told the patients I must have been running an inflammatory clinic at that time.
I told them that the clinic was coming to a halt because I was no longer going to be working in Oxford
because my training programme had come to an end around the time I remember Dulci Goodings saying to me,
We think it's in your interest. Or perhaps it was Shirlee able. It was whoever was the dean of the part time trading scheme.
We think it will force the question of whether you will be best deployed, which was whether there would be a job in Oxford or not.
We think otherwise it would kind become like an endless piece of elastic. You might never get a consultant post.
Indeed they would. Yes. So I was sort of homeless, as it were.
But my little unbeknown to me, three of my patients, I think, wrote to the chief executive and said,
we don't know what we're going to do when we go back to the general clinic, which is very good, very good of them.
So you saw David Wilson. I saw David Wilson.
And I remember Alex Gatherer was the head honcho managerially, and I had to go and talk to him best from time again.
And he was very helpful and very genial.
I think he'd been briefed by senior colleagues who knew me well and also the way that the funding was that they came over a with them.
I think there was more of support from general medical side, including the infectious disease.
By this time, because of the HIV,
also the rheumatologists were very supportive because I had developed with John Adams help and his expertise in the clinic,
I developed a particular interest in Sakiewicz and veganism. Beginners in particular can drill holes in the eye very quickly because you get a
vasculitis which cuts off the blood supply to the sclera and it can be very painful,
can be painless in rheumatoid arthritis. And you get this black hole appearing on the on the skin.
The real challenge is that Roger Smith said it would have been yes.
Yes, he would have been very supportive. And I asked him estimate. Yes, he had taught me when I was their opportunity.
They were up at the end of the clinic that I didn't because I went to Liz Graham to do inflammatory diseases and Thomases.
And I had the experience from John Ledingham, who had a lot of eagerness. Yes, I could patients and I believe and lupus patients indeed,
although they were by then pretty well managed with with steroids and brain and other immunosuppression cyclophosphamide,
that they didn't often develop vascular complications in the eye.
But I have seen optic neuropathies and skywriters in in lupus.
Now, you said you were, as it were, under Tony Bronzewing, but you were NHS not being correct.
I only came on the scene as far as university was concerned when I took up the post at the medical school.
Right. When we come to that later. The other question, during the Howard Williams deal, I know Howard Williams, Julia John Howard Williams diabetes.
Yes. Yes. When she was going through the same troubles as the combat.
Yes, I do know her name. I didn't know her personally.
I don't think she would have been in the eighties, you know.
Yes, she'd probably been a bit younger than me who she must have been around at that time.
She would be attached to further Vaudrey. I think about to say how interesting, though, because he was preheating, of course.
So it could have been at a time when I happened to be doing other things elsewhere.
Yes. And I'm not sure what happened when he came on the scene and took over from Philip.
Well, the diabetes diabetic. Well, he didn't me. I'm sure he did.
And he didn't. But in a sense, Filipov, he went on, as well as who and who was say that talked to him, that he got immersed in the new contract.
Yes, you know, that took a tremendous amount. I mean, he'd done a tremendous amount of damage is in London.
Yes. The vicuña. Yes. But in Oxford, I mean, until.
Well, I mean, he did a lot of calculation on this, but, you know, until as it were finished, when he wouldn't have done it all by any means.
No, I suppose all the trainees did their share of diabetic work.
Whom did the operative Laza.
Right. Which was where you had to use blunderbuss treatment for really resistant proliferative disease,
particularly if they'd had a vitreous haemorrhage which had cleared,
they would often anaesthetise them and put on big on bones, which is very painful, I think, to do in the unanesthetized patient.
So they would come in for quite major sessions.
And, you know, you could add more than at what time did you, in fact, move to the university.
And that's where it doesn't matter that they took it from Joan Trull.
David asked whether I was interested in the directorship of clinical studies,
and I felt that that would have meant giving up some of the clinical work that I'd established in Oxford.
And I didn't want to do that because I wanted the continuity with patients. But I said I'd be very interested if there were a deputy position.
And Sue, of course, who became director of clinical studies.
And we made a team together. That's four times when you were half and half, as it were initially.
I mean, I did two sessions, which later went to three sessions, which meant that I went up to I had three jobs.
I had a weekly clinic in London on Friday, which was all day.
And was Helter-Skelter absolutely beginning to end?
Because I didn't I didn't I was just making out the case for having someone to help me in
the clinic when in fact combination therapy came on the scene and AIDS incidence declined.
And in that clinic, would you still be injecting people? Busy, busy times?
Yeah, I think 1998, three jobs. So I had three jobs, which was sort of made up a full time number of sessions, but was over and above.
I became quite good at compartmentalising. Sure.
And saying, well, if you don't mind, I'll deal with that on Tuesday or Wednesday or whatever it may be,
depending on which day I was in that particular place. So what were you doing as director of clinical studies?
As deputy director of clinical studies, my brief became the pastoral care of the student.
I mean, I was supporting ASU, yes.
And the first thing we had to face was this first major inspections and I remember Sue helping everybody and cajoling
everybody and cracking the whip in the end to get all these blasted filing cabinets full of all this paperwork,
which had never existed, literally a room full with these filing cabinets.
It was like something out of Kafka. And she was brilliant. I remember her phoning up.
She may have told you this story about phoning up Peter Morris in Australia. Yes.
And he was saying it's not my problem. And she said, oh, please send somebody to I think, you know, in the nice way.
She's very proud of it. And it is. Absolutely. And I shouldn't tell this story, but maybe I will.
The day before the inspectors were due to give their report, she called me to her office and she said,
Betty, I have one problem you might be able to help me with. I said, was that so?
She said, When people say nice things about me, I tend to burst into tears.
And I said to her, well, that's going to be difficult then, because they're bound to say nice things about.
So what can we do? I said, treating it as if she might be one of my pastoral students.
I said, I see three possibilities.
Number one, you burst into tears and they wait until that settles down and then you explain no to you burst into tears.
And I explain that this might have happened and you can decide whether to leave the room or whether to not.
Number three, we tell them pre-emptively that this might. Oh, No. Four is we just tough it out.
And I do remember being there when the report was given and I was catching her eye.
She didn't know sort of began. And then we sort of.
So that was that was yes. She was terrific at that it pastoral care was necessary or was were you doing.
Because when I was a medical student there wasn't any public health.
So when did it come in and how did you find it?
Joan Troell had blazed the trail because she was with John Cyr.
Yes, he was director and she was deputy director and she had made pastoral care.
Big thing. And she told me when I took over, she said, Peggy, you will be surprised at two things.
One is the incidence of serious illness and indeed bereavement in the families of medical students because being in their twenties,
their parents in their 50s have a kind of blip in their mortality rate and heart attacks and cardiovascular disease in particular.
And she said the other is the level of mental ill health amongst students, medical students,
stress job, I think probably talented, quite high achieving, high attaining students.
There's quite high incidence as the incidence, particularly of women.
Rose, I'm not a sexist comment, but it's well known that eating disorders are much commoner in women.
So she said anorexia depression, which might well the stress of being a medical student might have contributed to.
So I thought she was absolutely right.
Of course, the fact that she was at the GMC, that it was quite easy to talk to her about fitness, to practise questions.
And in my mind, very early on, teasing out fitness to study as being very distinct from fitness to practise,
because fitness to study meant that, say, a student with eating disorders had to stop studying for their own health reasons.
That did not mean that they were not going to qualify as a doctor and that they would therefore be deemed less fit to practise.
But we were saying to them as students that they were not fit to study at that time.
Yes, just as if they've broken limbs or whatever.
And we worked with the College Doctors Association.
I was chair of the College Doctors Association for can't remember how many years, certainly more than ten.
And I think their provision for mental health in in students and medical students in particular is good.
We're very lucky these characters were coming to you or you in anyway.
So I decided in view of the time that I had and the fact that there were 150 each year by that,
it grew to that number quite rapidly with the GMC reforms and being asked to take more.
So it had already started under John Ledingham, but under John Seah and then on to see the numbers road,
I decided that I would appraise each of them once during their time,
the medical school, because it would be possible for someone with my timetable to do that if I was fairly efficient doing it.
So I asked the secretary if she could sort of call them up one by one,
not alphabetically, but at the same stage or with a potluck with her third year.
I would do it in year five.
So that would be the middle year of their clinical studies, because at that point they understood what it was to be a clinical student.
And as it developed, I actually focussed on what? Their career choice might be,
but it also gave me an opportunity to honour those who were actually thinking of leaving medicine or who had become disillusioned or who
actually were subliminally unwell in some way they might be depressed or they might be struggling with some undisclosed medical problem,
which they hadn't wanted to declare. So I had to tread a fine line between things on the record, off the record confidentiality,
often saying, would you like me to make an appointment for this person,
which might be their GP with them in the room so that they would know what I'd said, which was just can we make an appointment for this person?
Because left to their own devices, they might might not find the will to do that,
whereas they had agreed that I would do up to them whether they kept the appointment or not.
So it was treading that fine line between not being a nanny to them, but doing strategy with them.
Yes. And could you would you talk to the consultants?
They were working.
And at the time, sometimes I tried very hard, particularly with Tim Lancasters help to build up the cadre of clinical tutors within the colleges.
Some were excellent and some were dormant, weren't actually interested in doing this pastoral stuff.
They thought the medical school should do that, whereas we always felt that to have another string to the bow for the students to turn to
through their college was a very good idea and some of the college tutors were excellent.
And we set up training days. I remember Basil Shepstone Blessin departing because we had a role to play.
He didn't do role play, so he got up and left, which of course, he was quite entitled to do.
But Chris Bulstrode was very helpful in setting up certain things from the.
Yes, he was very interested in education. He said, as you probably know, he may have mentioned as well the educating the educators, the Unicon course,
right where we went away to some frightfully nice place like what's the place where the National Westminster Bank is now?
And he probably was and will be put up for a weekend.
And we do sort of quite intensive stuff to do because, I mean, in my time, which goes up to 92, the most they were doing was videoing people.
They just began to video teaching. Yes.
And there was nothing else. And it was very interesting because Chris was very good.
Intuitively, the courses were small enough that he would sort of have have a some idea of how each tutor
worked and he would try and show them that there were things greater than their horizons.
Mine was extempore teaching, which I would never do. I would always be well prepared.
And I said, but I'd have to have slides. I show them something. No, Peggy, these are not farmers.
Go teach them how to do ophthalmoscope. And that actually was quite an eye opener because you could see that if you if you if you took a deep breath,
you could use teaching methods that you wouldn't normally have felt comfortable using.
And so there was definitely. And then you became the director.
No, I didn't. I stayed deputy. But Sue became Tim Lancaster took over.
Right. Um, and he he was he was his great strength is in organising things and delegating things to people to get things done.
He also has a very strong suit in teaching himself and is much beloved by the students for being a very good hands on teacher.
He's also brilliant at remembering their names, which I absolutely hope is that that's just the way my brain doesn't work.
But I think it was very good for me to see each student once it ended up being an
a half hour slot because there was some work they had to do before they came.
And then we would go through the work that they had done to see how their profile stacked up with what they thought they might do.
Right. And often it was quite congruous. Sometimes it was other things would suggest themselves.
So it became a sort of career counselling when I was thinking that.
And in fact, I mean, second clinical year, many of them would change their minds after that.
And I mean, that's fine. And when they come back for reunions, they often say, do you remember?
I always say yes. And they said, you said to me that I might enjoy anaesthetics.
And I never thought it. And I said, well, I thought it was boring. But then I went, I did a special study module.
I realised this is exactly what I wanted to do. I'm not always that story.
I did meet I meet some who've left medicine right and they looked slightly sheepish.
They're always wearing very smart suits. They come back to the come, you know, they're so good in the lawyers or the city or what.
I am cheeky enough to say, Oh man, con, which is management consulting.
Yes, Dr. Frist, we're coming back to tell you how to run the children's hospital, and I say, oh, really good luck.
Good luck. And is that the thing you guys enjoyed most or what would it be, the clinical words going on or both of those?
I'm pretty chuffed that I broke into a sort of nonexistent clinical word and set up a clinic and that we kind of triumphed in the eye.
It wasn't me that triumphed over blindness in AIDS,
but I do working in conjunction with brave patients who are in the most extraordinary I mean, AIDS was the most ghastly.
Yeah, yeah. And working alongside HIV physicians was what I really did enjoy doing and felt very pleased about it.
And I wish that they kept that on. After I retired from the Inflammatory Disease Clinic at Oxford,
I came to find because the field is quite narrow and because I wasn't working full time,
that the actual conditions that presented were less of a diagnostic challenge.
So it sort of closed in on me a bit to the inflammatory disease.
But then we had novel therapies with the mono therapies, so it was exciting to see those becoming effective.
But I wasn't on the crest of that wave. I was in the sort of power wave of setting that up.
So I missed the dramatically. Yes, we'd moved by then. I was lead clinician at the hospital when we moved.
My goodness me. That would, you know, stories to tell about that.
Like none of the phones worked and all the bleeps worked.
What we're trying to run a seamless 24 hour emergency service for the whole of Oxfordshire and beyond here.
And none of it none of the phones worked and the bleeps didn't work.
Well, we were in some electronic black hole, so I had to jump up and down, get that sorted out pretty quickly if I could.
Anyway, they said there's hope stories associated with that. Um, I think that the most fulfilling thing probably has been working with students
and helping them get alongside their struggles and acting as an ally in that.
It's very like the work that one does clinically. Joan Child told me that she's just like another outpatient clinic patient.
So there were some students I got to know really well because they often had challenging problems.
And it was a we didn't lose many in the sense of leaving medicine,
all the eating disorders students came through and many of them have made brilliant doctors.
All but one of the depressives.
And I think even of those I chatted around who were thinking of leaving medicine, I would say, well, get your qualification,
think about GMC and then and then have another thing,
because otherwise you're turning your back on something that you will not be able to get back to.
Yes, that's very good advice. But they can put it in your back pocket.
Yes. And it's only a year or two. And you've got that for always, particularly if you've got your GMC registration, Camerata or whatever.
Exactly. Exactly. But I mean, in fact, in the 60s, I mean, bullying was a fact on the roads.
And in 2000, was it still happening? Yes.
Is the answer to that. But I think that the students are more open, particularly if asked directly, and that tends to be a domino effect.
I think they're more supportive of each other.
And I had a particular whether it's because I'm a woman and whether because there are proportionately more women students.
Now, I had a particular interest in helping to address sexism in medicine as it applied to students,
actually, the chaps that the male students who are often amongst the most supportive of the women's eyes.
And they were pretty indignant when they had been teaching me there was one particular teacher who shall be nameless,
who would pretty well exclude the women from his teaching as they all go away.
And I went to see Sue with this, and I had asked the students just to give me a sort of verbatim idea of what he'd been saying,
which made it clear that he wasn't really interested in teaching the student, the women students, his subject.
So she said to me, said, what do we do now? I said, Sue, either you go or I go.
We go together, I think. And in the end, she went and he said, But you have no evidence of this.
And she said, well, these are the things that some of the students have said, handed it to him.
And he went very quiet and he stopped the behaviour.
And I don't think she had to be pretty heavy handed with him, just became aware of the fact that that he'd lost his anonymity.
Yes. But there was also bullying of both sexes going on.
Yes. Yes. I think particularly when people are under pressure and they I think some people use pretty fruity language.
And I think the bullying associated with I won't give you a good reference has gone because they demolished
that system of patronage is so that that fear of blotting your copy book and of somebody saying,
I wouldn't employ this person if I were you for good or bad.
Yeah. And now no longer teachers. I think overt bullying harassment is actually now rarer than it was.
Well, I would guess it now it's gone to 12 there.
Is it still happening?
I would say that a senior people treat more junior people in a way that I would not countenance more often than I would feel comfortable with that.
I can't say that there's an epidemic. No.
And that the students are getting a bit better than the students, I think are getting better at saying, oh, I,
I don't know that somebody they need somebody to come to and they know that there will be
a system whereby without there being an inquisition or a sort of crucible sort of effect,
that if they say that somebody has said something, if they have a contemporaneous record of what's being said, that this may come to light.
And so I think that there is less of it as a result.
Of course, we don't know what's under the tip of the iceberg, but having seen the iceberg for nearly 20 years,
I think it did become smaller, but it didn't disappear completely.
Now, let's go back to work. All this time you would be writing papers,
something if that was one of my problems in being I don't feel I sometimes say
to people I'm not an academic by nature because I don't like writing things up.
My ideal combination would be to be the gofer who found things out, but get somebody else to write the paper.
I think I may be dyslexic in some way.
I find it very difficult to crystallise my thoughts in print.
I don't find it difficult to crystallise my thoughts when I'm teaching because you've got images in and that is true of handwriting.
As a typing on a PC, I still type with two fingers and I found it very difficult to learn the piano because I can't.
To me, it's a mystery that Angela sits there with these things in her ears.
I know it's already Carolyn who's done transforming jobs, fixing all our translator,
translating the audio to what comes out of their fingers to me is a miracle.
Yes, I can't see myself ever doing that. So I do.
It's always been a bit of a slog writing things. And you'd be going to national meetings.
Oh, yes. Yes. And we did. Yes.
I have spoken internationally on HIV and on pemphigoid, which was the subject of my M.D. thesis, again, with my dermatological links.
Sorry, I haven't picked this up when they developed.
Well, I joined I became an honorary dermatologist, so with a wonderful trail of of mostly women.
So there was there was Superjet, Vanessa Van Halen, mostly vanilla from your Oscar?
Yes, she was very influential, but I had no idea she was brilliant at writing papers.
She was this, you know, this drive to get things published.
And so she was an expert in blistering disorders of the skin.
And we knew that secretaryship pemphigoid, which is rare but tends not to produce much in the way of skin blisters, if at all.
But this was akin to bullous pemphigoid, which is a blistering disease, which Cicatrice pemphigoid.
The scarring pemphigoid does have potentially blinding repercussions because it affects the cornea.
Bullous pemphigoid did not appear to affect the cornea and then was a whole host of absolutely fascinating,
really rare, blistering conditions related to things going on at the basement membranes in skin dermatitis.
Pettifor Miss herpes gestation, as it was called.
It's got another name now, but we're pregnant. Women would get blistering in the skin and the deposition of immunoglobulin at the base membrane.
And then a whole fascinating group of children, some of whom would make it into adult life, who had genetic.
Programmed disorders of the basement membranes. So I studied hundreds of these patients, 400 and something, and I went to Great Ormond Street,
to the skin clinic there with David Atherton to see these children with blistering disorders, some of them very severely affected.
We found a higher incidence of corneal disease than we had suspected,
a higher incidence of symptoms in very little babies who were having corneal erosions where the corneal surface had blistered often at night anyway,
because they yes, they wake up screaming and rubbing eyes with a lot of watering and were inconsolable because it is very painful.
It's like having your eyes scratched and then they would often get an erosion that would wake them up for several nights in a row.
And often that wasn't realised, very often wasn't realised.
We came up with a very simple regime for the parents to use with lubricants and putting it pad over
the eye and it reduced the length of these episodes significantly induce an antibiotic ointment.
And I followed up some of those children in Birmingham. I went to Celia Moss's clinic in Birmingham.
She was a blistering specialist as well.
And I once had to give a talk at the Dowling Club, which is the dining club for dermatologists throughout the UK.
So that was very fascinating because we and I was looking at the conjunct over clinically and I was
also taking small samples of conjunctiva from the surface of the eye with forceps and little snip.
And we do immuno fluorescence on these tiny, tiny about the size of a pin, his right arm.
Anyway, I crunched together this theset. I remember saying to Robyn, I don't need to write this thesis.
I just can't do it. And he was saying, come on, Peggy,
think of that wonderful gown that you can wear as a nobody is doing that in the skin clinics in the in the Churchill.
And I went to Kettering in Northampton and I sort of moonlighted all over the southern U.K. I'm freezing these pieces of conjunctiva and you say,
yeah, so who's doing the immuno fluorescent and all that?
That was done by Peter Mylord. Right. Coming full circle back to my student days and what the really, truly wonderful person was,
the technician who used to cut the sections because dead easy to lose this pin before, you know, say there's nothing there.
And I would say there is. You've dropped it off and it's fallen into.
Yes. And then you just did the international you talk.
But did you go to many conferences abroad? I'm not a great conference person, I'm afraid.
I found it was a very small field and much as it was quite fun to hobnob with ones,
that meant we were very small group who would get together by referring patients occasionally clinically.
So I would often send my if I had really difficult patients, I would send them to Les Graham at Thomas's,
sometimes to John Darte, who'd been a trainee of mine who became also interested in Pemphigoid Warfield's.
So I thought it was a bit of a slog preparing papers.
And you know what? I'm not. For me, the thrill is in finding things out rather than in getting them out there.
I could be taken and was taken to task for that. When Martin Black looked at my thesis.
Who's he? He's a dermatologist, but he's another expert in blistering diseases at St. John Hospital in London that used to be in Chinatown.
He said there's so much interesting work in here, you should have published it.
And I thought, this is what this is. There it is.
I'm sure you me read it in the library, you know, gave permission because in a sense, I mean, you have it, but I know what you mean.
Yes. And what happened? I asked you about that.
I should have asked you don't think of March.
I'd rather rather anecdotally rambled on about a number of things.
Um, I have a position at New College because Alan, when John Ledingham retired from New College, Alan Townsend became the clinical fellow.
But because new college has always had a relatively large number of clinical students,
they asked whether I would help him to look after the students because they might pass by then was fairly well honed.
And that's been very interesting. So I do admissions and I enjoy that trying to spot candidates who are with the bema.
Now, all of them, I think, would be takeup, but it's trying to find a group who will hang together as five students who
will bring something extra without wanting them to be in a particular mood.
So I find that quite interesting. I mean, you really it's another group when you're admitting it's very to begin with,
the four of us, there are two preconditions to see of the students.
Is that what do you mean the group of five students? Yes. Yes.
I never thought of that because I always thought, you know,
the people who most would be good to come or you thought they did and then had to get on with it.
But yes, they were very interested, I suppose.
I suppose there was something sort of tacit I don't know whether it was ever made explicit between the four of us who were hunting,
as it were, that we were looking for a fairly convivial people who.
Oh, that's true. I mean, only one people. I enjoyed teaching. Yes.
And that they would have that human spark, which would mean that they would relate to each other as individual human beings.
Occasionally we would take a wild card and sometimes it didn't work out as well as we might have hoped.
But isn't that that's true? I'm sure everybody I guess that so I suppose the overall challenge of having had an
effect over the years by virtue of having been clinging on here for so many decades,
I suppose that I understood some of the players who were playing. The other thing I have been involved in is the dreaded Athena Swan.
Women in I say dread it because it's an awful lot of work which was foisted on departments by our wonderful chief medical officer,
Sally Davis, who said, where are all the senior women when it comes to allocating money?
And there was a sort of some people thought she was crazy and some people
thought she was meddling and interfering and other people thought she was dead. Right.
And so it has turned out, for instance, at Oxford, but it was fascinating going round.
I tried to sort of strike the match, as it were,
with heads of clinical departments for them to be enthused by the goods that might come from this rather than seeing it as a yes,
a troublesome, time consuming, annoying sort of diversion which they had to go through in order to get their their funding.
Yes. And I think actually it has been very informative.
And what you have spoken about is Gingery. Oh, oh, my goodness.
I mean, to my mind, the people, they changed Indrek,
but much for the better over the Cambridge people because they came in with the footlights and that sort of idea.
But what are your memories of my memories, Anthony? Well, I was a senior member, yes.
But most of the time last year I was. But I was member of quite a long time.
And I brought in the idea of getting the script right.
And David Smith did that for a time when may have done right.
He may have done I don't think the scripts were being vetted very vigorously when I took over.
That one would be talking. It would help. I haven't done it for many ten years.
I would have done it for the time in 2001 after 2000, probably would have I think I was already doing it.
When I say that was 1998, because I think it was around 1990, said yes.
Oh, well, maybe I wasn't the first, but I might. I did a number of stories that you can't divulge, but I do.
And what do I do remember saying to them? Because they left it very late to send me the script and I took advice from people fairly high.
Administration and I smelled a rat, something that was going to be politically very sensitive,
so we had to change the identity of a particular nationality. One of the consultants portrayed in Tingeing.
Right. Who is in trouble and the sensitivities around that the students simply hadn't understood.
No, no. So do the admin. People would bail out of anything. But nonetheless, you know, I do understand.
Yeah. Yeah. And then another, you know, more scurrilous things to do with the personal lives of certain senior members of staff,
which I had to point out to them that this might be in the student's imagination.
But just suppose that it wasn't entirely clear what should happen here.
Oh, my goodness. This look of horror came over their face. You mean this is actually happening?
I suppose it might be. How are you going to feel and how is the other person going to feel?
But we managed to smooth that one out with a bit of fancy footwork. Is I mean, way back you took part in it?
No, I sold the story. I was a part of the firm, but I sold the tickets, did the backroom stuff.
No, see, Sue was a great actor, Sue, but. Right. I would have like to be a good actor, but I never had the courage.
My courage failed me. I think.
Well, I've been on stage a number of times to be lampooned, usually as a goody goody, as a senior member, often against Michael Donaghy.
I think they used to find that was funny. No, I mean, you went to quite a few hospitals while you were also in Oxford.
And I know it's very difficult and probably the answer's fairly obvious.
How did Oxford compare to the other hospitals to do think as a hospital and medical school?
And I sort of thought specifically about that, I think it was very well run actually,
compared with those hobnob places like Green Square, which were very specialised, I reckon that we did as well clinically.
And and we often would send particularly difficult diagnostic cases to them.
But I think that acumen was pretty. You know, if we found we were puzzled as to what it was often they were.
On the whole, I think Oxford did a remarkably good job of combining its district hospital aspect with its specialised aspect,
because I think it did both remarkably well.
Certainly in the days that I was treading the boards on the wards, which was when I was more junior, I think that's quite remarkable that we had.
A cadre of very talented consultants who taught us and who worked clinically alongside and I think that's the unique thing about medicine,
even more than law, probably, that you actually analyse in detail as it happens on a live person,
a patient with someone who's more experienced than another pair of eyes that knows what's going on here.
I find this absolutely fascinating. And so I think Oxford did that as well as well as any other place.
Hey, what about the nursing home? That's hard to say because most of the places that I went were outpatient days.
So I had very little exposure to inpatient nursing in the London hospitals and a lot of backup investigation, pathology.
Biochemistry, again, probably isn't quite.
I think one of the things about Oxford was this close association with the people who were doing the specialised work.
So someone like Peter Mylord, who was doing skin pathology,
the people who were doing renal pathology and actually going and looking down a microscope.
So I'm John Ledingham was very keen on that when I did the renal unit, that if you had a biopsy and it was a difficult diagnostic case,
we'd all troop off to the pathologist and Michael Dumbell or David Davis would have the slides there forced the renal unit.
Oh, yes. Yes. For the people who were doing renal pathology and actually going and looking down a microscope.
So I'm John Ledingham was very keen on that when I did the renal unit, that if you had a biopsy and it was a difficult diagnostic case,
we'd all troop off to the pathologist and Michael Daniel or David Davis would have the slides, therefore, the renal unit.
Oh, yes, yes, yes, yes, yes, yes, yes.
In the days when we didn't dialyse, anyone over 60 or so, because, of course,
they went blind on their first or second dialysis with the heparin because they were with diabetic,
they they had high incidence of proliferative retinopathy and the strategy that they would begin dialysis sited.
Right. And very often get haemorrhaging one eye because Victa persons at Kings, that got them going.
But it it's interesting, but I don't know what you did, but, you know, I know it was a big influence peddling.
I'm about to close you down. Anything else you want to say? So I'm in a super interview.
Thank you very much. Yeah.