John, we're recording interview on what is it,
the 20th is the 20th of November one three about you and your experiences with the Oxford Medical School.
What led you to come to Oxford, would you say? Oh, job, yes.
But were you advised to apply? Were you invited to apply?
Did you see the advert? No, I was I saw the advert because those days you saw what was coming up in the BMJ, of course.
But I wanted to come to the Oxford Neurology Department as opposed to having to go into the London system,
which would almost certainly have meant going to the National.
And Oxford had a very good department.
It was headed by Richard Russell and it had a very good while Richard Russell was there.
They just appointment at that time, I think.
But anyway, there were other NHS consultants who were of good reputation and it had a very good neurosurgical department,
which in some senses had been spawned from the London hospital,
which is where I did my clinical training and where I did my first two years of post qualification jobs, because Pennebaker,
who was the senior neurosurgeon in Oxford, had come to Oxford from the London and indeed, uh, Professor Cairns had come to Oxford from London.
Although by 1965, when I came to Oxford, of course, Professor Cairns had been dead for a number of years.
So, yeah, Oxford looked very nice to me.
And I also wanted to stay in the UK for family reasons.
And if I hadn't come to Oxford,
I would very probably have gone to Boston because I had a U.S. Public Health Service Fellowship that I could have take it up.
And there were plans for me to go to the Boston VA where Norman Gershman was, but I opted for Oxford instead.
That's interesting. I mean, you use public fellowship. You did you ever take it up as well?
Did you ever start it? Did you do anything to them or had you applied for it or was it dropped from the skies?
Well, I can't remember, but I presume I must have applied for I mean, I don't think you know, I don't think these things dropped from the skies.
That was in case you didn't get a job in England that suited you. You know, it was.
Because at the time of that, I applied for, I thought that that would be the best thing for me to do.
And you know Gershwin. Yes, yes, yes. I knew no engagement.
And he had said, come. And I said, okay.
But time passes, of course, from between deciding that that was the thing to do and applying for the fellowship and take months before.
Exactly. Actually know that is possible. What did you just like about the London system?
Well, I was in a slightly unusual beast, I suppose, because I did my clinical training at the London after I had got a Ph.D. in Cambridge.
And I knew when I went on to clinical training that I wanted to be a neurologist because I was particularly interested in the brain.
And I before the U.S. Public Health Service thing arose,
I already had a mental health research fund travelling fellowship which had been awarded to me on the basis of some competition that I entered.
And although I got this fellowship, I didn't know exactly how I wanted to use it.
So I went to Oliver Zango, who was the professor of psychology in Cambridge,
who had sort of pointed me in the various directions that I had gone in up until then.
And I said, what would your advice be on where to spend this fellowship?
And he advised me to go and seek the advice of Roger Gillet, who was the professor of neurology at the time.
So I sought an appointment with Roger It and duly saw him.
And he was very disparaging, really. He told me that I should contemplate taking up this fellowship until I had gained the experience
of admitting some enormous number of patients as an essay which was certain the national.
And I thought that was rather boring, I guess.
And so you have membership at this stage.
You should have membership. No, no. I was only about 18 months qualified.
Yeah, I, um, I was actually doing a as a job in cardiology at the London time, but I, you know, I was getting old.
I didn't see a great point in hanging around too long.
And you came to Oxford and of course Richard was very conscious that he was different from Green Square.
And, you know, I was quite proud of it. But after, say, three or six months, did you regret your choice?
No, no, I never have. I never said the nursing in Oxford compared to the nursing in London was right up to scratch, would you say?
Oh, yeah, the nursing was very good.
And I'm in the Oxford Department at that time, had what basically, I suppose, two systems of nursing because it had the ordinary,
the inverted commas, neurology, ward, nursing of all the various forms of neurological patients.
But in addition, on the other side of the corridor, it had its own respiratory unit for the care of patients with friends, was killed very soon.
Myasthenia gravis in a severe state or tetanus who?
Needed respiratory assistance, it had this research unit, so it took in a very wide range of neurology patients.
I know that you got very involved at times with the respiratory unit.
We'll talk about that. But equally, A, your interest of yours was epilepsy.
When did that begin to develop? Well,
it had the germs of it had been sewn while I was still an undergraduate student in
Cambridge before I had done a clinical training because it was in the second half
of the 1950s that a lot of work was coming out of the Montreal Geological Institute
on the relationship between the cerebral localisation and cognitive function.
And in particular, in the late 1950s, there had been this realisation that the medial temporal lobe structures,
particularly the campus of the amygdala,
were extremely important for memory, that without these structures intact, um, one was highly likely to have a very deficient memory system.
And prior to the mid 1950s, that would be a very little inkling of that at all.
Um, you know, it was well recognised that the that the thalamus was very important in causing severe amnesia,
but the hippocampus and the amygdala had not really been recognised.
And that recognition, of course, came out of work that was related to the surgical treatment of epilepsy.
And so even before I went on to medical school, and certainly long before I was in Oxford, I had had an interest in focal epilepsy particularly.
And did that continue early in Oxford? Because I remember when this woman who was interested in epilepsy was always linking up
with Charles withi Yat-Sen there was it with Charles that we went down with Charles,
but also received calls that, um,
Charles had edited a book of his own on which is sitting somewhere else anyway on memory function and epilepsy and such.
And initially, you have been doing general neurology time on the respiratory unit.
And that was particularly Joan Spalding, I would guess.
Yeah. And that experiments with. Right. As the anaesthetist who integrated with them and I mean, they did tremendous things.
Yeah. They improved the treatment of the people with failure of breathing because they improved the swallowing angle didn't they.
They stopped people taking on their own saliva. Well, you know, they certainly stopped people through saliva.
But of course, um, the, uh.
Well, in some of these conditions, such as myasthenia, um, and also to some extent we working on very similar, but particularly myasthenia,
one of the major deficits is that the respiratory muscles aren't functioning, so the breathing becomes deficient because of that.
There is also in some of some condition.
Such as testimonies or even status epilepticus, the need to paralyse the patient and to breathe for them mechanically pump,
so it is partly the swallowing deficit, but also the weakness of the respiratory muscles, whether induced,
as with corollary, to try to control the disease process or whether the cause of the disease process has been much thinner with
the tetanus people that came the introduction of the beta blockers to help against those annoying storms.
That must have been a tremendous development. And how long did it take, really?
Oh, I don't know that I can answer that question.
I mean, they used to be enormous discussion as to what medication should be introduced to control blood pressure fluctuations.
One of the major problems is and the beta blockers really worked extremely well.
Is that right? Yes. Yeah. Yeah, that was great.
Now, I know that involved the whole working together, John Spaulding and Alex Cramton Smith.
And at one time, I gather John Spaulding put in for the chair of Anaesthetics of companies with it.
Was that a wise move, Derek?
I don't know. That's before my time. Right.
But did you know about that at the time that he'd put in for it?
And and the first I've heard about that.
But anyhow, what you do have feelings about are the various professors of neurology, which was the first professor in the chair, the Maxwell job.
Yeah, well, yeah, the actual research is I think you're right.
But and Ritchie, what would you say was Richard's great strength of imagination?
I would say is an observation. Yes. And observation.
But he was incredibly imaginative and he was not frightened of following an idea that he had had.
He he had some I mean, his major contribution was, of course,
getting proper respiratory care for people with polio and out of that developed the proper respiratory care for people with at that time,
less common diseases like John Burris syndrome, senior tetanus, respiratory care, them.
And that was a very major development in some areas.
His imagination possibly ran away with him a little.
He had, but now seem like slightly curious ideas about how to manage multiple sclerosis, for instance,
in which he was a firm believer in the idea that two hours rest on the bed each afternoon
was very important and that various sorts of exercise programme were very important.
And I think he felt that they were important not only to help muscles that were already weak,
but also to somehow or other diminish the pathological process by increasing the blood supply to the spinal cord.
And I think that would just relieve the tendency to spasm in muscles the rest.
But I mean, I don't know. They might have done well, possibly, but not very effective.
Mean. But anyhow, he didn't believe in tuberculin people, derivative and personally.
That was you probably know more about it than I do.
But did you work with on it or not? No, you don't.
I mean, when you've worked with on a peripherally occasionally as a registrar or call, one might have to do something about.
Patient on the department's meningitis unit,
but that would be very rare and occasional the as the registrar called the a consultant opinion one might need
to ask all because none of the main urology consultants happen to be around for all that would be covering,
but otherwise made contact with all that was at the Friday morning meetings were
all those opinion was always very interesting and very well worth listening to.
So that time you were working at the church, I guess, and honours unit was at the pavilion?
Yeah. Yeah. You had to travel over there. Yeah. And the other professors after Ritchie retired, which would have been, what,
three or four years after you went off to about 69, I guess you would ride over as late as that ride.
Okay. Okay. And who succeeded him then? Brian Matthews.
Was that a good appointment? Yes, it was. I mean, the whole yeah, it was.
Brian was a superb the experienced clinician.
And he was appointed at a time when Oxford professors were mostly very good clinicians.
And I mean, I don't know.
But yeah. Well, what philosophy and was Henry Miller involved in that appointment?
And he was certainly reputed to have been while he was on the appointments committee.
He was. Yeah, he was the external assessment. And of course, Joe Matthews.
Matthews was John Knox rather a.
Yes. I don't know how important that was, but he certainly had been a Henry Miller protege and his days in urology in the north.
And he had written a very influential book, I think. Yes.
Mhm. I mean did you think well of the book. I mean what was it.
Was. Yeah it. Yes.
Mm hmm. And then when I was succeeded by John Newsome.
Davis. Matthew Matthew. Yes. Yes, yes.
And at one time you thought John Spalding's should have been appointed professor.
Which action was that. Uh, that was when Brian Matthews was appointed.
I'm not sure I ever said that. I thought that I have a knack for paraphrase.
Yeah. Now,
I know you told me before it was a lovely interview and I'm sorry it was lost
was that Richard would pass all the students to John Spaulding to supervise.
In other words, he wouldn't take them on. And John was a very good academic supervisor.
John was a very good academic supervisor.
He had a number of people who he had supervised, who went on to very senior positions in neurology with an accent on the autonomic nervous system.
Um, he published a large ish for those days, a number of.
Papers mostly related to autonomic nervous system and physiology.
And. He had a flourishing autonomic nervous system laboratory at the Churchill, which he did in addition to his routine NHS work,
and it should be remembered that he was not only one of the small number of NHS consultant neurologists,
sort of Brossette, the vast number that there are these days for Oxford.
But he also provided the neurology for Northamptonshire.
So this he was doing in addition to his academic work.
And as far as the respiration unit was concerned, that was a 24 hours a day, seven days a week activity.
And from the point of view of neurological cover,
it was really entirely dependent upon him and the two NHS registrars who were in the department at that time and all that.
But for the neurology and John had a very heavy, critical node.
Yeah, I mean, it wasn't done in a sense, Northamptonshire,
because the department was linked up with the Mandaville to or was it linked up to a lot of other places back then, say, in the 60s?
Yeah, it was linked up to Buckinghamshire and to Berkshire and apart from Slough, which was linked up to one of the London teaching hospitals.
Um, and, um, I mean, if we are on the John Spaulding part of the system, there was what was called the respiration unit flying squad.
And the way that this worked was that if a patient with a neurological condition or believed bad or logical condition got
into respiratory difficulties anywhere in Oxfordshire or Buckinghamshire or Northamptonshire and and bits of Berkshire,
the respiratory unit flying squad could be called a part of this flying squad
consisted of one of the two neurology registrars and anaesthetics registrar.
And the neurology registrar would drive the anaesthetics registrar to wherever it was the patient in difficulties happened to be.
It could be in some remote farmstead in Northamptonshire. And so I remember going to one of those or to some remote place near Newbury.
And on one occasion actually the Chalfont epilepsy Kalakala.
Yeah. Where they would be met by an ambulance.
And the job of the neurology registrar was to assess the condition from the point of view of the neurology and the job of the anaesthetic
registrar was to intubate the patient if necessary and to maintain respiration until the patient got back to the respiration unit in Oxford.
Yeah, well, I mean, you know, this was amazing experience from the point of view of the oldest.
I remember there was one summer when because the senior registrar was away on a three week,
three month secondment to learn some aspects of neurosciences.
I was on call continuously for three months and I actually collected in that time seven patients with tetanus where you get that experience.
I hope you got some sleep, too.
But do you know at the end that ambulance service, emergency service come before sorbets, upset Trick Flying Squad or after it?
I don't. I don't. I don't know. No, ma'am, it's worth trying right now.
This time you would have been doing some written work. I mean, observation papers.
Were you submitting papers, doing research or up to your neck in clinical work?
Well, we started with we started actually submitting papers that were patient based.
So, I mean, one of the one of the papers that we submitted to and I submitted it was accepted,
was published in Brain was on a rather rarified condition called Cholerae Noemia.
Now, this was of enormous interest to Norman Cashman, which is partly perhaps why I had the opportunity of working with him,
because he had observed possibly had been observed previously, but he worked out that you could get this curious condition of colour.
I know. And dyslexia in a brain condition where there was a right hand to the left hemisphere dominant patient,
where there was a infarction of the back of the left hemisphere so that all the visual to the right hemisphere and in addition,
there was an infarction of the posterior part of the corpus callosum.
So that visual information had difficulty getting from the back of the right hemisphere to the language areas in the left hemisphere.
And as I say, one feature of this condition was Coleraine, Namu and dyslexia.
Well, soon I got out of two patients in the sixties.
Late sixties. Yeah. Yeah, great. Got hold of two patients,
one of whom had Cholerae Namir as a result of a smallish lesion in the left hemisphere or the other who
had died as a result of a bigger lesion in the left where there was involvement of the corpus callosum.
And we showed that there were various different features between these two patients,
which made it to the locus of the cerebral damage on this, bear in mind,
was in the days before CT scans of the brain or MRI scans of the brain or MRI functional imaging or all of that,
and was of the sort of thing that interested the clinical neurologists who were interested in the brain.
Indeed, we were greatly honoured because we got a letter from Charles Simons,
who was one of the doyennes British neurology at that time, telling us how interesting this was.
Had you localised that pathologic that death or by electrochromic, indeed.
No, no, we didn't. How did you recognise it? How did you know what was.
Well, how did we know in those days? We knew largely on the basis of what the various clinical signs were.
But how did you know the corpus callosum in the first page?
Well, we I suppose it have to be said he assumed it.
And then, of course, you never you never got the proper localisations or while your patient was still alive,
because even if you had angiography, you was a very sort of gross method of trying to decide whether a lesion was but neurology and.
Those days had to localise the presence of calls, horrible damage on the basis of what is found by examination period.
That's how I did. Now, let's just think when did you today on membership?
Well, I did my membership, but I'm probably about two years after coming to Oxford.
And did you find it difficult to get the non neurological stuff up to speed on not I mean, did you go do any courses or group treatment?
Group support? Probably. What didn't exist then? No, it didn't exist.
That famous person whose name I forget in London is who ran courses.
And I never went to any of them.
Yeah, there was a well, but I meant in Oxford really.
Nobody was helping in Oxford. Oh yeah.
There were people, there were people who did membership runs that were usually senior registrars in general medicine.
And one went and attended them and they produced patients with sort of typical type conditions.
And they have they're great, you know, I felt at the first time and passed at the second time.
Yes. Like many a good man, really. And then how much more were you writing?
I mean, did you feel you had a theme that you were getting interested in or was it a bit of a bit of that?
Well, whether it was with Charles, which we were very interested in status epilepticus and Charles was particularly interested in,
says Epilepticus, and he interested me in status epilepticus.
And we took out all the notes of patients in Oxford who had been admitted with epilepsy over a large number of years.
And we picked out from that sample the patients who had presented with or had developed whilst in status.
And we analysed the presumed underlying cause of the status.
And we showed that there was a very high incidence of frontal lobe pathology in people whose epilepsy presented as status.
And that got published in Brain and also in some slightly different aspects of it,
or published in the Journal of Neurology, Neurosurgery and Psychiatry.
So there was that. And then when Brian Matthews came along,
I became his first assistant and he but there was an NHS past or university press and the university and I had to
pay five pounds to have an Oxford AMA because nobody could have a university post without the honour per page.
And it's university. Brown Matthews was interested in the treatment of acute cerebral infarction,
and in particular he was interested in whether or not treatment with dextran intravenous dextrose improved the outcome from certain function,
the accused phase. So that was a prelude to that bit when we analysed all the patients who had been admitted
to the Oxford hospitals with acute stroke of the previous some number of years.
Involves examining innumerable piles of notes and having done that, I'm not quite sure why we did that first, but we did do it first.
And having done that, we then set out on doing this trial of patients admitted with stroke to the general medical wards,
almost invariably at the request.
And so over a period of, I suppose, about two years, I or we sometimes had a registrar working with us on the research money.
And at one time it was Greenhaw.
And one time it was something called Keith Granger, the Australian, who then went off and became a consultant urologist in Perth, Perth, Australia.
We saw between us all or as many as possible of patients with acute cerebral
infarction admitted to the Radcliffe Infirmary the next day or that night.
Well, from that night. Yeah, that was pretty demanding and that was very demanding.
Yeah, that was very demanding.
Um, and it was during that period that Sue and I bought a house in some part of the road, which is of course just behind the factory.
So I didn't have to drive in from country to did all of this kind of thing.
Um, and that went on for a while.
And ultimately it was published again in the brain.
It showed the dextran was really very much good.
But it also, more importantly than that, I think showed the problem for the first time,
although it's always difficult to say that anything is for the first time
because you really sort it out and somebody else knew it a long time previously
or what that you could predict virtually on the day of admission what the outcome was going to be according to what you found on the examination,
because, again, you didn't have CT scans of that ilk, although he was just beginning to come in then.
But it was all right for excluding haemorrhage, but it wasn't very much good for localising precisely where the infarction was in anyway.
In the acute phase of cerebral infarction, you often don't get any abnormality on CT.
It's not until four or five days later that the abnormality appears so that we sort of have to do.
A series of publications came out of that.
And, uh, um, but textiles really weren't very good.
And I was followed into that post as Brian Matthews's read up by Charles Warlow,
who subsequently became really the the king of UK cerebral vascular disease and
remained so until his retirement from the chair of neurology in Edinburgh.
And he developed an enormous contingent of cerebral vascular disease and neurologists, some of whom have become very famous.
But and I don't think that he thought very much this trial had gone on before he arrived on the scene.
But I did notice in one of his writings fairly recently that he cited this trial as one of the first such trials in the treatment of Cerebrovascular.
And now presumably when he came, that was when you were appointed consultant.
Yeah, but before we get one thing he said, because just on the organisation of the Orleans Department,
you said when I was working for Charles withI so did you, as it were,
a take between consultants or were you just the registrar, one of the registrars to the.
Well, there were two the two there was a scene in which John myself was sceneries trying to register and there were three NHS consultants.
And what happened was that, yeah, we rotated.
I think I'm so irritated between when you were working for in the leadership post, you know, did you see any epilepsy in those days, those years?
Well, yeah, because I hope I was then became an honorary consultant.
Yeah. Once you did that, I was an honorary honouree and I had my own clinic and I got sent out to Britain as well.
And so I had mean, I was doing general neurology as part of the review.
It was called First Assistant way back in the 60s.
Which consultant had read under that umbrella? Well, no, that's what it's all about.
None, because there was John Kid, who was a general physician and interested in neurology,
and he provided the neurology for reading and also for Amersham and high Weyco.
And, um, but at some point or other, when I was the first assistant, he called for help and because he had too much work to do.
And so I used to go down to Redding.
He called to Mathieu's for help. What are you. Well, not to me. No, no.
I just wanted to show you a message. Yeah. And you were sent.
And I was sent. And you continued that right to your retirement, is that correct?
No, no, no. When he retired, which would have been when he John Kidd retired when which would have been two or three years, I suppose.
After I started going down to the clinic, the system was reorganised.
So Richard Greenhaw was appointed to be a consultant in Oxford, but with more sessions in ridding of me.
And I then shifted over to doing I wouldn't.
Right. I saw peripatetic. You know, I got shifted.
Now you've been an honorary consultant, then you became an NHS consultant.
And what difference do you feel that made your working habits and practises?
Well, I think that I could only answer that by observing what happened to successes in my university post,
but I think what happened really was that as an NHS consultant from that time,
one got progressively less and less facility to do other than clinical work.
Mm hmm. And even if one was working in a rather specialised form of neurology, because by from about the mid 1970s,
on until the time that I retired in 2000, I was increasingly involved in the assessment of people for possible epilepsy surgery.
And I think progressively throughout that time, one had less and less time medication to do one's specialist neurology work.
Well, I think before that, being in the university post, that would not have been so.
I noticed that some of my successes in university posts were quite successful
at dropping and NHS commitments that had been imposed upon them by I mean,
I think very wisely. But but now you were very instrumental in epilepsy surgery story and did the impetus from that come from you?
Because I think you were going down to London a bit before Chris Adams came.
Why is that wrong? I was going down to London to discuss things with people who were moving.
But Chris Adams started it with you? Yeah, well, I mean,
I think Chris Adams would have to be said to have started it because Chris Adams had been my Faulkner's senior
registrar at Kings and Murray was the epilepsy surgery king of the UK at the time that Chris was his senior registrar.
And so, um, Chris brought this facility, particularly the temporal lobe.
She said to Oxford with him, Chris also, who developed hemispherectomy, which was not, I think, one of my forclose particular operations.
But Chris made it very much his own. And I mean, in terms of success, it probably has the highest success rate now.
People always sort of fall over backwards when they hear this suggestion of taking away one hemisphere and curing something.
But it has to be remembered that the hemisphere that is being taken away is extremely damaged
and that the person from whom it is being taken away already has a heavy Plager and very
possibly has a heavy knife being on the same side and has appallingly frequent epileptic
seizures several a day and very often has severe behavioural disturbance going with it,
presumably because of the more or less continuously ongoing abnormal electrical discharges in the brain.
And when the operation is being done, they have no more weakness hemiplegic side than they had before it was done.
And they have virtually always no further loss of.
Is your function and the behaviour often resolves to normal, just like that, Mark, like switching off attack and they were having an anaesthetic, too.
Yes. Yeah. Yeah. Um, I mean, use that tremendous development.
How dependent was it on improved imaging or would it have happened without that?
Um. Well, the, uh, the temporal lobe work became extremely heavily dependent on good imaging because the, uh,
temporal lobe, temporal back to work and ultimately not total temporal lobe, but medial excisions lateral.
Um, they were heavily dependent upon you being able to demonstrate that there really was pathology in one hippocampus,
the one that you were not the one that you were going to take out,
and that there was little or no damage in the hippocampus that you're going to live in.
Because if you took out a good hippocampus, you were left with a patient who was severely amnesic and also you didn't use the epilepsy.
So you had to develop sophisticated techniques for determining as far as possible
that the hippocampus that you were not to operate on was more or less normal.
And of course, the one that you wanted to take out was well, when the MRI came in.
And that was a fantastic advance because you could image the size of the two hippocampi.
But before him came in, one indulged in a certain amount of sort of physical activity with CTE, but it wasn't really anything like.
So the more I became the falsity, you had to do it on the basis of, uh, psychological function, essentially.
And what happened in carotid amatol testing.
And if you got it wrong, the patient got a very severe disturbance of memory.
And fortunately, we never had this happen to us.
But people did that to some university and I guess we were lucky.
Uh, so imaging I've made a big difference.
How much help with the Aegean? What was your experience with the guys in Oxford?
Um, well, Chris Christie's great dictum as a surgeon was you've got to remove pathology and if you don't remove pathology,
you're going to get into difficulties. And he didn't much like EEG is a method for localising pathology.
Um, but of course, there are other epilepsy surgery centres, particularly nowadays, who are extremely heavily EEG dominated.
But Oxford never was. And, uh, so we got on without it.
Was there for the Energy Department interested in other things then, or what was the problem?
Um, well, I don't think that the Oxford EEG Department was particularly interested in that surgery.
And indeed, what EEG or a lot of the e.g. that we obtained was obtained from outside Oxford, particularly some Thomas's patients were good.
And yes, indeed, we got funding from the regional board to send patients down there.
And now you'd have been saying all this time tremendous development in the drug therapy of oral therapy, of epilepsy.
Did that. Change life or not? There was that added stone thing, I don't think that was a great change.
And as you know, phenytoin had been available since the late 1930s and carbamazepine had come in a bit later than that.
And from that point of view, treating focal epilepsy, the next development really was LaMotte's gene.
And our impression very much then, and I think it was a correct impression, was that the changes in medication,
the developments in medication are very important from the point of view of reducing side effects of medication.
But they're not actually terribly important from the point of view of improving seizure control.
So you got I mean, phenytoin, of course, produced a good antiepileptic drug for stopping seizures, but it had a lot of very undesirable side effects.
The arrival of Lumosity at the scene was particularly good because it didn't give any better seizure control,
but it gave a much better side effect profile.
And Petit Mal, was that a therapeutic challenge of our diagnostic challenge while Petie.
Now, of course, surgery had no place in the treatment that it.
Yeah, I mean, it could be a diagnostic challenge, but it shouldn't be because the seizure pattern is pretty typical.
The age pattern is pretty typical and the characteristics are pretty typical.
The thing that really causes the problem is not pediment as such,
but seizures arising from very small areas of of malformation with the brain because they seem to produce
rather weird seizure patterns and weird EGFR abnormalities and extraordinarily difficult to control.
But of course and so everybody prayed that surgery would have some place in their treatment.
But on the whole, it didn't, because the these displays, as they're called, tended to be distributed rather widely through the brain.
You take one out, you left with elsewhere. How much were you getting involved with sort of national meetings and national organisations?
I've never been involved with national organisations. It's not the way to any extent.
Of course, we went to national meetings that we had students who obviously know as well.
I mean, I think the answer's the same, but neither of us has ever been much involved in national organisations.
We become sort of committee members on this sort of organisation or that.
But we went to the majority rather than the national meetings, and we went to a lot of the international meetings.
We went to the American epilepsy almost virtually every year.
And we went to we both members of the International Neuropsychology Symposium,
which was a very interesting group, um, and we used to go to that every year or two and.
We would go to the occasional international epilepsy meeting, but usually the we went to the American role and how often are you presenting papers?
And one in two. And when I was said, at least one in two.
Yes. I mean, we we went to the the international epilepsy in Sydney in 1995.
We I think we and the people with us presented something like 10 papers that was a little
exhausted and we had a similar number that would have been at the American epilepsy.
And well, they both actually in San Diego and in in Florida,
which would have been two of the years in the last five years of the last century, we presented about the same number papers.
Do you think Medicare nowadays work as hard as you used to?
Well, I think the health service ones do.
I mean, the the one that the I mean, I'm in contact with two NHS consultants who are very much concerned with epilepsy and neurologists,
physicians who are very much concerned with providing epilepsy services in epilepsy surgery services.
One of them in Oxford, Jane, that cop and the other one in Bristol.
And they strike me as working amazingly, amazingly hard.
They they work just as hard as we used to.
What I think the advantage that I have to so they have to some extent, is that they don't seem to have to fit in quite so much.
General neurology around all of this. When I was doing it, I used to get criticised.
I was supposed to be devoting four sessions a week to neurology in High Wycombe.
And from the point of view of High Wycombe physicians, that should have meant that I sat in High Wycombe for two whole days a week.
And then what happened to the patients that came to Oxford with the wards in High Wycombe?
I have no idea. But the attitude was that that's what you should be doing.
So one had to somehow rather resist that, because in addition to that,
one had to be doing on call in Oxford and the general neurology in Oxford and this rather specialised epilepsy stuff.
No, I don't think that the modern NHS physicians get labelled with quite that amount around the specialist area in your time.
Were you got to stroke patients as a neurologist acutely,
or would that only be a sort of later referral to stroke patients admitted to general, you know?
Yeah, not much, because in in my time in Oxford, there was a move to get as much neurology as possible,
admitted to neurology beds, and that that worked quite well.
And a lot of strokes are going to neurology. Quite a number.
Yeah. Yeah, quite a number. Of course, the neurologists then became selective.
Inevitably, I'm criticised for doing so because they said, well,
we will admit strokes under the age of 65 or 70, and that wasn't thought to be terribly acceptable to.
I mean, it depends on the number of beds that you have.
And do you feel that the neurology people or the patients were being advanced by that you mean that the physicians would be advanced?
Yes. Yeah, I think they were being advanced.
And neurology has always been a slightly sort of curious, slightly curious relationship.
I think, General, it's, uh, and I think that the neurologists have been seen by general physicians,
probably quite rightly, as being a little standoffish and, uh,
but at the same time have been arguing that all neurologists should be seen by neurologists,
but they don't actually really have the facilities to do all of this.
And I don't know. It's it's very, very tricky, isn't it?
I mean, the Association of British Urologists is still arguing about all this, but things are changing now, I think, in various ways.
But go back to the now you have written, Ed, distinguish textbooks and massive encyclopaedias, as it were.
When did you do that? Before you retired after he time. No, no, no.
I haven't done anything since after I retired the end of June 2000, supercharging at same time.
And the, uh, the big epilepsy book that was edited by myself and Charles Pocky and I go to Charnley that was published about May 2000.
Yeah, I've done it since then. But you've done a textbook of neurology before that.
Yeah. Yeah. OK, so that was while you were working. I mean. Yeah.
And then actually I mean you must have been busy Gemalto.
I mean now you mentioned more than once. When did you start working with her.
Well so I came to I came to the neurology department in Oxford in.
June 65 and Sue came to Oxford with me.
At the time, she was working at Meadowvale and you'd met in London or in Cambridge?
In Cambridge, we introduced by all of the English and French, German, French woman.
And so anybody who came came to Oxford in June 65 and used to commute up to fail, used to meet Jellinek on the train from Oxford,
and he knew the quickest way to get from Paddington Station to avail with two bus change.
And anybody she knew was working as a neuropsychologist with Ritchie at that time.
Charlie Research. And it was a good day as he went along to Ritchie and she said, oh, she said, you know, have you got a job that I could do?
He said, Oh, well, I think I'd like to have a health service psychologist in the neurology department.
And I've got a little bit of money and I can take you on for a year.
So she was taken on for a year. And in that year, you know, towards the end of that year,
we went on our tour of North America and she went and sat with Brenda Milner for three weeks in Montreal.
And I went and visited Northern Ireland and all of that.
Very nice. And at the end of the year, she said to Ritchie, Well, what about it now?
He said, I think he said, well, it's been extremely useful having you working with us all now till the regional board or the
health authority or whoever it was who controls the purse strings that we want full time person.
And May Davidson was the controller of clinical psychology at that time, and Sue had been trained by May and May said, oh, no.
She said we must have this job jointly between psychiatry and neurology.
And Ritchie, I think, said, oh, no, no, that's not part of that.
Anyway, Ritchie got her this job and and that's how the NHS and clinical psychology in neurology actually commenced.
And so we would have been working with each other, really, I suppose, since about September, October 65.
Right, right. I mean, every neurologist does a bit of mental testing.
And is it fair to say that clinical psychologist just do a whole lot more?
I mean, it's still a clinical observation, clinical enquiry, but obviously much more detailed than any bedside neurologist as well.
What they do now is very different. They do a whole lot of things now that they didn't do back in the 1960s.
No. One, they'd be outraged if I suggested that they only do what we did then.
But no, no, but you didn't do it. But what I mean is it's an extension of that sort of activity observation enquiry, probing or with words.
The clinical psychologist now would say that they're involved in treatment.
Right. They would say that if you have a clinical psychologist attached to epilepsy surgery,
that the function of clinical psychologist is not simply to tell you whether or not they think that the.
Their examination shows that what you are about to do is the right thing to do or is not the right thing to do.
They would think that there should be big involvement in rehabilitation and in social management that they have to say and that sort of thing.
What happened last year about that? I should have. Well, I can't say no.
There's nothing on the tip of your tongue that you're burning to declare.
No, I don't. I don't think so. I mean, if I was forced into the confessional, I think I would have to say that they agreed to pay tribute,
I think, to the people who have influenced me and all of his anguish.
I really do put it at the top of this list or the reason he was not a urologist,
but he was much involved in neuropsychology and was ran the neuro psychology
department at National for several years while he was still a professor of neurology,
a professor of psychology in Cambridge. I was being greatly influenced by two neurosurgeons, one of whom was Douglas Northfield,
for whom I worked for six months with her surgeon at the London at the London, and also by Joe Pennypacker.
And I think in neurology, I was, um.
Well, I was equally influenced in different ways by Richie Charles and John Spaulding.
I mean, Charles, which he was not really a very hands on neurologist in the way that John Spalding was very much a hands on neurologist.
But Charles was a very astute clinician and he was very influential in terms of the sort of ethos,
philosophy and all the rest of it of managing, well, neurological patients, particularly epilepsy patients.
And Richie, as I said, already was very imaginative and very inventive and very special in a very broad sense.
And so those who what did you get from Japan of South Korea and Japan?
Remarkable. Absolutely marvellous. From Joe Pennypacker.
I got the extreme care that you must take in examining patients and listening to the history and
making a decision as to whether what you're thinking of doing is clinically right for the patient.
I mean, Joe would appear in the neurology wards at the Churchill late in the evening to see some patients that had been you'd referred to him.
He would come in his Macintosh would sit on the patient's bed making talk,
and he would take the history in a very small number of words that he would get it all exactly the same as that was Moorfield, actually, possibly.
I think he actually had more words than he.
He was very sparse with his words and the examination was exquisite from both of them.
And they would they wouldn't usually explain precisely what it was that they were doing,
because they would expect that by then you would know what they were doing. But just watching them.
But they would tell you exactly what they were.
Looting from it, and I don't think I ever saw that actually from any perspective on Spaulding, not close to it, but I mean,
so then and you have to bear in mind that these days is very much just, you know,
showing me the images showing you and the Washington, you know, and you think that attitude is justified.
Mean the image in the sense that it's so good. It tells you everything.
A careful examination. But I mustn't make any criticism about the the current practise of neurology or neurosurgery.
I don't know anything about it. But Chris Adams merged the two.
He merged the sort of Joe PennyMac Douglas Law failed by Fogler approach with the imaging, and he merged them superbly.
So it has to be both, I think.
But they and I have actually seen it recently.
I seen David Jones in action examining a patient, and I thought that his was a masterclass in who exactly this.
So it still exists, whether it's hard to find now.
Did you come to regret not staying in London or not going to Boston?
Well, I've never regretted not staying in London, not in the slightest.
Uh, I think that I mean, London is still the sort of centre of him very much.
But I don't regret not being there or I Boston, of course, I've been back to Boston many times since.
Um, but I don't regret it. No, not at all.
And I did have another. Oh, I know the medical students.
How much did you have to do with the medical students. Well I think.
The same amount as everybody else in those days of the medical students were largely taught by,
well, Brown Matthews was extremely good teacher of the medical students.
Jonathan Davis was a very good teacher. The medical students I don't have experience of subsequent professor of neurology teaching medical students.
I can't comment on that. But because of the weight of the system, the health service consultants have to teach them as well.
And did you enjoy that? Oh, yeah, that's great, John.
That's been an extremely interesting interview. Anything else you want to say?
Nothing else. Well, many, many thanks for the pleasure that that's recorded.