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The record of Professor Peter displayed with Derek Hockaday, 22nd September one,

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the three, Peter, what was it that really led you to come to Oxford in 64?

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That's a very good question.

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What happened was that I had been to well, first of all, what happened was that I was at St George's Hospital as a first assistant.

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That's next below below consultant senior equivalent.

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And I was told by all the people there, the the important people like Kenneth Robson and James Down,

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John Barton, that I the physicians that I was going to get the next consulting job at St George's.

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So I front up for the interview and I don't get the job.

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And this was quite right because a chap had come from the states, an Englishman who had been seven years in the States,

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and he had got about, I think in those days, about 14 publications.

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And I think I had to answer. So they said to me, well, Peter, it's you know, there's nothing we could do.

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And I accepted that.

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And I said, but what you've got to do is go and see Professor Don Horst, who just arrived at St George is a very difficult and prickly person.

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And he was actually known as Professor Sian Horst after the popular war.

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And then. Yeah, yeah. And I went to see him and we had a major, major disagreement about how to treat myocardial infarction and things you say.

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And I said, I think you could do more for people than just give them morphine and stuff.

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And I wanted I wanted to go and investigate reflexes from the heart, stuff like this.

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And he poured scorn on it and then went back to my boss, who was Aubrey Leatham.

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And he said, well, I'm afraid your thing with Professor Don Horst was really a bit of a disaster, you see.

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And I said, well, you know, I just disagreed with him.

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And he took umbrage. And then I thought, well, that's ruined my relationships.

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But Don Host was a nice chap at heart and actually he was very helpful afterwards.

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So they said, well, what you've got to do is write some papers.

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And to do that, you've got to go to the states are all believed and wrote to three people.

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One was Gallin in Boston, another was Gill Blount in Denver, and a third was Morris Sokolova in San Francisco.

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And I chose Maurice Circler because it was the furthest away and Popsy and I had no idea much about them.

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And so I went and worked with soakings, who was called, who's a lovely man.

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And after months of work, he said, Peter, he said, I can't teach you any clinical cardiology.

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He said, what you'd better do is go see Julius Komarow in the Cardiovascular Research Institute and work with him,

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which was a very generous thing of Soki to do.

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It's a 63 six sixty one.

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Yeah, at 61. And we've done some homework.

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And in 1961 I went to California and then as a result of seeing I saw that he was JH Comoro Junior,

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and I thought naively, he must be the son of the man who wrote the book on him with Jeffrey Dawson things.

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But it turned out it was him and he was very helpful.

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And so I joined the group that was working on the first magnetic flow metres in,

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was doing they were doing studies on right and left ventricular ejection in dogs.

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And I had my project, which I thought was a bright idea.

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It turned out to be no good,

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but I had a project thinking there were reflexes from the pericardium and nobody had looked at reflexes from the pericardium.

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So I thought that would be a good thing to do.

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But it was clear to me, working with this fellow media group that in the year I had there, there were never, ever going to get to my project.

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So I said to Julius Komarow, I could I the only did these huge studies with follow me to and things twice a week.

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I said, could I use the lab and the days in between and could I have some money to to study this.

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Cardio reflexes in dogs, so he said certainly.

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And so I really work quite hard that year and and in fact, to cut a long story short, there was no reflexes from the pericardium.

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But I found that when I applied nicotine patches to the dog heart, I got a profound bradycardia and hypertension.

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And I discovered I thought a new reflex was an old reflex, a very long bedsore.

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But anyway, nobody knew where the receptors were for the better reflex not and that they were largely from the left ventricle.

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And then I went to the American College of Cardiology and I put in this work for the Young Investigators Award.

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And in those days to just one now they're about 50. But and I got it right.

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And so that sort of, you know, as they say, it was all downhill from there.

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And I got lots of offers to work in the States, but I thought, well, I'd like to work in the UK if possible.

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But what happened was that when I had discovered these reflexes and published, it was a single authored paper in the Journal of Physiology.

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And I said, oh, Julius said, what do you what do you want to do next?

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Stay another year and work on this. And so I thought, well, I'd like to do that.

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I wrote to my boss or release him and he said it was extremely inconvenient and he couldn't guarantee that I'd get my job back.

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And I showed this and showed this to Julius, Uncle Julius.

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And he said it could have been a lot worse. I would have been a lot worse.

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He said he could have said stay forever.

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So then three weeks later, Aubrey wrote me a lovely longhand mail letter saying he was sorry he'd behave like that.

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And obviously I had to stay. And then I wanted to record from these receptors.

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That was my plan to to learn how to dissect single fibres in the Vegas and record from these receptors to see whether they were,

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in fact, kema receptors responsive to nicotine and other things, or whether they were Meccano receptors, as I suspected.

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And cut another long story short, the local people that told me it would take three years to learn this technique,

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I said I'm a clinician, I don't have three years to pick fibres.

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And so Julius said, well, I'll write to a chap called John Vinnicombe who's been here and likes it.

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And he he he he you know, he will come over and do the fibre picking.

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But John couldn't. So he said, not knowing I was English, I think he said, why doesn't this chap come over to Oxford?

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And so I did that. And I spent four months in the physiology lab in Oxford.

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I never set foot in the Radcliffe Infirmary. I had nothing to do with medicine there.

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And I picked fibres and saw that 64, not 64.

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And who is paying Julias Conrads? Yes, the Americans were paying me for this for months in Oxford.

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And then the second dog we did, we got recordings of CE fibres,

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which had never been recorded from the heart before, and there are obviously lots of them.

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So this was very exciting.

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So John and I published this together again in Gisèle and then I went back to London and then by some fluke, the professor of physiology,

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Cylinder Brown and George Pickering were having put together and they said,

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bemoaning the fact that there was no link between preclinical and clinical medicine in Oxford then.

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And so Linda Brown said, well, we've had this chap who's a respectable physiologist now, but he's really a clinician.

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So I got a telephone call to meet George Pickering sample or a letter, I think.

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And finally I met him on a bench in Paddington Station and that was he.

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Then I kept meeting him office meetings and then he got invited to come to Oxford.

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And this was a three year senior MRC fellowship with consultant status with the lab in physiology consultant status in the hospital.

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And then I was so I finally I said to George Pickering before I came, I said, well, I'd just like to know that one.

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GW Pickering will back me up for the consultant. All you're saying is going to come, provided I don't fall on my nose in this three years,

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and he looked at me steely eyed and I thought, well, that's baloney just because it used to be a dress like this.

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And then he grinned and said, it's a deal.

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But then it was quite tricky because Walter Somervell, who was one of the you know, because it was the same panel,

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Walter Sam got on the train in London and said he was told this was fixed for slight and he was going to fix it anyway.

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George Pickering one. And I came here and then I had a marvellous time because I thought I'd be working in physiology with John Widdecombe.

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But Linda Brown, when I arrived, I said, oh, no, no, says you've got to have your own lab, you know?

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And that was very expensive to set up with six channel Tektronix oscilloscopes and things like that.

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And well, for that, the say and was marvellous in those days.

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Linda Brown said, how much is this going to cost? And I said, I don't know.

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It's very expensive. And he said, well, come back in two or three days and tell me how expensive.

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So I've costed it and it was a huge amount of money.

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And Linda Brown looked at it and he said he said, well, you order it now, that'll save time and I'll ring up.

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BMR said that's how it worked.

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It was fantastic. So within three months, I got a laugh.

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I got stuff. I was picking Founders'. I had the Denville students and things, you know, and so it was very hard work.

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I don't know the details. Did you know physiology?

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No truth, no physiology.

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And they had people who were going through and wanted to do say something like fibre picking in those days was like molecular biology.

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Now, really, I mean, fibre picking was the top of the tree.

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And was it in any way regulated? How much clinical, how much physiology just did what I did, what I wanted to go, how much?

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It was about half, because Grantly and I headed up this cardiology department.

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We were both NHS primary consultants with, you know, in those days university sessions, I think four or something, university research sessions.

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And so we headed that together and and that was amicable.

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And we got on all right. More or less difficult to grasp.

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Could be. But anyway, then I went to Australia for after a while,

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I was finding it very hard to keep up with all the fibre picking side of things as well as the clinical work.

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It was, you know, it was difficult. So I thought I needed I needed some time off and I got a sort of sabbatical.

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It was six months paid by the university for study leave and six months I funded with some sort of junior

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fellowship in in Sydney that I went to Port Corner's department and Physiology in University of Sydney.

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And it was about a 20 percent cut in my total salary.

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But my golly, it was worth it because, you know, I,

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I worked hard and got some very nice new results and things started getting interested in garrotted Barasat and I was picking five.

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But you've got about receptors there. And I never did any clinical work in Sydney.

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In fact, they thought I was rather Bogucz person clinicians had thought I didn't know what it was,

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stethoscope from another, which wasn't exactly true.

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But nevertheless, that's what the cardiologists in Sydney.

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But they were friendly, but I didn't have anything to do with them.

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How much do you think your time is the Cambridge preclinical student led into this physiology interest?

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I'd say absolutely nothing because I did like duties.

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I did the part to perform. And you see, and that was very much a routine teaching type course with very no research at all.

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And then do a part two. She must have been in the past, been doing something else, I think.

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But anyway, I did the part two in. The natural sciences, tribalists and the but it was really not very good.

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So when did you get fired up about really investigating things?

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Well, it was this trip to the site, actually.

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I mean, us getting into the Cardiovascular Research Institute through through Soki Morris Circler was an absolutely life changing experience.

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And there were fellows from 20 different countries there and nearly all were either dead or friends still,

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you know, and it was a transforming experience.

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So much so that I had a sort of mid-life crisis and I didn't know whether I wanted to be a physiologist or a cardiologist.

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It was as bad as that. And so then when I came back after my year two years away, I was very fortunate.

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And in the physiology field, I met the Coleridge's George Courage and his wife,

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Hazel, who now lives at the other end of this village, aged 90 or something.

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Dead. Yeah, yeah. And we're very good friends. And we'd go see each other and I'd take her out.

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So then you go back. But anyway, I've got I got back from Australia, but while I was in Australia,

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Paul Beeston wrote to me and said were advertising the first chair in cardiology

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in the country supported by the British Heart Foundation and told me about it.

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I negotiated that ambition, but I think largely Grantly had negotiated it with the Heart Foundation, of course, with the Oxford authorities.

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And of and I said to Jill when I was in Sydney and I heard this, I said, well, this is meant for Grantly is four years senior to me.

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He is a very intelligent chap, you know, hot competition.

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And I said, but if he gets it, I think I will leave Oxford because I said, wow, Grant and I were equally running the department.

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That was fine. But if he was the boss as the professor and I was an NHS position in the department, I said things will be different tomorrow.

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And so she said, well, why don't you apply?

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So on the very last day of posting, Jill and I put together twenty copies.

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I think you had to send by email and posted them to Oxford again with difficulty cos I've been playing golf that afternoon,

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probably tell you the story. But anyway, we put this thing together about 20 pages and I left it with my secretary,

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not my secretary and secretary in physiology to staple them all together and everything.

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Well, when I came back after golf to pick up this application to mail on the last mailing day, it it was wasn't collected at all.

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So Jill said if they could see you and I now stapling this together on the floor and I said they wouldn't give you any sort of a job.

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And she was quite right. But anyway, I took it to the post office in Sydney and I took it at about midnight and he waited.

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He said no good. And I said, What do you mean no good? And he said to me, I said, what is it we don't know to the bottom of his scale.

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So we had to take this back into physiology. I had to get in.

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I had to wait. They only scale was in ground. So I then had to convert it and then divided into two parts and then about to mail it.

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Of course, it's marvellous that they're open at the general post office in Sydney.

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In those days, I was the only one where it was open 24 hours.

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But in those days, I guess they really would not know.

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So then so then I came back and came back early, as it were from said no, no, as I did as planned.

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And then I had to set up a lab in physiology and and the department here, I had no idea really about what to do quite.

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But in the end it worked out. Grant was obviously very disappointed and quite difficult and understandably so, but he retired early.

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I think and then it came much, much smoother, but now a lot of water flowing under the bridge by then because when you go the consultant job,

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you were working as an Ontake position as I was. I thought it was very interesting when I got the chair.

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I don't know if you remember this, but I don't remember it very much because in those days there were six physicians and surgeons around.

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The hospital is unbelievable now. And the two story.

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Yes. And the two professorial teams. But the physicians said to me they were very friendly laughter.

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You know, and they said to me, now you're a professor of cardiology.

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You won't want to do Ontake work. And I had not thought about this at all.

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But in about 30 milliseconds, I sort of started out, well, if you want to take me out of general medical and taking,

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all I can say is there will be a big fight and there was no fight.

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And I continued, as well as being a professor of cardiology, to be an authentic physician.

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It turned out that was the best decision I have ever made in my life, because as a result, all my boys, the senior registrars, all did Ontake work.

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So when they went for a job to another hospital, they didn't just look like an ordinary cardiologist, they looked like general physicians as well.

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So they sound like hotcakes. All my chaps in a very difficult time, all got jobs in three years with the senior Raj, which was unheard of in others.

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Now you've had the opposite, I guess. What are your memories of him?

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Oh, wonderful. They asked me for the appointment committee when I got the job.

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They said, is there anybody any do you have any preference for who you'd like to work with?

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And I said, I'd like to work with Dr. Buzzard. And that's what happened.

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And it was simply wonderful. A real gentleman, a very good doctor.

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And he was just charming and helpful to me thinking about these.

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Do you remember? And I thought of that a little room in the Whit's department, the sort of senior registrars,

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the sort of people who were coming up to this consultant who used to meet and discuss cases.

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Yes. And what was your feeling about all that?

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Because in a sense, you were a slight outsider and, you know, you were in physiology partly, but part of their mouths, but not so much on general.

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Take a little time. I wasn't. Yes, no. Yes, right.

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Right. I liked to be doing it with Magnum and maybe things I think with Teddy.

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But you were already already. Yeah, Teddy, that makes a lot of sense.

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Yeah, yeah, yeah. Those meetings were very good. I guess I always remember I remember Alec Cook very,

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very well because I started we started the the second pacemaker in the world

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was a homemade pacemaker built in the bottom of St George's Hospital by all,

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believe the technician, Geoff Davis. And so I'd grown up with the first pacemaker.

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So when I came to Oxford, I introduced a pacemaker service, which nearly killed me because the pacemakers were not reliable.

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You got up in the middle of the night a lot to put these in.

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And I remember coming to me, he got some distinguished person that I'd put a pacemaker in.

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I think she was an Olympic skier. And and this failed several times.

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And it came to me and he said, slightly sad.

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Isn't it possible to test these things before, you know, he was pretty upset, but but in the end, it was a terrific improvement.

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There was a terrific story about atomic batteries, the uranium.

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Oh, no, no, no, no. It was there was there were two sorts of pacemaker.

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One had got one sort of battery, which was cheapish and lasted about two years.

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And the other one was a lithium ion battery, a very first the lithium batteries.

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And that lasted theoretically three to five years.

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And I wanted to put these in. And Rosemary Roux, who was then the regional medical officer, said, I couldn't do this.

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And I went to her and I and I said, Rosemary, this is.

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This is. Absolutely crazy because it it'll save all the work of putting another one in, it'll save the surgery for the patient.

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I agree it's twice as expensive, but it's worth it.

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And she said, well, people were like a widow who has to buy sugar.

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It would be much cheaper if I could buy a sack, but I can only afford so much at time.

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And so I had to put up with that for about three years.

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And then finally the light was seen and we could put in a proper place like this.

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You were burning out the department and would you be doing different outpatients?

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And Romney, you both run separate or would you combine?

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We were sitting side by side in a tiny little room in outpatients in the old Radcliffe left of the door if you go in and we

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had two tiny little tables and and Grant was here and I was here and Grant was there and we used to and a patient here,

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a patient that we used to do our interviewing and stands side by side.

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But it was nice and quiet to listen to the patient. Well, when you go, you go on the tube, you could listen to that.

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Right. Now, what were the things you were building up in the department?

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The pacemakers, which went into cardiac care unit that started.

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Let me think, if we weren't the first Desmond Julian in Edinburgh was the first person to start it.

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But we started pretty soon afterwards. And I guess, you know, when did Celine come swim?

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Came in about 1976, I think.

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And I think we'd started the coronary unit maybe a couple of years before that, maybe two years after Desmond Julian started it.

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We we built that. And was there enough knowledge then to improve results with it once you've got a complication and.

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Well, you could defibrillator people and that was a big advance,

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but there wasn't much else you could do that aspirin had come in and that they certainly got aspirin.

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And then streptococci started to come in for thrombolysis beta blockers before streptococci and be the blockers probably.

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I don't know, you know, think of whether the first beta blockers were, but they were probably early 60s because I mean,

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I always associated you with beta blockers and receptor candidates because we did us this one trial.

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I had got a I got a A student from India called Saleem Yousef, and he was from southern India, from near Bangalore.

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And he had never, never used a knife and fork.

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And he told me later that when he came, of course, to dinner in our house,

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because the Christmas the first Christmas he came, he couldn't afford to go back home.

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So we had him here and he ate Christmas. And he said his biggest terror was watching what people did with their knives and forks around the table.

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We had a dozen of us around the table. And anyway, Saleem had come.

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And so I said to him, I just come back from the American Heart meetings.

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And Brown World was arguing with the Sobell about the best way to measure infarcts size the brown world had got.

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I mean, we've got it the wrong way round, but one of them has got epical Prikhodko mapping with 35 just leads to determine the size of an infarct.

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And the other was measuring the enzymes released in the blood.

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And they were arguing at the meetings about which was the best method.

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And I came home and I said I said, well, you need to sleep, OK?

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I was about his third choice, I think, as a supervisor. And because his first choice was, I think Grantly.

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And then he didn't like him, so he didn't want Grantly. Second choice was Douglas Pickering.

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And then Douglas Pickering, you remember, had a stroke. And so that didn't seem good.

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And so he chose me as sort of third down the line, but we hit it off very well.

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And I sent him a thesis. I said this. Two groups in the states spitting at each other about the best method, why don't we do 100 patients,

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consecutive patients in the CCU and see if we can use both and then see which is the best or

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whether we can amalgamate both and get a better thing since we should add in the enzymes?

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Yes, we added in enzymes and mapping and Saleem had to collect blood every four hours and I think he hardly slept during that time.

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It was a [INAUDIBLE] of a task, but he knuckled down and did it.

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After two years he came to me and said, Prof. He said, this isn't going to work.

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I can't see my way out of this. And I said to them, you've got absolutely enough data for any thesis now already.

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But if you just persist with this, maybe it'll come good.

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And that's what happened. And so then we thought we could do a clinical trial and we thought we would start with intravenous beta blockade.

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ISCI had the newest drug, TANEL all it was doing very well in hypertension,

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but they weren't at all interested in us using it in college because they thought it might be dangerous and ruin their drug.

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And actually, John Crookshank from NCI funded it out of all sorts of different pockets.

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The bosses of I see, I didn't know about that. And it started off.

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And then finally when it was clear it was going, I put their weight behind.

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It was here. Medick John Coltrane was a medical person that I see.

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Right. And so that's how I was. This one started.

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And then when we had finished it, we know we were doing this small pilot study first.

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And Saleem wanted to do a clinical trial. And I said before we do that, we need to go and see Richard Peto,

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because when I come back from Australia in 1973, I got firing range from carotid sinus.

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Barasat was in hypertensive versus normal dogs, and I'd had about three statistical courses, you know, by then.

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But I still didn't trust myself to do a test. So I went to Richard Dalil and I said, I need some statistical help with these this stuff.

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And Richard Dahl said, there's a young chap called Peter just arrived.

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He's he's underemployed. I go to him. So I went to him with is firing range.

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And and he did the stats in about two days.

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And they came back and he said, look, he said here, the one that you wanted.

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But he said, I'm not a physiologist.

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He said, I'm only a mathematician. I have no biology. He said, but when I look at these figures, there's something else here.

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And I looked at it and I thought and I said, Richard, I'm going to rewrite this paper and you're going to be an author.

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And he said, That's nonsense. I've only done two days work. I said, nevertheless, you're going to be an author.

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And that was the best that I ever done in my life because that led to this collaboration that led to all these things,

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because he said he'd been doing a wee wee slim.

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And I went to see him and and he did some back of an envelope statistics and said,

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you're going to need several thousand patients to answer this question, whether it be to blockade versus placebo would work.

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And and then I said, well, we don't have that number of patients and I'd be dead before I know the answers I'd give up.

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And then he said he'd been involved in London in some multicenter cancer studies.

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And why didn't I start to set up a network? And that's how the the trial as this trial network began, it was Richard's suggestion.

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And then I and Saleem Saleem was sent off to the continent to recruit other centres that I talked to,

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all the people who'd been registrars and things and were now in cardiology consultant posts.

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And we got together a good group of 200 or something centres.

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And we started really what was the first proper big clinical trial in the world.

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And that was it was a lot of fun just to go back cardiac radiology, angiography, all that.

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Well, how was that when you first. Kind of, but, uh, very difficult.

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I've done some cardiac catheterisation in the Brompton sitting at the foot of poor wood, and in those days it was terribly difficult to see.

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It was a small fluoroscope in the dark and you appear in the stuff.

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But we started to do it with John Hammil, who lived at the other end of the week here.

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And and we started a coronary angiography.

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I can't tell you the data. No, no, not yet. But with that relatively easy to get going with how relatively.

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Yes. Yes, it was. It was it was quite it was I think it was in the seventies and there was much more space.

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In fact, the Ashes trials were all run from unused X-ray room in jail to in the basement of Jowhar,

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too, because there wasn't enough money to equip the X-ray room.

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And so there was a free room. And I found this room and put all the boxes and Rory and Rory Collins and joined by then Rory Collins,

298
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had come and was after Psyllium was a registrar on the coronary care unit.

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And after that he went to epidemiology of Richard Peter.

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But they were very exciting days.

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And then the Chinese thrombolysis got thrombolysis, came in, and that was quite controversial.

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I mean, Brian Greyman, for instance, who had been one of my boys and now become a consultant,

303
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he refused to join ISIS, too, with streptococci because he believed it would be dangerous.

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And Brian is a very he knows what he knows and he is a Scot and he is very, very you know, and I was absolutely pissed off of taking this, too.

305
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But that's what that's what he did. And he never joined in that trial.

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Afterwards, when the results came out, of course, he then started using it.

307
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Yes. But he didn't believe in it to begin with. Like, a lot of people were worried about it because it can cause cerebral bleeds and things like that.

308
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And Grant was doing his plethysmograph, right. He was doing a plethora of the plethysmograph, not ever hear anything useful.

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I yielded some useful physiology, I would say.

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Is beachball right? Absolutely. Yes, he did. Yeah, I would say yes.

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It was it was tricky stuff to to do, but he he did it.

312
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When did you start doing Ontake medicine properly.

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I mean, I never stopped right. With the right to the end. All to the end.

314
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Right. And we had we were firm ce and and there was Jim Holt as the other consultant and then we had a lot of people who who joined in.

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The geriatrician was, you know, Professor, what really happens was the geriatrician we remember in those days,

316
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the Ontake physician sort of gathered in groups of of people.

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And yesterday I went to a very interesting meeting at the Astra of the Aspirin Foundation, which Geoffrey Aronson chaired.

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And he was very nice in his introduction and said how he joined our firm to really it was very, very nice.

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And we had a very good group of people discussing.

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And we have now now more as the radiologist was after their first class.

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So it was a very you know, you had your firm B, I think.

322
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Yeah. But we thought firmly in the place and you would have to have an attached pathologist, which was good.

323
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And then. Yes, yes, yes. What was his name.

324
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Macci. Yes, McCants and I published some papers with them on myocardial biopsy, which.

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Peter, you were just talking about you were working with the various people on Syria and everybody was talking about fancy and and and really,

326
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as I said earlier, that was a terrific thing to be a general in taking position as well as a cardiologist, because the the the younger guys,

327
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they were bright chaps, admittedly, but they sold hot cakes to other teaching hospitals.

328
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Now, that became quite a difficult business with piles of patients and beds in the corridor and all this sort of thing.

329
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How difficult did you find that, say, in the 90s? Well, it was it was not as bad as it is now as all I can say.

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Where are you going? At least you had your own wards then and most of your patients were in those wards or they were in the car.

331
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Any care at all? They were occasionally there. Not so often. I can remember being in the corridors.

332
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We were down in the huts where you were in the hospital. And so we were down in those huts at the end where the car parked.

333
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And, you know, it was it worked.

334
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Mind you, there wasn't so much you could do for patients. So, you know, you know very well on emergencies.

335
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There was a limited number of things you could do. So you weren't as busy as the people are now.

336
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How much did the move to the John Radcliffe change things for you?

337
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Oh, that was really a complete mess because I was in Australia when I was appointed

338
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and we had planned with Grant and I had planned a proper covid department,

339
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you know, with our own beds and places and stuff. And when I came back from Australia, I found the other powerful beasts who'd decided to take over.

340
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I mean, Peter Morris, I think, took all our beds and they came up with a devastating idea that we cardiology would stay down in the

341
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old Radcliffe Infirmary because they said we need to preserve some prestigious department there.

342
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Otherwise it'll just become a geriatric home. You say. And I was devastated.

343
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There's all the plans with my head completely being wiped out while I was away.

344
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And we had no foothold at all in the John Radcliffe.

345
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And I can remember it to this day, feeling sick to my stomach about what the [INAUDIBLE] was going to happen.

346
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And then I, I went round the new outpatients there, which compared to the tiny outpatients at the old Radcliffe, was huge.

347
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And I said to sister patient, as I said, what are you going to do with all these rooms?

348
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She said, I have no idea. We can't possibly fill them.

349
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And I said, Oh, I don't think so. So I got, I think, 17 rooms in what was the outpatient department and still the cardiologist, some of it.

350
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And and so then I said to the Ontake physicians, I remember saying, well, if you want us to be down in there,

351
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I said, what are you going to do about acute coronary care and things like that?

352
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I said, I think that'll be up here, you see?

353
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And I said, well, I'll I'll make a list of the duplication of equipment like ultrasound, echo, you know, all this sort of stuff.

354
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I'll make a list of what it will cost. And it was so expensive that they finally saw the light and said, come home.

355
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And then by then I said, oh, so I could find some rooms and outpatients that weren't being used.

356
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And so we we went there. It was unplanned, but it worked.

357
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How much were you involved with national and international groups?

358
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Were you travelling, you know, to London for meetings and abroad?

359
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Yes, I was travelling a lot because, I mean, you know, we were one of the leading groups.

360
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The ISIS trials were hugely important.

361
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Everybody wanted to have you at the American heart or the whatever meeting in Europe and things and such as travelling a lot.

362
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In fact, people used to say that God is everywhere.

363
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Slices isn't enoxaparin through some truth,

364
00:44:59,340 --> 00:45:11,970
but I travelled a lot and and I had to travel because of the keeping this group of of trials together for the various ISIS trials.

365
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And that was mainly a problem. I mean, you must have had to put in a grant after Grant, but you kept going.

366
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Yes, I think people could see that it was an important thing.

367
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So we really were funded largely by the Heart Foundation.

368
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Well, I was there first chair, so they were particularly good to me.

369
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They were always good. I remember we used to have site inspections every four or five years.

370
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We would have some visiting team would come and look at what you were doing.

371
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And I remember by by some error in administration, I got a copy of the letter of the visit.

372
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Then who was Tom James, physiologist from the states Southern States.

373
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He wrote a devastating report on our department.

374
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And unfortunately, I got a copy, but I was I was summoned up to the Jack Shillingford,

375
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who ran the medical part of the Heart Foundation, and Brigadier Cardiff, who was the military gent at the hand of a very nice man.

376
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And they asked me to come and have lunch with them up at the Heart Foundation.

377
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And so then they they sat round the table and they said, Peter, we've had this really very bad report from Professor James.

378
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You said and I said, I know. I said I'm absolutely hopping mad.

379
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It's completely inaccurate in all sorts of ways.

380
00:47:01,620 --> 00:47:06,000
I said, I don't know, but I can just show you how inaccurate it is.

381
00:47:06,000 --> 00:47:14,910
And I said, he criticises me mainly because we're going in about 50 different directions.

382
00:47:14,910 --> 00:47:25,710
He says we ought to focus on one thing, you know, and it's known for his work on Barasat as we ought to focus on reflexes.

383
00:47:25,710 --> 00:47:36,210
And so I said, well, I think he got completely the wrong end of the stick on several things or several grants.

384
00:47:36,210 --> 00:47:43,620
I said. And frankly, the reason why we have this spread is that I have bright people and I like them to do

385
00:47:43,620 --> 00:47:50,580
their own thing rather than be my slaves and do all become by reflect people you see.

386
00:47:50,580 --> 00:47:55,770
And so I remember kind of saying, oh, well, that's fine.

387
00:47:55,770 --> 00:48:01,950
Just forget about he said, let's have lunch. And that was that was British.

388
00:48:01,950 --> 00:48:08,610
Just on the money. We are getting more from academic support charities than from the pharmaceutical industry then.

389
00:48:08,610 --> 00:48:17,520
Oh, I was giving the trials were nearly always funded by the pharmaceutical industry and this one was ISCI.

390
00:48:17,520 --> 00:48:23,040
ISIS, too, was bearing Lacher in in Germany who made streptococci.

391
00:48:23,040 --> 00:48:27,510
That is. And that's a remarkable story because Richard,

392
00:48:27,510 --> 00:48:41,850
Peter and I went over to bearing work to see if we could get funding for a trial of strapped to versus the nothing in acute M-I.

393
00:48:41,850 --> 00:48:54,420
And then when and then somehow it was sitting around this table because Jilian used to host dinner and Rori Richard,

394
00:48:54,420 --> 00:49:02,370
Salim and I would sit round and chew the fat about the trials we were doing and what we were going to do.

395
00:49:02,370 --> 00:49:06,930
And none of us can remember who suggested factoring in aspirin.

396
00:49:06,930 --> 00:49:09,930
And this is quite interesting.

397
00:49:09,930 --> 00:49:20,100
I think it might have been Roehrig, but nobody is certain Richard Peto was the obvious one, but I bet he didn't think of it.

398
00:49:20,100 --> 00:49:30,030
But anyway, we suddenly cottoned on to the idea would be good to do a factorial design, restricted Kano's and aspirin.

399
00:49:30,030 --> 00:49:40,830
And Sir Richard Peto and I went over to Germany to Magdeburg, where the hemispheres off to meet the directors of Bearing Work.

400
00:49:40,830 --> 00:49:54,240
And we met in the house of one of these directors. And the two problems, first of all, on the data sheet for STREAT Striptease there.

401
00:49:54,240 --> 00:50:00,360
Streptococci is said not to be used with aspirin because of the danger of bleeding, you see.

402
00:50:00,360 --> 00:50:07,470
Yeah, and so that took a [INAUDIBLE] of a lot of argument with them to say, well,

403
00:50:07,470 --> 00:50:17,100
we had tested this in the pilot and it wasn't very dangerous, didn't seem and it would be worthwhile doing.

404
00:50:17,100 --> 00:50:22,260
And and then we had dinner.

405
00:50:22,260 --> 00:50:31,710
But before we had dinner, I think we drank between five was about half a dozen bottles of muscle or hock or something in there.

406
00:50:31,710 --> 00:50:42,210
So everybody was very relaxed. And then finally, in those days, two days later, I got a letter.

407
00:50:42,210 --> 00:50:51,120
There was no AMA or anything like that. I got a letter from Barry Wirkus saying, yes, they would fund this for two million quid.

408
00:50:51,120 --> 00:50:59,820
And this was remarkable because that was another streptococci is made by Kabhi Kabhi canonise in Sweden.

409
00:50:59,820 --> 00:51:10,720
And so both were non patented. And so to use to put two million into a trial of that drug that we know, we had a lot of discussion about that.

410
00:51:10,720 --> 00:51:16,740
And I said, well, you know, if your drug wins in this, I said,

411
00:51:16,740 --> 00:51:21,720
Cobbe won't be able to squeeze in on it, you know, because it's being done with your drug.

412
00:51:21,720 --> 00:51:25,680
And it's slightly different from ComicCon, I should say.

413
00:51:25,680 --> 00:51:30,210
So they bought that and funded it, but it was remarkable. It's so quick.

414
00:51:30,210 --> 00:51:36,640
I mean, two days to get a decision that we could go ahead. Why couldn't they be patented as natural product?

415
00:51:36,640 --> 00:51:41,130
It was a natural product, I think, and they hadn't patented it.

416
00:51:41,130 --> 00:51:44,810
Very interesting. It is now that it would be done for that use.

417
00:51:44,810 --> 00:51:54,270
Absolutely. But now then it wasn't. And it was a very brave decision of those directors of of Boeing work.

418
00:51:54,270 --> 00:52:05,550
It was remarkable. They got it right over that they were really, really happy with the result and the asprin result.

419
00:52:05,550 --> 00:52:13,380
You see, that was fantastic because it put aspirin on the map for my college information,

420
00:52:13,380 --> 00:52:20,700
which had never been used for in the acute phase before, and that was nearly as powerful as district strap.

421
00:52:20,700 --> 00:52:24,540
Connect the two together. We're at it now.

422
00:52:24,540 --> 00:52:30,750
Yeah. Now they're always the students in Oxford.

423
00:52:30,750 --> 00:52:33,630
How much did you have to do with them?

424
00:52:33,630 --> 00:52:47,070
Always taken a fatherly interest in the students and Jill took a motherly interest because I've got here as I showed you our dinner book,

425
00:52:47,070 --> 00:52:54,900
which was the only record really of the students, I had students lists and I've kept those.

426
00:52:54,900 --> 00:53:00,040
I've kept all the firm lessons every three months.

427
00:53:00,040 --> 00:53:08,820
I've got a follow up. And and but they didn't have the wives and the children because the top student parties,

428
00:53:08,820 --> 00:53:13,530
we used to call them the wives and the children used to come as well.

429
00:53:13,530 --> 00:53:18,970
And Gillian wrote all their names down in this book. And it was marvellous.

430
00:53:18,970 --> 00:53:25,810
The the as far as a record, really, you know, and that's extraordinary.

431
00:53:25,810 --> 00:53:33,440
See, and I wrote down the wine we drank and she wrote down the food she gave Gillian.

432
00:53:33,440 --> 00:53:43,860
And and this is a fantastic social record because as time went on, less and less wine was drunk, more and more fruit juice.

433
00:53:43,860 --> 00:53:51,630
And they weren't because they were driving because they'd come on the bus. OK, and so it's it's quite interesting.

434
00:53:51,630 --> 00:53:56,590
I'm just telling them about your parties telling about the book.

435
00:53:56,590 --> 00:54:03,540
I don't think they've got them. All right. So, yes, it is anyway.

436
00:54:03,540 --> 00:54:08,940
Do you have a good game of tennis? Oh, you know why I played it wasn't good.

437
00:54:08,940 --> 00:54:17,130
No. Well, we'll go on, if you don't mind. So where were we with the students just doing this?

438
00:54:17,130 --> 00:54:26,250
So I would say we had a very good record with the students because whenever I travel and I see people now,

439
00:54:26,250 --> 00:54:36,120
they remind me of where they came to this house and and and it was really Jill who was responsible for the she do the cooking.

440
00:54:36,120 --> 00:54:41,370
We used to have a woman from across the way who came and did the washing up, which was considerable.

441
00:54:41,370 --> 00:54:50,310
And we still don't have a dishwasher, don't you, and say, well, it probably is, but there isn't.

442
00:54:50,310 --> 00:54:57,780
Room in our kitchen is very compact and it works. And there's nowhere to put a dishwasher washer, that is.

443
00:54:57,780 --> 00:55:01,380
So anyway, we don't have a dishwasher, but now you can be a barrier.

444
00:55:01,380 --> 00:55:06,510
Is that interest going because you went to Russia? I remember. And it's an absolutely.

445
00:55:06,510 --> 00:55:14,880
Well, Russia well, Russia was fantastic because what happened was that one Monday morning,

446
00:55:14,880 --> 00:55:21,390
I used to do my sort of provide outpatients on a Monday morning.

447
00:55:21,390 --> 00:55:28,350
And you remember in those days, would we put the money into research and other things?

448
00:55:28,350 --> 00:55:39,900
Anyway, one Monday morning when there was myself, a secretary, a technician, and that was about it.

449
00:55:39,900 --> 00:55:45,930
I mean, that was the department and the secretary came out and said, there are two Russians downstairs,

450
00:55:45,930 --> 00:55:52,410
that reception in the old Radclyffe and they would like to see the department.

451
00:55:52,410 --> 00:55:56,850
So I said, Crumpler at a time. I wish them further.

452
00:55:56,850 --> 00:56:04,950
But I went down between patients, introduced myself, said I'm seeing patients all morning, but if you're free for lunch,

453
00:56:04,950 --> 00:56:16,500
we'll have a sandwich over at the pub opposite, which was called the Rhine at the Railroad, and I've forgotten that.

454
00:56:16,500 --> 00:56:23,220
So we went to and had a sandwich and I said, I like these two.

455
00:56:23,220 --> 00:56:27,840
You know, you walk out, it's not usual to talk to Russians.

456
00:56:27,840 --> 00:56:32,640
And they spoke reasonably English, which is, again, was unusual.

457
00:56:32,640 --> 00:56:38,310
And so we had a chat. And so I said, what are you doing anything this evening?

458
00:56:38,310 --> 00:56:44,940
And they said, no, they were staying in Oxford to the night and then they were off in the morning.

459
00:56:44,940 --> 00:56:49,440
So I said, well, if you're not coming and doing anything this evening, I said,

460
00:56:49,440 --> 00:56:56,520
my wife's a doctor, she's working, but she'll be able to produce some spaghetti or something.

461
00:56:56,520 --> 00:57:05,160
And so Jill came in about seven thirty having and some general practise found around this far.

462
00:57:05,160 --> 00:57:11,190
And in those days we had a big roaring fire going up a big chimney there.

463
00:57:11,190 --> 00:57:15,210
And we were into about a third bottle of wine, I think.

464
00:57:15,210 --> 00:57:22,080
And so she then produced spaghetti or something.

465
00:57:22,080 --> 00:57:34,170
And then they heard that I was going to the World Congress of Cardiology in New Delhi in 1966, which was the next year.

466
00:57:34,170 --> 00:57:38,730
And they said, why don't you come through the Soviet Union?

467
00:57:38,730 --> 00:57:49,380
And I said, how? And they said, well, you can fly in and then you can take flights or trains or whatever.

468
00:57:49,380 --> 00:57:59,280
And there's one flight a week from Tashkent in the southern part into Kabul, in Afghanistan.

469
00:57:59,280 --> 00:58:07,380
And then from Kabul, you can get a flight into unwrite in the top of India.

470
00:58:07,380 --> 00:58:18,000
And so I thought about this and I was very excited because I had read ages ago, Fitzroy, MacLaine's Eastern, a protest broke out.

471
00:58:18,000 --> 00:58:23,220
And if you if I have been to Bob Carr says.

472
00:58:23,220 --> 00:58:32,130
So I thought, well, I'll be able to go there. And and then, uh, I planned this.

473
00:58:32,130 --> 00:58:36,750
And then we used to have a chap called and shushed.

474
00:58:36,750 --> 00:58:49,290
He made my first oscilloscope camera physiology. He was a scientist, VMOs, the precursor of the Masti scientist.

475
00:58:49,290 --> 00:59:00,660
But instead of doing science, he was in huge demand because he could make machines for people in the days when

476
00:59:00,660 --> 00:59:08,760
there weren't there was no commercial oscilloscopes camera to photograph the spikes.

477
00:59:08,760 --> 00:59:17,190
And so they told me in physiology get just to build you out and [INAUDIBLE] say it'll take a year but it'll take less time.

478
00:59:17,190 --> 00:59:25,770
So I did this and I went and saw this old chap in both Oxford in North or south or the big house.

479
00:59:25,770 --> 00:59:37,350
He was widowed and he worked in what was a garage converted into a fantastic workshop.

480
00:59:37,350 --> 00:59:41,390
And I went to see him there and I got to like him.

481
00:59:41,390 --> 00:59:51,180
And he was lovely chap. So when he'd built my camera, we had him back to lunch here fairly regularly about every three weeks on a Sunday,

482
00:59:51,180 --> 00:59:54,640
and we would entertain and go to lunch.

483
00:59:54,640 --> 01:00:05,560
He would make his own way out here and then I would run him to South Park somewhere in the car and he would walk through the back and,

484
01:00:05,560 --> 01:00:17,770
you know, to get to Northmoor Road. And and then when Edgar heard that I was going to do this trip to through Russia,

485
01:00:17,770 --> 01:00:26,160
he wrote me a letter and said, I'm going to be very offended if you refuse this, but I'm a rich man.

486
01:00:26,160 --> 01:00:36,010
You know, I think some of his relatives were chancellor of the Exchequer and things were a bit so he had lots of money.

487
01:00:36,010 --> 01:00:43,600
He said, I got a lot of money. I'm very old. And I would very much like to have Gillian go with you on this trip.

488
01:00:43,600 --> 01:00:56,710
And so he paid for Pickering, paid for the trip itself, the affair to New Delhi to present some of our ashes stuff.

489
01:00:56,710 --> 01:01:04,150
And then 66. I don't know what it was, but maybe that wasn't a nice thing.

490
01:01:04,150 --> 01:01:11,230
Anyway, we went to New Delhi and and we went all the way through the Soviet Union.

491
01:01:11,230 --> 01:01:16,400
We became known as the slight delegation. You had to be a delegation.

492
01:01:16,400 --> 01:01:29,980
Right. And we had the most fantastic trip when we I said to Jill, I would like to go to Leningrad because normally the flights go to Moscow.

493
01:01:29,980 --> 01:01:34,330
In those days, it was a central part for foreigners to come here.

494
01:01:34,330 --> 01:01:41,650
And I said, there's a chap called Cheny Gorsky who I've never met.

495
01:01:41,650 --> 01:01:55,150
But when I published my first paper in the in the paper, in the geographies of this reflex from the left ventricle,

496
01:01:55,150 --> 01:02:00,370
I got a letter on really dirty paper saying, dare not to slide.

497
01:02:00,370 --> 01:02:10,390
You will not know of this work of mine, but it was published in Russia during the war time and he included a Tatya you reprint and he said,

498
01:02:10,390 --> 01:02:18,010
we did the same thing as you had done in dogs, but in the rabbit it's clearly the same reflex.

499
01:02:18,010 --> 01:02:27,640
And I felt like I've been kicked in the guts. You know, I got this terrific praise were the first people and I was very pleased with myself.

500
01:02:27,640 --> 01:02:35,380
But then I thought, well, you've got to be honest. So the next paper acknowledged Charlie Gosney.

501
01:02:35,380 --> 01:02:43,840
And so then I wrote to him and I said we were coming to Leningrad on these days,

502
01:02:43,840 --> 01:02:50,740
would it be possible to visit meet him, you see, and I got no reply at all.

503
01:02:50,740 --> 01:02:58,090
But anyway, by this time we'd fixed the the fare to well,

504
01:02:58,090 --> 01:03:04,780
we went to Helsinki first and that was when you could get a flight to Leningrad instead of Moscow.

505
01:03:04,780 --> 01:03:09,760
And we got on this plane and all the people seemed to know each other and it turned

506
01:03:09,760 --> 01:03:15,440
out they were all fur traders and they were going to the fur auctions in Edinburgh.

507
01:03:15,440 --> 01:03:21,610
And one of them was obviously a major figure.

508
01:03:21,610 --> 01:03:26,740
And he said, where are you staying in Leningrad?

509
01:03:26,740 --> 01:03:32,140
And I said, I think we were crying or something. Oh, he said, that's a barn of a place.

510
01:03:32,140 --> 01:03:36,470
He said, you don't need want to stay there. I said, Well, well, that's where we are.

511
01:03:36,470 --> 01:03:38,600
Oh, he said, come with me.

512
01:03:38,600 --> 01:03:50,440
And so we went to this small sort of hotel in the middle of Leningrad, old fashioned, a lovely hotel, and he just stood at the back.

513
01:03:50,440 --> 01:03:55,870
All the people come, all the people coming in trying to scream for their rooms.

514
01:03:55,870 --> 01:03:57,400
And he just stood at the back.

515
01:03:57,400 --> 01:04:06,160
I'm pretty certain pretty soon he was spotted by somebody, a concierge, who came across to him and said, what could he do?

516
01:04:06,160 --> 01:04:11,290
So he said, what you can do is find my friend here and that.

517
01:04:11,290 --> 01:04:16,720
And for me, so and so.

518
01:04:16,720 --> 01:04:24,220
Then when we come in through the airport in Leningrad, it was a huge reception committee.

519
01:04:24,220 --> 01:04:28,060
We could see a large crowd at the gates going out.

520
01:04:28,060 --> 01:04:32,470
And I said, do I want to do some VIP?

521
01:04:32,470 --> 01:04:34,480
Obviously, you know, they're meeting.

522
01:04:34,480 --> 01:04:46,660
It turned out that Tony Gorsky had arranged he was the probably the fourth most important scientist in the Soviet Union at that time.

523
01:04:46,660 --> 01:04:55,840
And he had got together a three day conference with people coming from all over the USSR.

524
01:04:55,840 --> 01:05:01,240
And and I was going to give a talk not.

525
01:05:01,240 --> 01:05:11,980
And furthermore, the worst thing was he said, we have missed this technique of dissecting nerve fibres and recording from them during the war.

526
01:05:11,980 --> 01:05:19,840
We will miss that. And I, I my laboratory and technicians are at your disposal.

527
01:05:19,840 --> 01:05:25,030
And I would like you to demonstrate how to recall the nerve fibres.

528
01:05:25,030 --> 01:05:33,730
Well, you know, it was incredible. We had to build a metal cage and scream grimoire.

529
01:05:33,730 --> 01:05:38,410
First of all, we then had to get all his technicians to get together,

530
01:05:38,410 --> 01:05:45,880
all the amplifiers all wrapped up in series to be able to record microphones, which they had never done before.

531
01:05:45,880 --> 01:05:56,350
And then so I thought it'd be easier in a rabbit you because I could have a series of rabbits and no difficulty.

532
01:05:56,350 --> 01:06:04,450
And so finally on day three, I got a single Barasat of fibre from a rabbit.

533
01:06:04,450 --> 01:06:14,080
Right. And but in the meantime, I had been working with all and he had about 20 young graduate students.

534
01:06:14,080 --> 01:06:17,860
I'd been working with them and we got very close.

535
01:06:17,860 --> 01:06:22,690
And so when wherever we were going across the Soviet Union,

536
01:06:22,690 --> 01:06:34,150
we were met by these students who telephoned ahead to their colleagues in these various places, the Intourist guide was pushed aside.

537
01:06:34,150 --> 01:06:39,710
We had the tourist car and we went everywhere off limits and things like this.

538
01:06:39,710 --> 01:06:43,450
And we had a fantastic daftari. Did you go?

539
01:06:43,450 --> 01:06:53,650
Well, we went to down to the Black Sea and then to Sukhumi and then down to Tbilisi in Georgia.

540
01:06:53,650 --> 01:07:01,480
And then we went down to Tashkent and then we got to Bukhara and Samarkand and all these places.

541
01:07:01,480 --> 01:07:08,970
It was a fantastic trip when they left. And that was all exhaustive is for Jill.

542
01:07:08,970 --> 01:07:20,140
And and then and then when I was there, who was it I heard really?

543
01:07:20,140 --> 01:07:36,470
Oh, when I was in Delhi, somebody had gave a talk on the first six patients that the implanted a pacemaker and that was in 66.

544
01:07:36,470 --> 01:07:51,730
And so I cabled home to Jim Johnson, who is the technician, and I said, see if you can get one of these catheters, you see.

545
01:07:51,730 --> 01:07:58,540
And so we oh, no, this was it was not a catheter.

546
01:07:58,540 --> 01:08:04,060
It was my biopsy. Right. Was that right?

547
01:08:04,060 --> 01:08:15,070
I don't know. But there was some new technique I saw there and I was able to get the same catheter.

548
01:08:15,070 --> 01:08:21,820
Who was it? For me, what it was about,

549
01:08:21,820 --> 01:08:36,220
but it introduced a new technique that was absolutely red hot and the U.S. catheter company sent over to a catheter to me to to be able to do this.

550
01:08:36,220 --> 01:08:42,110
You talking about biopsy. And you said you'd written a paper with a pathologist result of a biopsy or something.

551
01:08:42,110 --> 01:08:47,870
Yes. About that was about with what's a car that was about Torrealba.

552
01:08:47,870 --> 01:08:53,710
And did you learn much from that? Nothing. No, no, no, no.

553
01:08:53,710 --> 01:09:00,530
But they now do it and they learn more because they do all sorts of genetic testing on a biopsy.

554
01:09:00,530 --> 01:09:09,100
Well, you are able to. But in those days I did it and we wrote papers about it, but really nothing came of it.

555
01:09:09,100 --> 01:09:18,700
When you first came to Oxford Clinical, I'm talking about you being in America and seeing a bit of that, and particularly in London, a lot of.

556
01:09:18,700 --> 01:09:23,980
How did the sort of standard in Oxford strike you? Good.

557
01:09:23,980 --> 01:09:33,310
I thought it was a very good hospital. I liked it because it wasn't inward looking like most medical schools only have their own people.

558
01:09:33,310 --> 01:09:38,980
Oxford was unique in taking people from all over the place on merit.

559
01:09:38,980 --> 01:09:49,300
And I thought that was that was terrific. And actually, in clinical terms, we were better than the Americans in cardiology.

560
01:09:49,300 --> 01:09:54,300
I would believe them. And Paul would win best in the world, you know.

561
01:09:54,300 --> 01:09:55,690
Though it was a remarkable man,

562
01:09:55,690 --> 01:10:07,890
I always thought he was he he I gave a talk with his 80th birthday and he died a year and a bit ago now, quite old, 90 something.

563
01:10:07,890 --> 01:10:14,120
I gave a talk with his 90th birthday and wrote about the nursing.

564
01:10:14,120 --> 01:10:22,440
How did you find that? I thought it was very good because you remember we made beds of students,

565
01:10:22,440 --> 01:10:29,880
we made beds with the nurses and things, and you learnt how to do your corners and things like this.

566
01:10:29,880 --> 01:10:36,780
The nurses were good. And, you know, the matron was some Thomases said to the girls, don't talk to the doctors.

567
01:10:36,780 --> 01:10:43,800
They're a lower class as so the nurses, the nurses.

568
01:10:43,800 --> 01:10:44,190
I mean,

569
01:10:44,190 --> 01:10:54,130
the biggest disaster in nursing is to be in this clipboard degree nurses who don't actually do any nursing that's responsible for all this scandal.

570
01:10:54,130 --> 01:10:59,400
Now, if they'd stuck to being nurses, it would have been much, much better.

571
01:10:59,400 --> 01:11:04,530
Now, ultrasound came in. How much did that change cardiology?

572
01:11:04,530 --> 01:11:16,170
A lot, because I can remember I used to do outpatients in one of those little rooms and I'd have an ultrasound, the ultrasound machine there.

573
01:11:16,170 --> 01:11:20,280
And I used to do my own EKOS on the patients just for one.

574
01:11:20,280 --> 01:11:27,810
I wanted to know about this part. You know, it was it's sort of replaced the stethoscope, really.

575
01:11:27,810 --> 01:11:33,430
It was very important. And then with two dimensional ultrasound, a big advance baby.

576
01:11:33,430 --> 01:11:37,050
Good advance. Yes. Yes. And he's got better and better.

577
01:11:37,050 --> 01:11:47,680
But now the snag is that it's all done by technicians who don't always appreciate what the clinician wants to know.

578
01:11:47,680 --> 01:11:52,500
And you've got a long report. It takes a lot of time. It's expensive.

579
01:11:52,500 --> 01:11:59,460
And the days when you had a simple machine and you could work it yourself with the patient,

580
01:11:59,460 --> 01:12:05,940
they're two minutes and you'd see all valve or the marshal or whatever you wanted.

581
01:12:05,940 --> 01:12:12,120
It was absolutely remarkable. Then there was the opposite interaction with the surgeons.

582
01:12:12,120 --> 01:12:15,720
Did you ever feel cardiac transplantation? Where did it come to Oxford?

583
01:12:15,720 --> 01:12:20,700
I have no control over it. You know, it never did.

584
01:12:20,700 --> 01:12:28,440
And when we first I mean, the main problem when I first came was cardiac surgery had a high mortality.

585
01:12:28,440 --> 01:12:41,420
And then I remember asking Celia Oakley, who still is still alive.

586
01:12:41,420 --> 01:12:49,580
I asked Celia, who was then at the Hammersmith with Jacques Chirac, and I asked her about surgeons she'd met, you know,

587
01:12:49,580 --> 01:12:59,570
young surgeons and she said, well, put it this way, that if we have a really difficult case, she said, we wait until the evening.

588
01:12:59,570 --> 01:13:06,860
And then Steve Westerby, who is a senior Reg does it as as an emergency.

589
01:13:06,860 --> 01:13:09,860
And he's very good.

590
01:13:09,860 --> 01:13:20,630
And so I talked to Steve Westerby and I said we wanted a new cardiac surgeon that would be hanging around while we got the funds together.

591
01:13:20,630 --> 01:13:24,320
And he came. And of course, he's been a very controversial bloke.

592
01:13:24,320 --> 01:13:32,900
But yeah, my God, there's the mortality went from about 25 percent to three percent the day he arrived.

593
01:13:32,900 --> 01:13:37,370
And he was remarkable as a surgeon and still is, I think.

594
01:13:37,370 --> 01:14:00,330
Yeah. He was a terrific technically, and that's really made a huge difference, and if I know it's a stupid question, but of your papers,

595
01:14:00,330 --> 01:14:08,710
which you made fun of really far from the first words I know you'd have loved, but after that, it's a stupid question.

596
01:14:08,710 --> 01:14:18,450
No, it's not stupid. I would have said ISIS, too, probably that's had the most impact worldwide.

597
01:14:18,450 --> 01:14:29,400
But I also have been lucky in that I went on a sabbatical to Pavi and worked with a chap called Luciano Banaba.

598
01:14:29,400 --> 01:14:31,980
And he is a real genius.

599
01:14:31,980 --> 01:14:47,940
And and this was a bit of a fluke in that in the early 60s, the nineties, I think Julian thought that I was about to perish from an MRI.

600
01:14:47,940 --> 01:14:58,680
And she said because I was really very busy in the environment to grow an administration and grow, you know, it was lots and say.

601
01:14:58,680 --> 01:15:02,850
And so she said, it's time you had a sabbatical.

602
01:15:02,850 --> 01:15:09,200
And I said, well, I'm 64. You know something? I don't think I can take a sabbatical.

603
01:15:09,200 --> 01:15:15,990
Oh, she said, lots of people take sabbaticals. I said, then finally I said, I'm going to.

604
01:15:15,990 --> 01:15:21,300
So Gillian said, I worked it out. You've got eight months. You got to go.

605
01:15:21,300 --> 01:15:26,700
And we've had two sabbaticals in Sydney, one in Adelaide and one in Sydney.

606
01:15:26,700 --> 01:15:30,610
And I liked Australia. I said, we'll go to Australia.

607
01:15:30,610 --> 01:15:38,810
Got we got James. And Jill said, I remember she said, very boring.

608
01:15:38,810 --> 01:15:48,510
And so I said, well, I I've been reading the papers of an Italian I haven't read called Luciano Banaba in Paris.

609
01:15:48,510 --> 01:15:56,370
And I said he's doing some interesting work on spectral analysis of heart rate and blood pressure.

610
01:15:56,370 --> 01:16:02,910
And it's obviously there's something in this and I don't understand it properly and I might go there.

611
01:16:02,910 --> 01:16:11,130
So we agreed and I wrote to Banani and I said, I have my own money for eight months and I come and work here.

612
01:16:11,130 --> 01:16:21,270
And he said, yes. And when I got there, I was very surprised because he was very young and was a young bearded chap of about 30.

613
01:16:21,270 --> 01:16:24,720
And I was about 50 or 60 or miles.

614
01:16:24,720 --> 01:16:37,260
I was 16 and and I then he was studying spectral analysis in a heart rate and blood pressure variability in diabetics.

615
01:16:37,260 --> 01:16:43,500
And I said and when I got there, I discovered that he didn't really understand it either.

616
01:16:43,500 --> 01:16:47,760
So I said to John and I said, let's start from square one.

617
01:16:47,760 --> 01:16:55,830
Let's not study disease. Let's take medical students off the corridor, young people who are fit and well,

618
01:16:55,830 --> 01:17:04,440
and we'll study that the control system in these people and it will be possibly easier.

619
01:17:04,440 --> 01:17:09,450
So we he agreed and we did that.

620
01:17:09,450 --> 01:17:19,830
And then in that eight months, we got four papers in the very best cardiology and research journals out of eight months work.

621
01:17:19,830 --> 01:17:27,630
And it started a completely new field of of circulatory control analysis.

622
01:17:27,630 --> 01:17:35,610
And it was really very exciting. And Jill said when I got back, she said, you know, you're ten years younger than me.

623
01:17:35,610 --> 01:17:41,260
When you when did you get back to the diabetic's? I find out that he didn't.

624
01:17:41,260 --> 01:17:49,050
He didn't. But but what happened was that when I got back, she said, what are you going to do now?

625
01:17:49,050 --> 01:17:58,530
And I said, I thought for a bit. And after a month I said, you know, and I'm going to do I'm going to retire two years earlier at 65 rather than 67.

626
01:17:58,530 --> 01:18:03,690
And and she was very worried that all this would peter out.

627
01:18:03,690 --> 01:18:07,530
And I said, no, I think it go on for a few years anyway.

628
01:18:07,530 --> 01:18:15,480
And Luciano wrote to me after I got back and said, would I come back on a regular basis of being really good?

629
01:18:15,480 --> 01:18:27,660
And and so then they said they would provide an apartment for me and no money, but they'd provide an apartment and a telephone.

630
01:18:27,660 --> 01:18:30,670
And that was that was good enough.

631
01:18:30,670 --> 01:18:40,720
So we lived in the very middle of puffier in an old palace that would have been taken over by this foundation around.

632
01:18:40,720 --> 01:18:46,770
And and that continued then for twenty years, twice a year and.

633
01:18:46,770 --> 01:19:01,290
This year, because and only because the administration and Pavi had embezzled something like 17 million euros,

634
01:19:01,290 --> 01:19:12,270
not all in five people had, it was an elaborate fraud that took the Guardian to finance some time to unravel.

635
01:19:12,270 --> 01:19:22,980
But what they've done was they set up what they call collaborating centres in the Mediterranean, in Cyprus and also Malta and all sorts of places.

636
01:19:22,980 --> 01:19:28,350
And these were all on paper funded money going here and then bills.

637
01:19:28,350 --> 01:19:41,010
You know, it was an incredible fraud. And but in the end up in Paris, the whole thing looked like the first day we arrived for September a year ago,

638
01:19:41,010 --> 01:19:45,570
we arrived there and in Jill brought the paper and said yes.

639
01:19:45,570 --> 01:19:55,770
And this was the local paper full of this scandal. And then seven of them went to jail and the boss was put under house arrest.

640
01:19:55,770 --> 01:20:01,330
And, you know, but in fact, the hospital didn't collapse.

641
01:20:01,330 --> 01:20:12,360
But Maria Teresa Landrover, with whom I was also working there, thought we'd better lie low before before we have applied for some more support.

642
01:20:12,360 --> 01:20:22,320
And as the Italian retired, now he Luciano, you know, because he was very young when I first got there.

643
01:20:22,320 --> 01:20:31,980
But then partly mostly because he is incredibly intelligent person.

644
01:20:31,980 --> 01:20:36,210
He's now full professor there and still working.

645
01:20:36,210 --> 01:20:38,610
But actually he travels a lot now.

646
01:20:38,610 --> 01:20:47,340
Unfortunately, I introduced him to some friends and they bought him, in effect, paid for him to come and work there.

647
01:20:47,340 --> 01:20:52,740
So he's been working mostly in Helsinki now and now.

648
01:20:52,740 --> 01:20:56,830
I don't really associate you with hypertension, maybe wrongly me.

649
01:20:56,830 --> 01:21:03,660
Yes. Oh, I've always been well, I know. I was thinking the treatment of that has changed massively.

650
01:21:03,660 --> 01:21:09,540
And how much did you get involved in all that? Well, quite a bit.

651
01:21:09,540 --> 01:21:14,880
We did trials of, you know, antihypertensive drugs.

652
01:21:14,880 --> 01:21:18,570
The beta blockers you must have. Yes, of course. That's how it started.

653
01:21:18,570 --> 01:21:30,500
But I've certainly been a member of the British Hypertension Society, and I like going to that more than the cardiac society where I'm old friends,

654
01:21:30,500 --> 01:21:39,290
that the nicer people, cardiologists have become less nice people at all, making huge amounts of money.

655
01:21:39,290 --> 01:21:43,480
And I think that rubs off on them a bit.

656
01:21:43,480 --> 01:21:48,030
They're all doing it. They become like sort of unthinking surgeons.

657
01:21:48,030 --> 01:21:53,230
Were you president of the British Cardiac when Mrs Hypertension?

658
01:21:53,230 --> 01:22:00,060
Yes, I was. I presume the British context. Yes, I think I was to learn to be like that.

659
01:22:00,060 --> 01:22:07,590
But how have you felt the change in hypertension has gone big success?

660
01:22:07,590 --> 01:22:12,210
Oh, I think hypertension is is a big success.

661
01:22:12,210 --> 01:22:25,940
And the thing that I am interested me about hypertension was that it it's a broad church which brings together and the criminologists,

662
01:22:25,940 --> 01:22:32,040
nephrologists, the cardiologists you get your beta is proper.

663
01:22:32,040 --> 01:22:37,710
Medicine is really hypertension large. And and it's it's interesting.

664
01:22:37,710 --> 01:22:52,050
And now particularly I'm involved chairing a huge trial called Compass, which is testing the BARASAT,

665
01:22:52,050 --> 01:23:01,490
testing cardiac denervation, which which lowers blood pressure rather dramatically.

666
01:23:01,490 --> 01:23:12,360
And I'm also involved in another trial, which is doing BARASAT to denervation and Daris after stimulation and people.

667
01:23:12,360 --> 01:23:25,410
So I've got a big interest in one of the things actually that latter years, one of the things that takes most of my time clinical trials.

668
01:23:25,410 --> 01:23:33,240
And so I'm there are a limited number of people who are on data monitoring committees for clinical trials.

669
01:23:33,240 --> 01:23:35,790
And so the pool is very big.

670
01:23:35,790 --> 01:23:46,440
And if you get to be reasonable and not in bed with this or that drug firm or other, then you get asked the other ones at the moment time on a.

671
01:23:46,440 --> 01:23:55,130
Big insurance trial is run from Denmark, but no, and I'm taking your blood pressure, not for blood, so.

672
01:23:55,130 --> 01:24:04,370
No, no, no. I understand they're testing new insurance, but I understand and and I checked I had to work it out the other day.

673
01:24:04,370 --> 01:24:12,150
I'm on nine of these big international data monitoring committee is not charitable.

674
01:24:12,150 --> 01:24:19,070
That is a lot of work and phone calls, travelling to meetings, that sort of stuff.

675
01:24:19,070 --> 01:24:24,500
But it's it's huge fun because it keeps you abreast of what's happening.

676
01:24:24,500 --> 01:24:28,040
So from this, I guess you're glad you came to us.

677
01:24:28,040 --> 01:24:38,030
Oh, it was one of the best things that happened to me after marrying Jillian and coming to Oxford was the best thing that has happened to me.

678
01:24:38,030 --> 01:24:43,940
Now, anything I haven't asked you about that you regret it? I don't know.

679
01:24:43,940 --> 01:24:49,850
Barbara Cassaday is a very good that goes through the intelligence stuff.

680
01:24:49,850 --> 01:25:01,640
Well, Barbara came to me as a research fellow about 20 years ago for she thought was for six months from northern Italy.

681
01:25:01,640 --> 01:25:06,530
And and then she just stayed ever since.

682
01:25:06,530 --> 01:25:12,530
And now she's got a research group funded by the Heart Foundation.

683
01:25:12,530 --> 01:25:16,730
She's a full professor. She's a terrific person.

684
01:25:16,730 --> 01:25:21,290
And she's doing some stuff I don't understand.

685
01:25:21,290 --> 01:26:16,150
But she she has been a huge success, I'd say.

686
01:26:16,150 --> 01:26:22,450
I mean, the other thing is, is, is the boys I mean, the thing I'm most proud of my chickens.

687
01:26:22,450 --> 01:26:32,070
I mean, yeah, when you look at Barbara, you look at something music, who's the next president of the world?

688
01:26:32,070 --> 01:26:39,660
And you can't get better than that when when you look at Rory College.

689
01:26:39,660 --> 01:26:53,410
Yeah. It was just a terrific lot of people that came through and were good to work with and have done really very well indeed.

690
01:26:53,410 --> 01:26:58,360
Is paediatric cardiology a separate subject? Was it really all separate?

691
01:26:58,360 --> 01:27:08,020
A I started paediatric in cardiology here, but after a few years it became clear that this is a separate subject.

692
01:27:08,020 --> 01:27:18,730
And I got a job for, you know, Grossman Smith, you remember, who was very bright, but she was married to David Smith at that time.

693
01:27:18,730 --> 01:27:29,200
And so she was rooted in Oxford. So I advertised a job which nobody else would want to apply for but got her consulting job.

694
01:27:29,200 --> 01:27:34,340
And then she just. Absolutely. But I mean, Thomas Pickering is doing it.

695
01:27:34,340 --> 01:27:39,230
Doesn't speak for you. Yes. Yes. But Douglas got ill decided.

696
01:27:39,230 --> 01:27:42,940
No, no. Douglas was doing it after me.

697
01:27:42,940 --> 01:27:50,890
Yeah, I started it. And then I rapidly realised that you had to have a separate paediatric.

698
01:27:50,890 --> 01:27:56,350
So you were on his appointments. And I know what it was in New Delhi.

699
01:27:56,350 --> 01:28:09,010
I had gone to New Delhi. And the day I left in the early morning, about four a.m., I had catheterise, a blue baby who was blue as a blonde,

700
01:28:09,010 --> 01:28:22,570
but it was being kept alive because it had not completely transpositional to circulation's, but had obviously and and that kept the baby alive.

701
01:28:22,570 --> 01:28:33,420
But this baby was about seven or eight days old, was Weisburd was lit and then blue was about less than his birth weight.

702
01:28:33,420 --> 01:28:47,080
And when I got to Delhi, I heard Bill Rafkin give the first talk on six cases where he had used a balloon on a catheter to

703
01:28:47,080 --> 01:28:55,210
rip through the atrial septum to increase mixing between the two circulation's and transpositional.

704
01:28:55,210 --> 01:29:02,050
And so I came home and said, see if you can get me a Rafkin catheter.

705
01:29:02,050 --> 01:29:06,940
And Jim Johnson got got this from the States.

706
01:29:06,940 --> 01:29:19,750
And when I came back, I did this baby, but was still alive six weeks later because this was a six week trip that gave just barely alive.

707
01:29:19,750 --> 01:29:33,040
And and when I pulled this balloon through on this baby, it was incredibly worrying because when you pulled on the balloon,

708
01:29:33,040 --> 01:29:40,060
you saw me as soon as you saw the whole heart going down into the belly, you know, before it ripped.

709
01:29:40,060 --> 01:29:46,060
And when it ripped, pulling the baby suddenly became pink.

710
01:29:46,060 --> 01:29:51,460
And Eileen Jones, who was the catheter cyst and a very hard bitten nurse,

711
01:29:51,460 --> 01:30:04,390
indeed burst into tears because this baby was suddenly pink and that baby lived another 30 something years before dying with pulmonary hypertension.

712
01:30:04,390 --> 01:30:12,400
But it was fantastic. And that was the most dramatic Raschein procedure I had ever done or see.

713
01:30:12,400 --> 01:30:21,890
And it was the first one I had. But that was what I learnt on that trip to New Delhi in 66 was the Rafkin procedure.

714
01:30:21,890 --> 01:30:27,400
You may not be the right guy to ask this because you didn't work a tremendous lot in the Pickering corridor.

715
01:30:27,400 --> 01:30:33,490
I mean, you were in physiology and so. Oh, I'm in the sleep study is there to look,

716
01:30:33,490 --> 01:30:45,640
if we had our that level with Alan Bevell and with Frank Start and with Bill Littler and all of these little you do that beven recording that.

717
01:30:45,640 --> 01:30:50,320
No, no, that was Beven. That was Beven him. That was Beven Olmer.

718
01:30:50,320 --> 01:30:53,680
And stop that. Right. Okay. And I joined after that.

719
01:30:53,680 --> 01:30:58,360
Right. And so then I started to pick things that have to turn on.

720
01:30:58,360 --> 01:31:08,230
I mean. Oh, incredible. Very you know, it's very, very prickly and difficult person, but a brilliant technician.

721
01:31:08,230 --> 01:31:16,150
And and he really made a huge difference, I think, if it hadn't been for John Paul.

722
01:31:16,150 --> 01:31:23,800
I don't think Frank stock would have been as organised as he was and then but John Boehner was very,

723
01:31:23,800 --> 01:31:29,410
very jealous of his role in this thing and he was difficult.

724
01:31:29,410 --> 01:31:34,300
But but he was a terrific person. Yeah.

725
01:31:34,300 --> 01:31:38,860
And then else along anything else, Peter? Well, I don't think so.

726
01:31:38,860 --> 01:31:44,500
I think we've covered you know, we sit down to have another session, but that was fun.

727
01:31:44,500 --> 01:31:48,880
Well, terrific. And thank you very much. Remembering I made some coffee.

728
01:31:48,880 --> 01:31:54,550
Jill, can you pick the coffee machine? I meant was all set up.

729
01:31:54,550 --> 01:31:58,430
All it needs is switching on. And I meant to offer it to.

730
01:31:58,430 --> 01:32:02,830
I think I'll stop there. Yes. OK, well, many things.

731
01:32:02,830 --> 01:32:03,696
And then.