Download Aesculapius Journal 2012

Aesculapius
Summer 2012
The University of Birmingham Medical and Dental Graduates Society
The Barber
Institute
revisited
see page 40
The new Queen Elizabeth Hospital
see page 26
Aesculapius
No 32
Summer 2012
General Editor: Keith Harding
Dental Editors: Vacant
Assistant Editors: Liz Croton
Erna Kritzinger
Jonathan Reinarz
Kishore Shah
Bob Stockley
Damien Walmsley
Published once a year by:
The Sands Cox Society,
The University of Birmingham Medical School,
Birmingham B15 2TT
Design and Production by Page One
Telephone 01543 264 214
Printed by JPL Colour Printers
Telephone 0121 561 5020
ISSN 1356-3610
C oTni tt el n
e ts
From the General Editor.....................................................................2
The work of the Executive Committee.................................................3
Front cover:
The new Queen
Elizabeth
Hospital.
Inset: Portrait
of Sir John
Tavener, by
Michael Taylor,
2001.
General Practitioner Education in Birmingham Guy Houghton
and David Wall......................................................................................4
Royal Centre for Defence Medicine – Birmingham Keith Porter...........8
Is there a future for virtual reality based technology in Dentistry?
Ralitsa Danevska.................................................................................12
Wartime Odyssey George Thorpe........................................................16
Letters...............................................................................................20
Aesculapius: What’s in a name? Jonathan Reinarz..............................24
The new Queen Elizabeth Hospital David Rosser...............................26
A comparison of the management of paediatric cancer care
in the developing country of Belize with the UK Lisa Milverton.........32
Page 24
Monet’s Purple Paintings and Your Cataracts Erna Kritzinger............39
The Barber Institute revisited Andrew Davies.....................................40
Looking back in the Outback Harry Wooller......................................44
Photo Commentary Erna Kritzinger...................................................50
Page 26
For WHO’s Benefit? An Elective at the World Health
Organisation Jennifer Devereux...........................................................52
Life as a student before the NHS George Watts..................................56
Obituaries.........................................................................................58
A Service Evaluation of Obstetric Forceps Sizes in Uganda
Hannah Boyd-Carson and Faye Newport..................................................63
Page 40
News from the Dental School Damien Walmsley.................................68
Some Notes on the Development of Birmingham, with
particular reference to the Jewellery Quarter John Davis...................78
Sir Harry Guy Dain MD, LLD, FRCS (1870-1966) Liz Croton............82
Papua New Guinea Revisited John Speake..........................................83
Page 52
Reunions...........................................................................................87
The Sands Cox Society.............................................. Inside back cover
Aesculapius, Summer 2012 1
Editorial
From the General Editor
A
part from Presidents of Royal Colleges medical knighthoods are uncommon. We were delighted to hear that Keith Porter had become Prof
Sir Keith Porter and also that he agreed to write for
Aesculapius about the Royal Centre for Defence Medicine.
There are two unusual but very welcome contributions
this year: Guy Houghton and David Wall have written a
fascinating account of the history of GP training in the West
Midlands, and Henry Wooller described his archaeological
experiences in Australia. How refreshing to have these papers.
In addition to the News from the Dental School, as
interesting as ever, we have a paper from John Speake about
his visit to Papua New Guinea where he was a Dental Officer
in the department of Public Health.
John Davis, a regular contributor, has written this year on the
development of the Birmingham Jewellery Quarter from its
origin. Another gem of Birmingham is the Barber Institute
which I like to visit during the year. I thought you might be
interested in recent exhibitions there but could not resist
including two pictures from the permanent collection, their
emblem ‘the Countess Golovine’, and a favourite of mine
‘the beach near Trouville’, which is the background for my
computer desktop.
The student electives are as varied and engaging as ever:
paediatric cancer care in Belize, the WHO, the use of
obstetric forceps in Uganda, and a paper on virtual reality for
training Dental students in Amsterdam.
George Watts’ paper last year produced a lot of comment but
only one letter. I have apologised to him for misreading the
Medical Directory regarding his date of qualification. He has
submitted a paper this year on the life of a medical student
before the NHS. Student debts are not a new thing.
Our publisher’s letter on typography provoked a letter from
Tom Smith who is experienced in these matters and his views
were supported by the Editorial Board. We agreed that the
font and layout of Aesculapius is much easier to read than
most other journals
Floyd Barringer was an American doctor working in the
QE during the war and George Thorpe has extracted
from his books some of the more interesting features of life
at that time.
2 Aesculapius, Summer 2012
Photo Commentary again has some very high quality pictures
which Richard Harding (not a relation) took in or near his
garden. This should inspire all photographers! Many thanks
to Erna Kritzinger for finding him and his pictures.
I was particularly pleased with the ‘fillers’ this year because
of the range of topics. Why don’t other readers send in about
300 words on a topic which interests them and presumably
would interest others?
We could not let this year’s Aesculapius be published without
a paper on the new QE!
The Editorial Board hopes you enjoy reading our Journal.
Letters are welcomed.
Keith Harding
Any submissions should be sent, preferably before the end of
the year, to: [email protected]
Guidelines are available at www.sands-cox.org.uk
For those without email my address is:
Keith Harding
Huntroyd
27 Manor Rd N
Edgbaston
B16 9JS
THE 2012
SANDS COX SOCIETY
AGM
will be held on
Friday 26th October 2012,
at 10.30am,
at the Birmingham Medical Institute, Harborne Road,
Birmingham
Guest lecturer:
professor Paul stewart,
Professor of Medicine and Dean of Medicine,
University of Birmingham
There will be a meal at lunchtime.
Executive Report
The work of the Executive Committee
T
he key functions of the executive committee are to liaise with the College of Medical and Dental Sciences, to allocate Elective Bursaries which we
provide for selected students, and invite a speaker and
arrange the programme for our annual meeting. At this
meeting the students who have won Bursaries give a
short presentation on their Elective experiences. At our
next meeting we will celebrate the award of the first
John Rippin Elective Prize set up by the Rippin family
and the Society to honour the memory of our former
Chairman. The winner this year is Dental Student
Hurjoht Singh Virdee.
The Executive committee is ably supported in all these
functions by the Society’s Executive Secretary Mrs Sharon
Charles, who deals with all the practicalities of maintaining
the membership details, subscriptions, book-keeping,
etc. Her knowledge of everything that requires to be done
and how to do it means that the Society has excellent
administrative support.
As always, the Committee is concerned to get more members,
particularly younger members. One strategy is to provide
graduates with two years free membership of the Society,
but graduates are so mobile in this period that it is difficult
to keep track of their contact details. We have also allocated
for a trial period up to £5000 per year for travel bursaries for
doctors and dentists in training to travel for the purpose of
training and professional development. Graduates who have
been members of the Society since graduation are eligible to
apply for these bursaries. The effect on membership of this
incentive cannot yet be assessed.
We would welcome the involvement of any alumni in the
Society’s work, particularly if they are younger than most of
the Committee and able to attend three or four meetings per
year in the Medical School.
We should also be pleased to see you at our next AGM on
Friday October 26th 2012 at which the Dean, Professor Paul
Stewart, will be the speaker.
Martin Kendall
Acting chairman
John Jackson
Honorary Treasurer
Remember
Gift Aid!
The Gift Aid scheme is already a big help to us and we benefit by about £1,500
a year in reclaimed income tax; over £5.00 for each signature.
However, less than 50% of eligible members have signed up so far. The only criterion for signing is being a UK
taxpayer. Signing up costs nothing and indeed higher rate tax payers can claim a small rebate. Also, there is no
future commitment except notifying the treasurer if you cease to be a UK tax payer.
I do urge the many members who have not done so to take this simple step to help your Society.
If you cannot remember whether you have signed up already, please sign up again. There is no penalty.
John Jackson, Treasurer, Sands Cox Society
Aesculapius, Summer 2012 3
G P E d u c at i o n i n B i r m i n g h a m
General Practitioner
Education in Birmingham
Guy Houghton (M 1972 Camb) and David Wall (M 1970)
“...elective voluntary period to observe
general practice...”
The Department of General Practice
N
o curriculum time had been permitted for
general practice teaching at Birmingham
University Medical School until 1969, when
Professor Bill Hoffenberg, the William Withering
Professor of Medicine, encouraged students during
their final fifth year of medicine to undertake
an elective voluntary period to observe general
practice, organised by the Midland Faculty of the
Royal College of General Practitioners. The students
were offered a week’s attachment to local practices
to observe GPs at work and then discuss their
experiences with the two tutors, Drs Michael
Drury and Robin Hull, in a special session at the
conclusion, which concentrated on the outcomes
of the consultations in which the students had
participated. At this time, there was an increasing
interest amongst medical educationalists in the
psychodynamics of the consultation in general practice
and the process of the doctor-patient relationship,
which had been stimulated by a Hungarian
psychologist, Michael Balint, in his The Doctor, His
Patient and The Illness, published in 1957. In 1966,
the concept of Transactional Analysis was popularised
by Eric Berne’s paperback Games People Play, and in
the same year Patrick Byrne and Barrie Long analysed
doctors’ verbal behaviour in over 2000 audio
recordings of general practice consultations in Doctors
Talking to Patients. In 1972, a working party of the
Royal College of General Practitioners agreed on the
knowledge, skills and attitudes essential for general
practice, and the resulting document The Future
General Practitioner: Learning and Teaching was
accepted as a fundamental curriculum for general
4 Aesculapius, Summer 2012
practice trainees and an essential study for candidates
taking the MRCGP examination.
“Drs Drury and Hull were the first part-time
tutors in General Practice...”
Drs Drury and Hull were the first part-time tutors in General
Practice; but they considered themselves full-time general
practitioners by profession, undertaking the teaching
unpaid and in their own time, aided by a full-time secretary
and some volunteer local general practitioners. The tutors
introduced another early educational initiative, pioneered
in 1976, in which first-year students would observe families
identified by local practitioners in the city, with the idea
that students early in their careers would be attached to
families so that they could experience the effects of illness or
pregnancy on a family and understand the role of the general
practitioner. The Family Attachment Scheme was to become
a major and mandatory part of the medical curriculum. The
formal Department of General Practice was started in 1975,
following a grant from the Wolfson Foundation, in response
to the recommendations of the Todd Report. The Department
originally was allowed to use an empty converted old Nissen
Hut by the basement of the Queen Elizabeth Hospital.
Following vociferous support from the Birmingham Local
Medical Committee, Dr. Michael Drury was elected to a chair
of General Practice by Birmingham University with an official
contract in 1982.
“...introduction in 1975 of a taught
Masters Degree...”
The first initiative between the University of Birmingham
Medical School and the Regional Postgraduate GP
Education Committee was the introduction in 1975 of a
taught Masters Degree (M.Med.Sci.) organised jointly by
Dr David Wall, then an Associate Adviser responsible for
the Black Country sub region, and Dr Richard Hobbs, the
first Senior Lecturer in the Department of General Practice,
who was to succeed Professor Michael Drury to the Chair
of General Practice and subsequently became head of
the Department of General Practice and Primary Care at
Birmingham University. The M.Med.Sci course was designed
to provide higher professional training for individual GPs
who, having completed their training, wished to advance
their careers with an interest in education and research.
Financial stringency has halted this as a regular course,
but individuals are still encouraged to apply for
postgraduate qualifications at the School of Medicine,
which are available across a diverse range of subjects.
Most of these programmes last for one year of full-time
study or two years of part-time study, leading to Masters
Degrees, Postgraduate Diplomas or Postgraduate
Certificates.
“...Interactive Skills Unit...”
In 1994, Drs John Skelton, Connie Wiskin, Dave Fitzmaurice
and Phil Hammond decided to set up an Interactive
Skills Unit (ISU) to provide support for undergraduate
communication skills at the Medical School. This Unit
had been originally funded by a grant of £300,000 from
the Sigmund Warburg Voluntary Settlement in 1991, and
received a further £675,000 in 1994, which funded John
Skelton’s post. By this time the Medical School had
accepted the value of the Unit and had paid for the cost
of teaching the undergraduates. In 1998, Summative
Assessment was introduced as the mandatory pass/fail entry
examination into general practice, and in this year twelve
out of sixty-four GP registrars failed the section involving
videotaped consultations. As a result of this, Dr Steve
Field, the current Director of Postgraduate General Practice
Education, offered a contract to the ISU to provide remedial
training for Summative Assessment failures.
Despite the contract to ISU and the representation of
the Professors of General Practice at Birmingham and the
Universities of Keele and Warwick on the West Midlands
Regional Postgraduate GP Education Committee, the
undergraduate Department has no other formal responsibility
in relation to current postgraduate training for general practice.
“...enthusiasm and personal resolve of
individual practitioners...”
The historical development of medical education in
Birmingham had been the result of individual doctors such
as John Ash, Thomas Tomlinson and William Sands Cox,
who initiated the teaching of anatomy and medicine in
Birmingham during the eighteenth century; the Birmingham
General Hospital founded by them in 1779 still functions
as a teaching hospital. Drs Ingleby and Hyde individually
funded lectures suitable for both an undergraduate and a
postgraduate audience. During the twentieth century, the
initiative to impart knowledge and skills to potential general
practitioners has been the enthusiasm and personal resolve of
individual practitioners in addition to their full-time medical
commitments. Although Dr David Scott was appointed in
1972 as the first Regional Advisor in Postgraduate Education
and received a salaried contract, the appointment by the
Regional Health Authority and the expectations of the post
were the results of the personal efforts of Dr Robin Steel,
a general practitioner from Worcester, who wrote the job
description following his experiences setting up a ten-week
‘Orientation towards General Practice’ course first held in
1970. The Orientation towards General Practice course
from 1970 demonstrated the need for postgraduate
education for the potential general practitioners who had
had little experience of primary care as pre-clinical students.
The 1970 programme demonstrated the need to explain
and understand the administrative functions necessary for
the future general practitioners as well as the clinical aspects
of primary care which were not covered in the medical
school curriculum.
“...blueprint for the half-day release course...”
This programme, the first formal postgraduate course for
new entrants into general practice in the West Midlands,
was organised in conjunction with the Birmingham Medical
School Board of Graduate Studies and formed the blueprint
for the half-day release course for the future schemes in
Birmingham, as shown by the Central Birmingham Vocational
Scheme programme of 1981, eleven years later. Dr Robin
Steel’s initiative was continued the following year at the
University by a small working party drawn from the Local
Aesculapius, Summer 2012 5
G P E d u c at i o n i n B i r m i n g h a m
Medical Committees, the Birmingham Regional Board
General Practitioner Liaison Committee, and the Midland
Faculty of the Royal College of General Practitioners. This
working party became the official Regional Postgraduate
General Practice Education Committee, under the
chairmanship of the regional advisor for general practice
Dr David Scott, acknowledged by the University and the
Department of Health as the body responsible for organising
vocational training for general practice and appointing
general practice trainers and trainees until the NHS
reorganisation of the Postgraduate Deaneries in 2008.
The new Strategic Health Authority replaced Education
Committees with Postgraduate Schools of hospital specialities
and of general practice.
schemes in the Region. The following graph shows the
numbers of GP trainers in Birmingham from 1949 to 1972:
Graph of numbers of trainers by year – from
1949 to 1972 – appointed by the Birmingham
Local Medical Committee
Number of trainers
Observed
– Linear
R2 Linear = 0.937
“...regular weekly half-day release course
available for all new GP trainees...”
Following the success of Dr Robin Steel’s Orientation
Course, the Regional General Practice Education Committee
decided in 1972 that there should be a regular weekly
half-day release course available for all new GP trainees
within the West Midlands Region. These trainees came
in to the new Birmingham Maternity Hospital from as far
as Rugby, Hereford and Madeley in Shropshire. As a result
of the large numbers, two courses were organised: the first
was for new GP trainees who were starting their experience in
general practice immediately after their two pre-registration
house posts, led by Dr Alistair Ross, a GP based in the
urban area of Stoke on Trent and Dr Tony Williams, a GP
in rural Cleobury Mortimer. The second was for those who
had acquired two more years’ experience post registration
as senior house officers, and was run by Dr Robin Steel
from Worcester, Dr David Clegg from Tamworth and Dr
George Thorpe, from Solihull. The growing demand for
general practice training during the 1960s and 1970s
meant that half-day release courses were eventually set
up all around the region, with local courses in Hereford
and Worcester, Coventry and Warwick, Shrewsbury and
Burton on Trent.
With the increase in GP training practices throughout the
West Midlands Region, which covered a population base
equivalent to the whole of Scotland, the Regional Adviser
in General Practice was no longer able to supervise all the
training practices and the thirty-four vocational training
6 Aesculapius, Summer 2012
Year
In consequence, Dr David Scott and the Regional GP
Postgraduate Education Committee decided to appoint Area
Advisers assisted by local Area General Practice Education
Committees (AGPECs) to take on the responsibility for
running local schemes. Four vocational schemes were needed
to provide sufficient opportunities for general practice
trainees in Birmingham itself. These were organised by the
District Health Authorities, based around the district general
hospitals with the opportunity for specialist experience in
specialist hospitals, as detailed in the table.
The curriculum of these half-day release courses tended
to concentrate on learning about services which were
relevant to GP consultations but which trainees would not
have experienced as house officers in hospital practice.
These included Dentistry, Physiotherapy, Acupuncture
and Hypnotherapy; the advice and services offered by the
local Pharmacy; the problem solving of patient’s primary
presentations and symptoms (such as fits/faints, back pain,
headaches, sports injuries, dizziness, venereology and sexual
problems); the management of open access pathology results
Birmingham District
Health Authorities
Hospitals with GP VTS posts
Central Birmingham DHA/VTS
Queen Elizabeth Maternity / Birmingham Women’s Hospital
Birmingham Children’s Hospital / Midland Nerve Hospital /
Birmingham General Hospital (A&E)
East Birmingham DHA/VTS
East B’ham ‘Heartlands’ Hospital (A&E) / Marston Green
Maternity Hospital / Yardley Green Geriatric Hospital / Solihull
General Hospital Maternity and Children’s Department
North Birmingham DHA/VTS
Good Hope Hospital (A&E) and Maternity and Children’s
Department
South Birmingham DHA/VTS
Selly Oak (A&E) / Moseley Hall Geriatric Hospital / John
Connolly and Hollymoor Psychiatric Hospitals
West Birmingham DHA/VTS
Dudley Road ‘City’ Hospital / St.Chad’s/All Saints/
Summerfield Geriatric Hospitals
such as haematology and chemistry. The half-day release also
enabled the trainees to visit other primary care organisations,
such as the Deputising Services to understand out of hours
care, Cadbury’s at Bournville to view Factory Medicine
(now occupational medicine), and the Family Practitioner
Committee offices to learn about the National Health Service
administration. The trainees were taken to different practices
in various areas of the city to be shown varied types of
premises and different methods of Practice Management.
The Course Organisers regularly updated the half-day release
programmes to introduce sessions to cover newly identified
contemporary medical issues which had become topical after
the trainees had finished their training at medical school.
The following table shows the new topics introduced in
the Central Birmingham Vocational training Scheme course
between 1979 and 2000 (see diagram right):
both service and education interests and is also responsible
for selecting and recommending hospital posts for general
practice training. The RGPEC could establish its own criteria
for the selection of trainers to reflect local circumstances
and interest, but these must be congruent with the JCPTGP
recommendations for the selection and reselection of training
practices and training practices must meet the JCPTGP’s list
of minimum criteria, which are divided into three sections:
1. The Trainer as Doctor (based on RCGP/GPC Good
Medical Practice);
2. The Trainer as Teacher;
3. The Training Practice
1979 Consultation (“Doctors Talking to Patients” by
Byrne & Long/“Transactional Analysis” by Eric Berne)
1981HIV/AIDS
“Every Deanery had its Regional General
Practice Education Committee...”
The JCPTGP (The Joint Committee) devolved to each
Deanery the responsibility of inspecting and selecting training
practices. Every Deanery had its Regional General Practice
Education Committee (RGPEC) set up by and accountable
to the Postgraduate Dean to select trainers for general
practice training and recommend to the JCPTGP that they be
approved for general practice training. The RGPEC represents
1983 Hormone Replacement Therapy
1985 Evidence Based Medicine: “Clinical Epidemiology”
by Sackett
1987 Inner Consultation (Neighbour)
1989 Helicobacter Eradication
1993 Hypertension (BHS working party guidelines)
1994 Hyperlipidaemia (SSSS trial)
2000 Angina (National Service Framework)
Aesculapius, Summer 2012 7
G P E d u c at i o n
in Birmingham
The West Midlands Deanery was divided into the areas of
Birmingham and Solihull, Coventry and Warwick, Hereford
and Worcestershire, and Staffordshire and Shropshire. These
had already been developed by the West Midlands Regional
Health Authority as autonomous Public Health Areas. The
function of the Regional committee was to ratify the Area
recommendations, although it could also offer an appeal
process of accreditation visits to training schemes to monitor
the implementation of national guidelines.
“...accreditation visits to monitor
national guidelines.”
The JCPTGP visited Deaneries every three years as part of
its programme of accreditation visits to training schemes
to monitor the implementation of national guidelines. In
addition to fulfilling the criteria established by the JCPTGP,
all new trainer applicants in the West Midlands Deanery
must have attended and satisfactorily completed one of its
approved preparatory courses on the training structure and
a foundation course on principles of education and teaching
skills in use in the West Midlands. Guidance is provided as to
the type and extent of evidence which trainers and practices
might be expected to produce in order to satisfy a visiting
team with the authority to verify their performance and
capabilities as both doctors and trainers. For example, the
JCPTGP recommendations for the selection and reselection
of training practices state that the GP trainer is expected to
demonstrate:
• a high standard of professional and personal values in
relation to patient care
• appropriate availability and accessibility to patients
• a high standard of clinical competence
• the ability to communicate effectively
• commitment to personal, professional development as
a clinician
• commitment to audit and peer review
• sensitivity to the personal needs and feelings of colleagues
The aim is to ensure that potential trainers have appropriate
educational ability and can demonstrate that their practice is
satisfactorily organised with adequate premises and patient
care services to train a trainee.
8 Aesculapius, Summer 2012
History
“... stand alone Military Hospitals were closed.”
F
ollowing the Cold War, a Defence Review and
other studies, stand alone Military Hospitals
were closed. Uniform secondary healthcare
was transferred to busy District General Hospitals
close to high areas of military activity (Frimley Park,
Northallerton, Peterborough, Portsmouth and Plymouth)
with the military command and control effective through
the Ministry of Defence and the Ministry of Defence
Hospital Units (MDHUs) embedded within the host
hospitals.
During military operations, casualties are given first aid at the
point of wounding and are evacuated and treated at several
echelons of care which are normally described as Roles.
Role 1 is integral to a unit, ship or station. Role 2 provides
a higher level of care, Role 3 is a field hospital and Role 4
refers to definitive care at the home base. Responsibility for
providing Acute Role 4 Care was passed to the NHS.
“... Centre for Defence Medicine ...”
In response to the Laurence Report, concerns for training
standards, maintaining capability for deployment and staff
retention, the Government in December 1998 announced
a new strategy for Defence Medical Services which included
setting up a Centre for Defence Medicine (CDM) recognising
that military medicine was a distinct discipline in its own
right. The centre was to provide professional leadership,
provide a centre of training and develop a centre of excellence
for research.
From the beginning it was recognised that the CDM
should be developed in partnership with a civilian centre of
excellence, preferably a teaching hospital.
Defence Medicine
Royal Centre for Defence
Medicine – Birmingham
Keith Porter (M 1974 Lond)
An option to develop The Royal Haslar Hospital (Gosport),
itself uplifted and developed into a successful tri-service
hospital, were dismissed in view of the required collaboration
with a major NHS hospital.
The Selection of Birmingham
Following an extensive pre-qualification and tendering
process, three major teaching hospitals were shortlisted –
Newcastle-upon-Tyne Hospital NHS Trust, Guys and
St Thomas’ Hospital NHS Trust and University Hospital of
Birmingham NHS Trust.
“... UHB Birmingham was selected ...”
On the 13th December 1999 it was announced that the UHB
Birmingham was selected on the basis of its strong academic
and clinical partners.
Royal Assent was granted in 2000, the same year that it was
announced that The Royal Defence Medical College would
move from Fort Blockhouse (Gosport) to Birmingham. On
5th October 2000 a Service Level Agreement confirming
the partnership arrangement to cover the next 20 years
was signed.
Early Aspirations
“... centre of excellence for all UK military
medicine.”
The joint vision of the MOD and its partners was that by
2010 the RCDM would be an internationally recognised
centre of excellence for all UK military medicine. It would
be a teaching focus for military medical research, training
and education.
Aesculapius, Summer 2012 9
Defence Medicine
These have been achieved. Although not an initial stated
objective, the unpredictable clinical work load generated by
the two theatres of operation, (Iraq and Afghanistan) has
lead to significant clinical enhancements with the RDCM
being part of a robust chain of highly successful clinical care.
a different ward or different hospital (for example, The
Birmingham Midland Eye Centre). There are now sufficient
military staff both clinical and non-clinical including
psychological care, welfare and support personnel to create a
virtual “military bubble” around the patient group.
The RCDM Research Centre hosts the Medical Director,
Defence Professors and the Military Director of Research.
The Unit maintains strong links with the Defence Scientific
Technical Laboratories (DSTL) at Porton Down, particular in
relation to its Combat Casualty Care Programme.
“Important developments in the
evolution of Role 4”
Education
A strong educational link has been established at
undergraduate level with Birmingham City University for
the delivery of nurse training and that of Allied Health
Professionals.
Clinical Care
“... operational casualties are initially treated
and evacuated ...”
Clinical care is delivered by a hybrid model whereby
operational casualties are initially treated and evacuated
through a military medical chain, repatriated (now) to the
Queen Elizabeth Hospital Birmingham, before returning to
the military chain for rehabilitation, either at the Defence
Medical Services Rehabilitation Centre at Headley Court in
Surrey, or through regional rehabilitation units.
“... a military-managed ward was
established ...”
From the outset it was recognised service personnel and in
particular battle casualties should be cohorted and nursed
together wherever possible, initially at Selly Oak Hospital
and now at the new hospital, Queen Elizabeth Hospital
Birmingham, and therefore a military-managed ward was
established to nurse together service patients providing their
clinical condition allowed.
An uplift in military staff allowed the RCDM to cater for
casualties who for valid reasons must be cared for on
10 Aesculapius, Summer 2012
Landmark Developments
Important developments in the evolution of Role 4 Care
include:
• An increase in military staffing in key Specialties
(Anaesthesia, Trauma and Orthopaedics, Plastic Surgery)
which allows the services to meet surge requirements.
• Uplift capability in terms of capacity in particular, critical
care beds (sometimes up to five patients on a single
military repatriation flight).
• Extending theatre operating times including additional
lists (sometimes 2 to 3 additional all day lists are required
when the service is particularly busy).
• Establishing a robust military ward round / MDT meeting
involving relevant Specialty Consultants (including a
rehabilitation consultant from Headley Court), Junior
Doctors, Nurses, Allied Health Professionals, Mental
Health and Trauma Nurse Practitioners and Trauma
Audit Personnel.
• Establishing robust military feedback to Afghanistan
and supporting services (for example, the aeromedical
evacuation team) through a dedicated phone conference.
• Robust comprehensive trauma data collection.
• An evolving understanding of the microbiological and
mycological challenges and the needs in relation to
patient care.
• A full understanding of the specific critical care challenges
of military trauma, particularly in relation to blast injury.
• A service delivered mostly by Consultants.
• A standard for critically injured patients to be reviewed
in the operating theatre within 2 to 4 hours of arrival at
QEHB (regardless of the time of arrival) and for all key
specialty consultants to be present (sometimes this can
be up to 5 or 6 specialties).
• Development of a robust ongoing team to handle the
demand and logistics of theatre requirements. This often
includes the reception of up to 9 patients in a single
cohort. These multiple injured patients require frequent
visits to theatre. 1 patient recently required 37 visits to
theatre, totalling 75 hours and 15 minutes operating time.
Clinical staff are actively involved in providing education both
within civilian and military programmes and speak regularly
at national and international platforms.
Research
“... National Institute for Health
Research Centre ...”
The one weakness to date has been an inability to exploit
clinical achievements, which has largely been due to the
constant and unrelenting work load pressures. However the
recent establishment of the National Institute for Health
Research (NIHR) Centre, which will focus on surgical
reconstruction, medical microbiology, regenerative medicine
and rehabilitation will address this deficiency. The centre
is underpinned by a strong 3-way agreement between the
University of Birmingham, The University of Birmingham
NHS Trust and the Department of Health jointly funded to
the sum of £20 million over 5 years which will provide a
catalyst for world class research
and outputs.
Conclusion
Queen Elizabeth Hospital Birmingham and the Royal Centre
for Defence Medicine is proud of its recognition as the
leading hospital for trauma in the UK and of its world
class reputation.
“... strong civilian / military partnership
is a role model ...”
Its strong civilian / military partnership is a role model for
co-operation, co-ordination and achievement.
The recent recognition and selection of Queen Elizabeth
Hospital Birmingham, MoD and The University of
Birmingham as a partnership in establishing the NIHR
research centre is further recognition of clinical
excellence and academic capability which will generate
world class research.
Professor Sir Keith Porter MBBS, FRCS (Eng.), FRCS (Ed.),
FIMCRCSEd, FFSEM, FCEM, FRSA
Honorary Professor of Clinical Traumatology
University of Birmingham
Queen Elizabeth Hospital Birmingham
The NIH Research
Centre.
Aesculapius, Summer 2012 11
Virtual Reality in Dentistry
Is there a future for
virtual reality based
technology in Dentistry?
Ralitsa Danevska, final year dental student
W
hen I had to select a project for my elective
I already had heard about the 3D phantom
head at the Amsterdam Dental School. The
idea of experiencing a new method of teaching myself and
visiting the Academic Center for Dentistry Amsterdam
(ACTA) in their new building were the main reasons why
I decided to do this project.
Background
One of the important skills that a future dentist must
develop is learning how to prepare and restore teeth. Teeth
may be damaged by caries otherwise known as decay and
this diseased tissue is removed prior to the placement of a
filling. Undergraduate dental students are provided with the
background knowledge and then are assessed on their ability
to remove the caries leaving a tooth cavity that can
be restored back to the original form and function.
For many years Dental schools have used artificial mannequin
heads mounted on metal rods to train their students,
psychomotor and manual dexterity skills. With the advance
in computer technology, and particularly the rapid growth
of computer simulation technology, in the recent years a
new style of teaching is becoming more prominent in the
health care field. The development of computer generated
three dimensional (3D) virtual reality graphics and haptic
devices (sense of touch) has had an impact in pre-clinical
dental training since its introduction in the late 1980s. The
computerised system provides a 3D model of the mouth on
which dental students can practice various tasks with
a tactile sensation.
3D model.
Mannequin
head.
12 Aesculapius, Summer 2012
Worldwide universities have incorporated virtual reality
based technology in their curriculum for dental teaching.
These are used in various departments of the dental field:
restorative, periodontology, and oral maxillo-facial surgery.
One of the universities that have adopted simulator
teaching for pre-clinical dental students is ACTA. Working
in partnership with MOOG FCS (Amsterdam), a company
specialising in the development of flight simulators, the
University has developed the Simodont in order to improve
the methodology of dental education. The main aim of
this development was to decrease the current gap between
pre-clinical and clinical teaching and make this transition
easier by integrating realistic scenarios into the pre-clinical
teaching. The high quality and high fidelity of the system
allows students to be trained in a dedicated virtual reality
environment whilst at the same time receiving haptic, visual
and audio sensory information. Problem based learning is
achieved by incorporation of pathological dental conditions
within the system, allowing the education to be transferred
from preparation based to problem based.
“...a highly reliable simulator of
the dentition...”
The Simodont is a highly reliable simulator of the dentition
projected on a screen along with a “virtual” fast hand piece
and a mirror. The robot arm is connected to the software and
every movement is projected on the screen. The patented
admittance control paradigm by MOOG is the base of the
haptics. There are two separate loops on the simulator,
a haptic and a graphic one, both running at different
frequencies. The dental tool has six degrees of freedom
positional sensing, which generates three degrees of freedom
force feedback, and its movement is relative to the position
and orientation of a haptic probe. In the haptic loop collision
detection and tooth cutting simulation allow computing
realistic force feedback within 1 millisecond. The behaviour
of the drill is very realistic as the speed can be controlled with
a foot pedal. The force sensor allows not only drilling to take
place but there is the addition of sound that mimics a real air
rotor hand piece. The visual display is clear, replicates true
size and it approaches the acuity limit of the human eye. The
image seen through the 3D glasses has full resolution, full
stereo image and depth.
the marching tube algorithm. The teeth are then coloured
using the Phantom Omni® Haptic Device to represent a
realistic picture.
Aims/Objectives
The aim of this project is to assess the use of 3D technology
for pre-clinical dental student teaching. The study looks at
the benefits and drawbacks of using simulated virtual reality
technologies for undergraduate dental students. In addition,
evaluation is made of the potential of the Simodont to replace
conventional phantom head teaching.
“...an integrated part of dental teaching.”
Methodology
The study was conducted at ACTA in the Netherlands, where
the Simodont is an integrated part of pre-clinical dental
teaching. Assessment of the advantages and disadvantages
of Simodont was made via discussions and interviews with
students, clinicians and the software development team.
Personal observations and practical experience were used to
assess the technology to establish whether it is a superior
teaching tool in comparison to the plastic phantom head.
Evaluation was made on time
spent teaching using the
Simodont in comparison
to the phantom head and
the variety of tasks
performed on each
respectively.
“...previously extracted natural teeth.”
The teeth used for the Simodont are previously extracted
natural teeth, which are scanned using the NewTom 5G
CBCT. From the segmented volumetric output of the
segmentation tool a surface mesh is reconstructed using
The
Simodont.
Aesculapius, Summer 2012 13
Virtual Reality in Dentistry
A literature review was conducted on the use of other similar
technologies for clinical skill teaching for dental students.
This was used to establish if the 3D technology has a future
role in dental teaching.
advantage compared to the phantom head is that there is no
cost involved (currently all students purchase the plastic teeth
they practice on at £1.50 per tooth). Furthermore the high
cost of maintenance of the dental units and hand piece is
also avoided.
Results and discussion
Since November 2010 ACTA has 50 Simodonts in use,
42 of which are used for pre-clinical dental teaching and
8 mobile units are used by the software development team
for demonstrations or small group assessment. Currently
the curriculum includes 8 sessions of 45 minutes of
manual dexterity teaching on the Simodont in first year.
In comparison, the phantom head teaching is carried out
throughout the year with 2 sessions per week. From next
academic year ACTA is also integrating the crown preparation
module on the Simodont for second year students. The
Simodont incorporates not only the practical but also the
theoretical part of teaching by setting the exercises required
within a clinical context. This part is called the Courseware
and provides the educational context of the training. It allows
students to practice clinical reasoning, decision-making and
clinical thinking prior to undertaking this on a real life patient.
“...Courseware software includes different
types of drilling tasks...”
The cariology part of the Courseware software includes
different types of drilling tasks (e.g. drilling a cross-shape
cavity) and three virtual patients. Each patient comes with
full medical, dental and social history, reason for attendance,
complaints, special tests including radiographs, Basic
Periodontal Examination and vitality tests, and a treatment
plan. The student’s knowledge is tested with various
questions asked at each stage of the patient’s treatment
including selecting instruments to performing the drilling
task. They have to answer each question correctly to be able
to proceed onto the following stage. The pass rate required
when preparing a cavity is 95%, which is assessed by how
much caries has been removed and if the cavity has been kept
in the required margins. The student’s manual dexterity skills
are more closely scrutinized than on a plastic tooth. Using
the Simodont, the student has the opportunity to practice
many times until their ability reaches a satisfactory standard.
As all the instruments and materials used are virtual, the
14 Aesculapius, Summer 2012
“...limiting the unnecessary removal of
sound tooth tissue.”
The treatment of realistic pathology of a carious tooth
provided by the software teaches the student not just to drill
a type of cavity (e.g. Black’s Classification) but also to adjust
the preparation according to the pathology and therefore
limiting the unnecessary removal of sound tooth tissue.
Furthermore, this situation is superior even to the clinical
setting as it can be done in a safe environment without any
risk for the patient or the student. Additionally, as the water is
simulated with the drill there is no risk of Legionella problems
that has been known to arise. However the Simodont does
not provide a truly realistic picture, as even though the fast
hand piece can be used with or without water, the water does
not actually spray the tooth itself and in the clinical situation
the mirror often becomes covered in water whilst drilling.
“...no longer the reliance on the use
of natural teeth...”
By using the Simodont there is no longer the reliance on the
use of natural teeth that are often in short supply. To get a
“License to drill” as the Dutch call it, in second year students
are required to find a molar tooth with specific requirements
to the pathology size and location. They need to pass a test
on the tooth to be able to proceed onto clinical practice.
As many more patients in the Netherlands are keeping
their natural teeth it is very difficult for the students to find
such teeth, so many are delayed in starting the clinic. The
Simodont has the potential to provide a standardised tooth
with these specifications, which will be accessible to all
students and overcome the current problems.
The second part of the Simodont Courseware involves
patients that require crown preparation on molar teeth.
The student can choose a different burr depending on the
specifications of crown to be made. A new option has been
added to facilitate easier evaluation of the preparation.
A grid can be placed on the long axis of the tooth and is used
to measure the margins of the preparation. Each box on the
grid represents a millimetre and a quick and easy evaluation
can be made of the preparation on the computer screen.
Students have the chance to become less dependent on
a subjective assessment by a clinical teacher and learn to
appraise their own work critically. Furthermore, this method
allows clinicians to teach students in larger groups. At
ACTA during Simodont teaching there is only one clinician
per 42 students.
“...drilling through enamel and dentine can
be distinguished easily”.
The Simodont is designed to be suitable for left and right
handed use. The height of the screen can be adjusted and a
study has shown that students develop better posture while
working on the Simodont compared with when they are
working on the phantom head. Continual evaluation takes
place about what students and teachers think about the
Simodont. The feedback from students and clinicians overall
is that drilling is quite realistic and the sensation of drilling
through enamel and dentine can be distinguished easily.
One study about evaluation of student acceptance of the
Simodont conducted by ACTA revealed that 70% of students
reported that the force feedback felt like that experienced
in the traditional laboratory and it is usable to train manual
dexterity skills. However the caries density is still very hard
and does not provide the real sensation. This is currently
under development and should be ready in the near future.
“...drilling may only be done on a single tooth.”
Currently the use of the Simodont is very limited. The drilling
may only be done on a single tooth. However there is a full
mouth containing both upper and lower jaws with soft
tissues existing in the software but this has not been
incorporated into the teaching module as yet. Also, even
though there is a slow hand piece to select from the tool
section, the tactile feedback when drilling dentine with this
instrument is not very realistic. The software team is working
to improve the tactile sensation and hopes to incorporate a
hand excavator, which may be used along with the slow hand
piece to remove caries.
Concluding remarks
“3D simulators will be used alongside the
ordinary phantom heads”
The Simodont has been successfully used by ACTA as an
addition to the phantom head teaching to allow a better
transition from pre-clinical to clinical environment for
their dental students. There are many tasks (e.g. placing
fillings, matrix band, wedging, or rubber dam placement)
that can only be taught on the plastic phantom head at the
present time. In this respect the Simodont will not be able
to completely replace the phantom head for a few years
yet. However there are clear advantages to the use of 3D
technology for pre-clinical education that demonstrate the
benefit for the students in having this tool as an addition
to their curriculum. Further plans include the development
of endodontic, implantology and periodontology as part
in the Courseware.Many university dental schools are
following this new trend and incorporating 3D technology
into the undergraduate curriculum. Even though they
are expensive and there is still a great deal of debate and
reluctance in accepting such technologies, in my opinion in
the coming years 3D simulators such as the Simodont will
be used alongside the ordinary phantom heads rather than
replacing them completely.
The future for the Simodont looks very promising, as the
potential of the virtual world is always developing.
Acknowledgements
I would like to thank Prof Damien Walmsley who helped
me arrange my visit to ACTA and guided me throughout
my project.
Special thanks to the Sands Cox Society for selecting my
project and helping me fund it.
A big thank you to Prof Marjoke Vervoorn and the ACTA staff
for allowing me to visit their university and supporting me
undertake my elective project there.
Aesculapius, Summer 2012 15
A n A m e r i c a n N e u r o s u r g e o n i n Wa r t i m e B r i ta i n
Wartime
Odyssey
George Thorpe (M 1950)
F
loyd Barringer a young medical graduate
working in neurosurgery, responded to an
appeal by President Roosevelt in 1941 for
American doctors to volunteer for service in Great
Britain in their Emergency Medical Service. He
came from a medical family and his mother died
in 1938. Floyd wrote letters regularly to his father
during the years away and later in life he published them.
Some copies he sent to nurses with whom he had worked
in this country. Mrs Joan Jones née Hadley kindly lent me
her copy of his books.
“...the largest convoy of the year...”
Floyd’s trip over was exiting for him as it was his first ocean
voyage, in addition he came over in the largest convoy of
the year and it was the one that Winston Churchill came
through, returning from his meeting with President Roosevelt
off Newfoundland.
“They passed just off our Port side and I saw Churchill
quite clearly standing on a turret of the battleship
HMS Prince of Wales.
Our ship was a small freighter the Egyptian Prince with
a crew of about fifty and a very friendly young skipper.
There were three other passengers, a Frenchman an
Englishman and a Nicaraguan.”
“...as though I was a personal envoy
from President Roosevelt.”
“I was put ashore at Loch Ewe, a large sea loch in the
NW Highlands from where I was taken to Inverness
and I saw something of Scotland, it was beautiful.
During my first two days I met a Commander in
16 Aesculapius, Summer 2012
the Royal Navy, a General in the Army
making an inspection of a local hospital and I had tea
with Scottish nobility, Sir Hector and Lady Marjorie
McKenzie of Ross. I have been received as though I was
a personal envoy from President Roosevelt. Apparently
I was the first American doctor to arrive on the Doctors
for Britain program.
At Inverness I was told that I had been assigned
resident doctor at the Queen Elizabeth Hospital,
attached to Birmingham University. The Neurosurgical
unit was started a year ago by Dr Henry Heyl of New
England. Heyl will be the first American that I shall
meet since landing and he is returning to the States
in a few days.”
“Everything is rationed here...”
“I have been told that the Emergency Medical Service
was established at the outbreak of the war, primarily
to treat air raid victims. I will not be in uniform and so
short of clothes until I get some very necessary clothing
coupons, Everything is rationed here, also I lost my
luggage on the train from the Scotland, so I’m looking
a bit grubby.
I have been down town a couple of times. The bus
system seems to be no system at all especially in the
blackout where I had to be led around by strangers.
Most of the ticket takers on the bus are women. On the
streets most of the men and women are in uniform.”
“Birmingham was heavily damaged in
the air raids...”
“Birmingham was heavily damaged in the air raids last
fall and winter but there hasn’t been much air activity
since then. There is plenty of evidence of damage by
the raids but life goes on just the same. I don’t care
much for the weather here now. It is cold and wet and
so gloomy outside. These blackouts are really black.”
Floyd writes to his Father in September that the hospital
reminds him very much of Milwaukee County Hospital in
size location and in architecture. The QE has a considerable
number of senior resident doctors and a fair number of
housemen (interns). The Army claims fellows who have
completed 6 months internship.
“I am kept busy with “peacetime” neurosurgery. When
the raids start again we shall be very busy, at present
our cases include peripheral nerve injuries, brain
tumours and spine cases. Mr. Jack Small my Consultant
did a prolapsed disc and injected a trigeminal nerve
yesterday. I first assisted. I am not having trouble
now getting round the wards and making myself
understood.”
“...English are very courteous and polite...”
Mary Butler a Nurse on the neurosurgical unit, who lived
in Stratford obtained tickets for Richard the Second at
the theatre there on a Saturday afternoon in September
and was Floyd’s guide for the day. In a letter home he
describes it.
“With a cast of internationally known Shakespearian
actors, I enjoyed it very much; Almost to my surprise
the diction was perfect. In fact, I had much less
difficulty understanding l6th century English than
I have with 20th century English in Birmingham.”
“This was war time and this England
was in danger.”
“The big new Shakespeare Memorial Theatre stands
on the banks of the Avon river. The theatre is rather
modernistic in style and the interior is perfect for vision
and acoustics. There is one scene in Richard ll which
I will never forget. It is the death bed scene of John
of Gaunt, who struggles up on his elbow to give this
unforgettable tribute to his county “ This royal throne
of kings, this sceptre’d Isle..... This blessed plot, this
earth, this realm, this England.” As the actor finished
the last line there was a veritable explosion! The entire
audience were on their feet crying and cheering, and
I was with them. This was war time and this England
was in danger.
“My opinion of the English people is improved
greatly. The English are very courteous and polite but
conservative and distant. Getting acquainted with
them is a very slow and tedious process.
I am becoming accustomed to tea every afternoon at
4 o’clock. We have bread and margarine but no jam
or jelly. Could you send some over? It would be a big
help and add to my social standing here.
Time for the 9 o’clock news, so I’ll quit for now.”
Farewell to good friends, March 1946. Paul Dawson-Edwards,
Resident in Urological Surgery; Jane Green, Anesthetist
for Neurosurgical Unit; Floyd Barringer, Neurosurgical
Registrar; Ted Edwards, Resident Surgical Officer.
Aesculapius, Summer 2012 17
A n A m e r i c a n N e u r o s u r g e o n i n Wa r t i m e B r i ta i n
The lovely old town and the beautiful countryside are
so peaceful. I begin to understand a little of why the
English are like they are. They are not only surrounded
by history,– they are living it.”
“...watched, from the QE roof,
Coventry burning...”
Later in September Paul Dawson-Edwards, as a resident
surgeon, on November 14th 1940 had watched, from the QE
roof, Coventry burning in the memorable German Blitz, not
knowing whether his parents were dead or alive. He asked
his friend Floyd for the weekend to his parents home. Floyd
reports to his Father how they travelled by bus to Coventry,
where Paul’s Mother was expecting them and had tea ready
and they were soon joined by Paul’s Father. It was some time
before conversation shifted to the night of November 14th.
1940 They were anxious to hear what we had heard in the
States about the raids on Coventry. Then they began to tell
of the raid that first night they and their neighbours had
spent in their shelter. The men made a pretence of playing
cards, yet sat frozen each time a bomb dropped nearby. They
told of the screaming bombs.
“...some giant jagged blade had sliced away
half of the house.”
“The next morning Paul and I were taken by Paul’s
Father in their small car on a four hour tour of the
town: driving through residential districts we saw
frequent “vacant lots” where once houses stood. The
debris had been almost entirely removed but in places
part of the house still stood, as though some giant
jagged blade had sliced away half of the house. We
passed a place where a land mine had exploded after
being parachuted to earth. The bombing appeared
entirely indiscriminate except that it was most
concentrated over the very centre of the town.”
Floyd described it as being absolutely desolate.
“There are blocks and blocks where not a single brick is
standing. Occasionally, there is a lone little shop in the
midst of desolation which has miraculously escaped
with a sign on the door – business as usual –.We
18 Aesculapius, Summer 2012
drove on up the hill to the three spires and the ruins of
Coventry Cathedral, only the tower and walls remain”
On their way home they passed a shallow hollow where
there had been a big public air raid shelter. There had been a
direct hit on the shelter and everyone had been killed. Before
reaching home they passed the place where Paul’s school
had stood.
Paul’s Father drove Paul and Floyd back to hospital.
“Seeing Coventry in 1941 and man’s inhumanity to man
is an experience I shall not soon forget. Somehow, I felt
very tired when I arrived back to Birmingham”
On Sunday 7th December Floyd listening to a late evening
news and learnt of the attack on Pearl Harbour.
“Blackouts in America.”
“I have been in a daze all night. On Monday we operated
all day, Mr Sweet, the American neurosurgeon had
arrived. We had a radio brought into the operating
theatre to listen to the news bulletins and the President’s
speech to Congress asking for a declaration of war.
Tuesday we listened to the grim details of how 1500 of
our boys died at Pearl Harbour. Wednesday, more news
about Japanese raids and invasions and American’s
reaction to the war: planes over San Francisco! Planes
nearing New York! Blackouts in America! Then
suddenly a news report of the sinking of the British
battleships, the Prince of Wales and the Repulse: this
was a shocker for the British, They lost as many or
more on these two ships as we lost at Pearl Harbour.”
In the New Year American service men began to be seen on
British streets including Ben, Floyd’s younger brother, a
M.O. in American Air Force.
Floyd and Mr Sweet got on very well together and continued
to man the Neurosurgical unit until the end of the war in
Europe in 1945.
“I’m all right thank you, Doctor.”
In August of 1942 began the first of a further series of
bombing raids on Birmingham. Floyd described incendiary
Left: Floyd and Winifred,
The Grange, Ripley, Derbyshire,
2 June 1945.
Right: Floyd. Christmas 1945,
Passport photo for
going home.
The pattern of work on the Neurosurgical unit continued
a mix of civilian cases, service cases evacuated from North
Africa and Italy and Air raid casualties. Between June 6th
1944 marking the Normandy landing and the end of the war
in Europe May 7th 1945 cases were predominantly militarily
cases from Northern Europe.
A note in Floyd’s Journal August 1st 1944
bombs dropping near the hospital and he and other doctors
running out with sandbags to smother them, he also wrote
about the aircraft, artillery and bomb noise with background
explosions and burning buildings. He wrote home about the
long line of ambulances delivering the injured to hospital the
next morning.
“In the casualty ward the resident surgical officer (RSO)
was going from stretcher to stretcher, examining the
casualties, assigning them to the various doctors and
operating theatres. The patients all looked alike – black
with dirt and grime, quiet and nearly all wearing face
bandages (exploding incendiaries) and some of them
blind. They all answered the same to our opening
questions, “I’m all right thank you, Doctor.” Then our
work began, All head injuries were referred to us. The
first case was a 12 year old boy , an incendiary bomb
came through the roof of his bedroom. He had a badly
burnt face and a compound fracture of skull with the
brain exposed.”
Operating continued well into the night and most of the
cases were evacuated the next day to peripheral hospitals
to leave beds if further raids followed as happened later the
same week.
“Don just arrived this evening with a cablegram notifying
them of their father’s death after a short illness at the
age of 77.”
“...married from Winifred’s home at Ripley
in Derbyshire...”
On 1st Feb 1945 Floyd became engaged to Winifred Wain,
a nurse he had met on the Neurosurgical ward. They were
married from Winifred’s home at Ripley in Derbyshire on
2nd June 1945.With a honeymoon in Devon after a first
night spent at the New Inn at Gloucester; which Floyd
points out was built in 1450 after the Old Inn burnt down.
Mr and Mrs Floyd finally sailed from Southampton on the
5th April 1946 on the Ile De France to a happy and fulfilling
family and professional life together.
Passenger List
7000 Canadian troops
700 English – Canadian wa
r brides
Dr and Mrs Floyd Barrenger
Aesculapius, Summer 2012 19
Letters
Doctors and Nurses in Society
28th Feb 2012
Dr Keith Harding
[email protected]
Dear Editor
I very much enjoyed George Watt’s
article on Doctors and Nurses in Society.
He seeks to explain why the status
of doctors and nurses in society had
fallen at the same time as our ability to
provide more active scientific treatment
has risen.
I would agree with George Watt’s
that over specialisation has caused
tremendous damage to the practice of
medicine overall, although of course
it has produced advances within
increasingly narrow spheres. Super
specialisation has been driven to
some extent by the universities and
the Research Assessment Exercises
by which they receive the allocation
of a large proportion of their money.
Increasing specialisation has, of course,
led to better treatment from the
technical point view for the patients
who happen to need it but one of the
biggest problems is how the patient
with the specific problem finds a super
specialist that can best treat it. Even
more difficulty arises if the patient turns
out to have a complication which is 1
or 2mm outside the area of expertise of
their super specialist. The unfortunate
patient may well get badly treated by
that super specialist or even referred
to another super specialist who might
provide contradictory advice and
therapy. Recently one of my retired
Consultant colleagues was admitted
to hospital in the south west and he
ended up being under the “care” of
seven different Consultants, none of
20 Aesculapius, Summer 2012
whom seemed to know much about
what the others had done and even
the GP, who should have known
better, seemed unable to guide our
former colleague through the maze of
problems. What is needed is a good
sound sensible General Physician
or General Surgeon or even General
Practitioner who can act as a chairman
to co-ordinate all this committee of
experts. One of my greatest regrets
is the demise of the true General
Physician and General Surgeon
who had an overview of the width
of medicine and surgery and who
could guide wisely to the appropriate
specialist for treatment.
What have been the pressures to make
this super specialisation happen?
Partly I suppose it is the enormous
increase in knowledge and the sheer
mass of information available in
journals and the internet. There is
also pressure from patients who want
to see the expert in their particular
condition, not realising the truism
that is attributed to Mark Twain that
“to a man with a hammer everything
is a nail”. It could well be that if the
expert one is referred to is an expert in
only one particular technique, that may
be the technique you get, whether you
need it or not. It was often said when
I was a Registrar, rather scurrilously,
that one particular consultant, who
shall remain nameless, did a beautiful
cholecystectomy whether the patient
needed it or not. I am afraid I get the
impression from observing colleagues
with medical problems that they
sometimes get treated by a particular
“latest technique” simply because the
person they have been referred to is an
expert at that, whether or not it is the
most appropriate thing for them.
At a recent meeting of the Retired
Doctors Forum in Nottingham, one of
the greatest concerns of the members
present was the declining standards of
medical and nursing care that they or
their family had received in the last few
years. It seems as though there is often
a lack of basic nursing activities, such
as making sure the patient has food
and water and someone to talk to
about their situation. My own
experience of two hospital admissions
in the last five years was that the
person who took the most notice of
an extremely debilitating attack of
hiccups that I had post-operatively
lasting for about five days was not
a doctor or a nurse. It was the ward
cleaner/ domestic who said that her
husband had similar problems and
she knew how to deal with it. She put
her fingers in my ears and made me
swallow water. Although this did not
completely cure the hiccups in the
long term, it certainly alleviated them
and made me feel better. Someone had
taken notice and something had been
done. That to my mind is an essential
part of proper medicine and surgery.
It is often said that our mistakes and
errors start with failure to listen to
patients and hear what they are saying.
The next big failure is failure to examine
properly and then failure to investigate
appropriately and more importantly,
perhaps, to read and interpret the
results of any investigations that are
ordered.
As George Watts tells us in his
article, bonding between patient and
doctor is best established by human
interactions such as listening and
examining and not by studying the
computer screen which seems to be
so common, particularly in General
Practice nowadays. One often hears
of consultations where the doctor
has hardly taken his eyes off the
computer screen, simply presses
a button to produce a prescription
and dismisses the patient with hardly
a glance.
Personally I feel that the current medical
students and junior doctors have lost a
lot by not being required to take blood
from their patients, leaving the task to
specialist phlebotomists who take the
blood with extreme skill and minimum
discomfort to the patient. Somehow
the bonding between the doctor or
the medical student and the patient is
enhanced by inserting the needle and
withdrawing the blood. It is during those
times of intimate contact that patients
can often come out with very significant
parts of their story that would otherwise
be lost if they simply had an expert
phlebotomist do it for them.
Another great loss for medical students
and junior doctors has occurred
with the destruction of the clinical
firm whereby the patient was looked
after by a Consultant a Registrar and
Houseman. The patient always knew
who his Consultant was, who the
Registrar was and who the Houseman
was. They were consistent in their
approach, they all knew what the firm
policy for each patient was because
they were together on ward rounds and
sat down together for coffee in Sister’s
office afterwards to work out the best
way forward for each patient. From my
own observations as an in-patient and
having close relatives as in-patients, this
has now been completely lost. There is
a random team of junior doctors who
come round at different times of the
day and seem to have no understanding
of what the previous group of doctors
said or did and certainly have very
little understanding of the patient’s
treatment plan.
The concept of handover between one
group of junior doctors and the next
has been very difficult to establish.
The reason for this is of course that
the junior doctors’ hours have been
so reduced they are only on-call very
infrequently and if they have been
on-call they are not allowed to be on
the ward the following day or once
their reduced hours of work have been
achieved. This lack of continuity of care
is the source of great anxiety to patients.
Because of the reduced working hours
of the doctors, any individual junior
doctor now when he is on duty has
to cover a vastly larger number of
patients. He can hardly be expected
to know much about any individual.
Consultants on-call too may have
little understanding of any patient’s
specific problems because he/she is a
super specialist in some other area. For
instance, a colleague who was an eye
surgeon in Glasgow recently described
how he was expected to be the first
on-call Consultant for ENT, as well as
eyes, and felt rather out of his depth.
Increasingly numbers of specialists,
such as breast surgery, are requesting
to come off the general surgical rota
because they have not had to deal with
colonic, gastric or other general surgical
problems for some years and feel
unskilled. Increasing specialisation may
be of benefit, and probably is a benefit
to some patients but it is not all gain
and comes at a price.
Finally, I have heard that although Lord
Moran’s nickname “corkscrew Charlie”,
suggested that he was crooked, it was
also said unkindly by his compatriots
that if he swallowed a nail he would
vomit it back as a corkscrew.
Thank you, George for a provocative
and thoughtful review of the status of
the professions since the golden times
of yore. Nowadays even nostalgia is
not what it used to be. Nothing lasts
forever.
Brian R. Hopkinson (M 1961)
Typography matters
Hi Keith,
Have just received Aesculapius. It is a
triumph – a superb job of editing and
presentation. So interesting.
As for the article by Stephen Bunce, I
do appreciate that 12 pt is easier to read
than 10 pt for people whose eyesight
is less than perfect, but it does mean
that you have less on a page, need
more pages, and therefore end up with
higher costs. If that’s OK, and you feel
you owe it to your older and blinder
readers, then a shift to 12 pt might be
worthwhile. I do like the typeface you
use, and am very impressed by the
design and layout of the magazine. It is
very professional and everyone to whom
I have shown it likes it a lot. So I’d keep
with whoever designs Aesculapius for
you. Your comparison of Garamond and
Frutiger tends to suggest that Stephen
thinks Frutiger is easier to read: however,
I wouldn’t like to see all the text in bold,
which the Frutiger text appears to be.
Stylistically I like a lighter and finer type
for the main contents and to use bold
only when you are making a special
point or highlight. As for the tracking
and leading discussion, I prefer sample
A for tracking, and the A-B spacing
for leading, mainly because again this
would be more economical and just
as easy to read. However I admit to be
a professional reader, in that I am an
author and don’t like to waste space,
so my opinion on leading may not be
the most popular one. I bow to your
designer on both opinions. The most
important part of the magazine is the
content, and I don’t think anyone
could argue against Aesculapius on that.
With best wishes.
Tom Smith
Aesculapius, Summer 2012 21
Letters
1948-50
Hospital Staff Photograph
26th February 2012
Dear Keith
I thought that I might comment about
one of the recent articles in Aesculapius,
which I much enjoyed reading. It may
also be appropriate to report on some
personal news to update the record?
George Thorpe’s article about the
splendid photograph of the Hospital
Staff Picture from 1948-50 (Aesculapius
Vol XXX p5) was very nostalgic for me
and brought back many memories. I
was not directly involved in that era,
having graduated at least 16 years after
the picture was taken, but because of
family connections, I knew many of the
staff in the photograph and thought
that some comments might
be worthwhile?
K.D. Wilkinson (front row) was the
senior physician at the time of the
picture. George Thorpe may not
have known him much and made no
mention of him in his splendid article.
My interest is of course that I was his
youngest son and through him I knew
a number of those in the assembled
group – several of whom I worked with
in later years and remember vividly.
K.D. (Kenneth Douglas) Wilkinson
was a 1909 Birmingham graduate and
a contemporary of H.H. Sampson
(known as Sammie) in that year. H.H.
Sampson was the senior surgeon at the
time of the picture. Sammie won the
prize for medicine and K.D. won that
for surgery in the 1909 exams. K.D.
practiced as a paediatrician as well as
an adult physician and, like Sir Leonard
Parsons (from whom I was given
my middle name), he was a founder
member of the British Paediatric
22 Aesculapius, Summer 2012
Association. He was on the staff of the
Children’s Hospital from 1913 until the
time of the second world war. The rules
dictated that consultants could only be
on the staff for 30 years (Sir Leonard,
as the first Professor of Paediatrics, was
an exception) but K.D. was invited
to continue and only withdrew from
the Children’s Hospital staff after the
war. He was appointed to the Chair
of Pharmacology and Therapeutics in
1929 – being the first Birmingham
graduate to become a professor in
the medical school. His main area
of clinical interest was cardiology
and he was a founder member of the
Cardiac Club (forerunner of The British
Cardiovascular Society). He was also
one of the group who established the
British Heart Journal in 1939 and was a
member of its first editorial board.
Looking at the photograph which
adorned the wall of Fauset Welsh’s
sitting room I was taken back many
decades. Fauset and his family lived just
across the road from us in Harborne
Road and his youngest son was a
good friend with whom I used to play
frequently (often in their garden).
Fauset was still working when I was
a medical student in the sixties and
I remember him and his first wife
very fondly.
Similarly I knew Jack Collis’s family
socially and one of his sons was
not much older than I and another
childhood playmate. As a medical
student I used to attend Jack Collis’s
teaching sessions and remember him
with great admiration. At that time he
lived in Augustus Road, quite closely
adjacent to Chancellor’s Hall where
I was in residence throughout my
university life. I used to call in to see
Jack and Mavis from time to time.
Dr Ronald St. Johnstone lived round
the corner from us and his son
(Charles St. Johnstone), though not a
Birmingham medical student, was a
resident at QE in the early seventies
and a good friend (he is godfather to
one of my sons), with whom I still keep
in touch.
Jim Leather was a familiar figure
as he and his family had a holiday
house close to ours in Borth (near
Aberystwyth). His youngest son was
another good friend of mine during
those holidays and we occasionally
visited the Leather family at their home
in Birmingham. His daughter (Dianne)
was an Olympic athlete and captained
the English Women’s team at the Rome
Olympics in 1960.
Clifford Parsons followed K.D.
Wilkinson as a consultant to the
Children’s Hospital, where he
developed the paediatric cardiology and
cardiac surgical service after the war. He
was a another good friend and strong
supporter to my family throughout his
life and I corresponded with him up
until the time of his death. He was my
sister’s godfather and my eldest son
carries the name Clifford as a middle
name. He was also my mentor during
training in Paediatric Cardiology and
I applied (unsuccessfully) for his job
at The Children’s Hospital when he
retired in 1973.
Mrs Hilda Lloyd (later Dame Hilda)
delivered me and my two sisters and
we knew her well in later years, with
mutual visits and her presence at
various family functions. She was my
sister’s godmother.
Others amongst those shown in the
staff portrait who I knew in early
years and subsequently included Prof
Alphonsus (Pon) D’Abreu, who was
the Dean when I started as a medical
student, Sir Melville Arnott who I
knew both as a student and during
cardiology training and Guy Baines
(with whose family my wife stayed on
the eve of our marriage in 1972). Jack
Small (labelled in the picture as William
Small), for whom I worked as a resident
at The Midland Centre for Neurology
and Neurosurgery at Smethwick, was
another familiar figure.
Deb (R.K. Debenham), for whom I
worked as his last house surgeon before
retirement in 1966, was another who I
remember very fondly. I had previously
been a student on the firm of Deb and
Victor Brookes in 1963, before being
their HS in 1966, and I remember
both of them with great affection and
admiration.
Alec Innes lived immediately behind
our Harborne Road house, his house
fronting onto Highfield Road. I, with
my sisters, spent many happy hours
in his garden, with his children, and
one of his sons was another regular
playmate from those early days.
Alan Stammers, George Whitfield and
John Malins (my godfather) all had
rooms in the consulting suites that
my father had built onto our house.
They continued to work there after
K.D. Wilkinson died in 1951 and
some at least still used the house, as
consulting rooms, many years after
we moved away from Birmingham to
live in Bristol in 1953. In subsequent
years the house was used by many
of the QE consultants and was still
being so employed when I returned to
Birmingham as a medical student in
the sixties.
Sir Arthur Thompson I only knew by
name until he developed heart block
and required a pacemaker, when I was
a cardiology registrar at the QE. I got
to know him well at that time and
enjoyed talking to him and hearing
many stories about his life and the
prominent figures who he had worked
with during his career.
Carey Smallwood was an idiosyncratic
personality but an excellent teacher. I
attended his ward rounds as a student
– and they were always very popular,
despite his rather strange personality.
He was a cold and rather distant
person, who could be caustic in his
dealings with students, nurses and
medical colleagues, which meant that
he was not well liked by many of his
staff and colleagues. His son was my
anatomy tutor and had undoubtedly
inherited many of his father’s character
traits but I was extremely grateful for
his help and support in my early days
as a medical student and maintained
contact with him occasionally for
several decades afterwards.
JimWilkinson (M1966)
Niall remembered
Dear Keith,
May I once again congratulate you on
the 2011 edition of Asculapius both
for its presentation and content. I was
pleased to see that George Dalton had
reproduced “Final Year 1946-1947”
compiled by “Niel” Daniel Hanson.
It is probably his only contribution
to the literature having been killed
in a mountain climbing accident in
August 1947. I am sure of the date
because I heard the news of his death
while in the Out-patient Department
of the General Hospital, another J.F.K.
assassination moment. Niall intended
to have a career in academic medicine
and was due to take up an appointment
for research into endocrinology at
Birmingham Medical School. His fellow
students appreciated at the time the
immense loss to medicine by his early
death. This publication illustrates what
an erudite and witty author he would
have been.
Keith Shinton (M 1947)
P.S. The “year” for George Watts
in two articles should be M 1944
(see Aesculapius November 1996.
p.15 “The Spirit of the General
Hospital”).
Aesculapius, Summer 2012 23
Greek God of Healing
Aesculapius:
What’s in a name?
Jonathan Reinarz,
Reader in the History of Medicine and Director, History of Medicine Unit
“Aesculapius’s father was Apollo...”
A
esculapius (or Asclepius) was, in Greek
mythology, the god of healing and is first
mentioned in the writings of Homer. According
to fifth-century poet Pindar, Aesculapius’s father was
Apollo, the physician to the gods, who reputedly had
the power to start epidemics with an arrow from his
bow. In contrast to his divine father, Aesculapius’s
mother was a mortal, variously identified as Arsinoe,
the third daughter of Leucippus and Philodice, or
Coronis, a princess of Thessaly and daughter of King
Phlegyas. Following his mother’s premature death, he
was raised by Chiron, the centaur, and instructed in
the art of herbal remedies. He used these to heal other
mortals, and was said to be so successful as a healer that
the underworld experienced a period of depopulation.
After restoring the life of a dead man, Hippolytos,
Aesculapius was destroyed by a thunderbolt hurled by
Zeus as punishment for transgressing the laws of nature.
According to Hesiod in about 700 BC, Aesculapius had
a wife called Epione and several daughters, including
Hygeia, the goddess of health, and Panacea, the goddess
of healing.
“...Aesculapius was enrolled among the gods”
Following his death, Aesculapius was enrolled among the
gods. The cult of Aesculapius probably originated in Thessaly
and gradually spread southwards over many centuries. By
the second century AD, he had even begun to eclipse some
of the traditional Olympian deities and had many temples
of healing dedicated in his honour. More than 100 such
healing shrines were built throughout Greek lands, often
in healthy locations, such as on hills or near springs, many
24 Aesculapius, Summer 2012
containing baths, gymnasiums and dormitories for patients.
Many sick and infirm individuals, particularly from the
educated classes, travelled to these temples when other
treatments had failed.
“Therapeutic regimes tended towards prayers
and incantations.“
The chief temple was the Epidaurus. Built in a small valley
in the Peloponnesus, approximately six miles from the town
of Epidaurus, the Sanctuary of Asklepios was constructed
circa 430 BC during a period of rapid urbanisation, civil
strife and possible epidemic disease. It comprised a new
Asclepian temple, a theatre with capacity for 12,000 people
and a stadium for 20,000; today, the site is considered
a masterpiece of Greek architecture. The second shrine
dedicated to Aesculapius was established on the slopes of the
Acropolis a year later, another appeared in Pergamon around
370 BC, while that in Rome existed since at least 293 BC.
Therapeutic regimes at the shrines tended towards prayers
and incantations. Patients often received sedatives and were
directed by Asclepiad priests to sleep in an adjoining temple;
as a result, they are often described as the earliest hospitals.
Messages sent to patients by Aesculapius in dreams were
interpreted by priests to direct further cures. These might
include dietary changes, bathing or exercise. Others claim
to have initially been summoned to temples by Aesculapius
in their dreams. Successful cures were recorded by priests
on votive tablets, which were reputedly the foundation
of later Hippocratic medicine, which coincided with the
expansion of the pan-Hellenic healing cult associated with
Aesculapius. Even the island of Cos, the presumed home
of Hippocrates had a functioning Asclepieion from about
420 BC. The Ancient Greeks believed that all doctors were
direct descendants of Aesculapius, the family of Hippocrates
having therefore claimed descent from the god of medicine.
Picture Courtesy Mr G Watts
Marble statue
of Aesculapius
at Ampurias.
“...his healing staff, is depicted as a single
serpent encircling a branch.”
While images of Aesculapius are quite common, he is most
often symbolised by his healing staff, which is depicted as
a single serpent encircling a branch. The snake was
considered to be a symbol appropriate to medicine due to
its ability to shed its skin, a process that highlighted the
physician’s powers of renovation. In recent years, the staff of
Aesculapius is regularly incorrectly referred to as a caduceus,
the fabled wand carried by Hermes, the messenger of the
gods, comprising two winged and entwined serpents. The
French journal of military medicine famously perpetuated this
confusion since its first publication in 1901 by being named
Le Caducée. It has, nevertheless, become recognised as a
symbol denoting the medical profession internationally, both
in Europe and in North America.
Aesculapius, Summer 2012 25
Th e N e w Q E
The new
Queen Elizabeth Hospital
David Rosser (M Cardiff 1987)
Medical Director, University Hospitals Birmingham NHS Foundation Trust
“This imposing building dominates the skyline...”
A
s the city’s landscape has been altered by the
construction of the new Queen Elizabeth Hospital
Birmingham, so has its position in the world
of healthcare delivery. This imposing building which
sits astride one of Edgbaston’s natural elevations not
only dominates the skyline but also the field of NHS
organisations striving to be at the forefront of treatment,
research and innovation. It has put Birmingham on
the world map thanks to its international reputation
for clinical training and education, quality of care,
informatics/IT and research.
It’s been a long journey, in fact, almost 15 years, to get
to where we are today: from the initial consultation and
planning on possible designs to the last phase of the scheme
being completed – with the opening of the new Laboratories
Above: Viewed from Selly Oak, the QEHB dominates the Edgbaston
skyline.
26 Aesculapius, Summer 2012
– in April 2012. So-called Short Life Working Groups first
met back in 1997 and continued their work for two years to
consider how the new hospital should be designed to meet
future service requirements. By March 2002 the outline
business case for the new hospital had been approved
and in October 2004 full planning consent was granted,
with Consort Healthcare already chosen as the preferred
construction company.
“...smoothest, most efficient and effective care
pathway for patients.”
Work officially started on the site in June 2006 and four years
later – on June 16 2010 – the Queen Elizabeth Hospital
Birmingham admitted its first patients. Even then the work
did not stop. In a series of seven phased moves specialties
from the old QE and Selly Oak hospitals have gradually
populated the new hospital. They have been brought together
in one fit-for-purpose structure and in multi-disciplinary
configurations to ensure the smoothest, most efficient
and effective care pathway for patients. The merger of two
major hospitals onto the QEHB site, in close proximity to
the University of Birmingham Medical School, also brings
together all major sub-specialties and academics for the
first time.
“...link between academia and healthcare
reinforced...”
The collaboration between UHB and the University of
Birmingham serves to make Birmingham one of few
centres internationally that can complete the full circle
of translational medicine. Through this close working
relationship we serve a very diverse population the same size
as an average European country. The link between academia
and healthcare was reinforced recently with the launch of
Birmingham Health Partners, a joint working agreement
enabling patients to benefit from new therapies delivered by
expert clinicians working alongside world-leading clinical
trials teams within the University. The new agreement will
fuel partnership projects in key research areas, including
cancer, immunology and infection, experimental medicine
and chronic disease. It is intended to strengthen and develop
the global reputations of both institutions and builds on a
long history of collaborative achievements.
“...the highest performing of the
Wellcome CRFs...”
Ten years ago the Wellcome Trust Clinical Research Facility
(WTCRF), rated as the highest performing of the Wellcome
CRFs, opened at UHB. A paediatric facility to complement
the Trust’s adult arm opened at Birmingham Children’s
Hospital in 2008. The UHB/UoB campus is also home to the
first Cancer Research UK Centre which makes Birmingham
one of the two largest centres for clinical trials in the UK and
means UHB is recognised as a leading European centre for
early phase clinical trials. Other recent developments include
the launch of the new Centre for Translational Inflammation
Research, also based at the QEHB, which brings together staff
from a host of specialist areas to work on major collaborative
research programmes in state-of-the-art laboratories.
Historic fortifications have been maintained in the grounds of the
new hospital, which has a link bridge to the old QE.
Aesculapius, Summer 2012 27
Th e N e w Q E
The Trust has also been recognised as a Centre of Excellence
for its world-class haematological cancer research by the
Leukaemia and Lymphoma Research charity. A key part of
delivering such improvements is translating research into
clinical practice at the bedside. In addition, UHB is part-way
through its three-phase plan to become a world-class centre
for adult and paediatric radiotherapy within five years. We
are the second largest centre for paediatric radiotherapy in
the UK and in January 2012 we became the only centre
in Europe to have two Tomotherapy HD machines, used
to provide high quality general radiotherapy to around
20-30% of our patients, with fewer side effects than with
traditional radiotherapy. UHB is also investing in Cyberknife
technology to provide better specialist radiotherapy
treatment, predominantly for brain tumours. One of the
Trust’s greatest responsibilities – and one which continually
puts us in the headlines – is as host to the Royal Centre for
Defence Medicine (RCDM). We treat all seriously injured
The new Queen Elizabeth Hospital Birmingham site is adjacent to
the University of Birmingham campus. The Joseph Chamberlain
Memorial Clock Tower can be seen in the distance.
28 Aesculapius, Summer 2012
British military personnel evacuated from overseas and
have earned a world-renowned reputation for trauma care
through development of pioneering surgical techniques in the
management of ballistic and blast injuries, including bespoke
surgical solutions for previously unseen injuries. As a result,
UHB has managed to save the lives of more than 80 military
personnel who were not expected to survive, based on injury
severity scoring.
“...one of the largest healthcare campuses
in the world.”
Because of this clinical expertise in treating trauma patients
and military casualties, UHB was in January 2011 announced
as the host for the UK’s first £20m National Institute for
Health Research (NIHR) Centre for Surgical Reconstruction
and Microbiology. This is a joint venture between UHB,
the University, the Department of Health and Ministry of
Defence, and will be led by UHB’s Professor Sir Keith Porter,
who is the UK’s only Professor of Clinical Traumatology. The
centre is focusing on the most urgent challenges in trauma,
including identifying effective resuscitation techniques,
surgical care after multiple injuries or amputation, and
fighting wound infections. The co-location of the Queen
Elizabeth Hospital Birmingham, RCDM, University of
Birmingham Medical School and Birmingham Women’s
Hospital on one site makes UHB one of the largest healthcare
campuses in the world. Our large and accessible patient
base has helped to deliver internationally-recognised clinical
programmes for liver, renal and stem cell transplantation
over the past two decades. UHB also has close strategic and
operational links with other nearby hospital trusts, including
the Royal Orthopaedic Hospital.”
The foundations of where we are today and what we have
achieved to date can be traced back pre-war and the concept
of a ‘Hospitals Centre’ as described in the 1939 QE royal
opening souvenir programme. According to the Executive
Board of the day, this would provide ‘an organic and
integral connection between the scientist and the clinician’
The Trust has two Tomotherapy HD machines, used to provide
high quality general radiotherapy with fewer side effects than with
traditional radiotherapy.
and ‘secure the best treatment of patients and training of
medical students and nurses’. Without specific regard to
that futuristic vision, we have actually achieved its aims and
in doing so have built an international reputation for clinical
training and education which has translated into some of
the best expertise in the world and exemplary care for our
patients. In short, people want to work with us and, because
of this, we train, attract and retain some of the finest medical
staff in the world. As host to the RCDM, UHB trains all UK
military medical and nursing personnel, ensuring that they
are fit to serve when deployed to conflict zones. UHB and
UoB also provide a broad range of postgraduate, leadership
and clinical skills training to nursing staff.
The Trust is internationally recognised for the quality of
its specialist medical and surgical training and has forged
relationships with hospitals in many different countries to
provide leadership and share clinical expertise. For example,
Aesculapius, Summer 2012 29
Th e N e w Q E
between 1984 and 2010 nearly 600 surgeons and physicians
from more than 60 countries came to the Liver Unit at UHB
to undertake training in liver transplantation or hepatology,
with visits ranging from two weeks to over two years. The
unit has now developed a formal international fellows training
programme which has been approved by the General Medical
Council and many of the world’s liver transplant programmes
are headed up by doctors who have been trained by UHB.
“...one of the leading teaching hospitals
in the UK.”
Our expertise has been shared in many such ways. UHB
staff played a key role in the first successful multi-organ
transplant of its kind in Australia, helping to retrieve the
liver and small bowel from a donor before then assisting
in the 12-hour transplantation operation of those organs.
A new road network has been developed around the Queen
Elizabeth Hospital Birmingham to create links to the University
and city centre.
30 Aesculapius, Summer 2012
Consultant staff now are helping Australian doctors develop
their own bowel transplant programme. Geographically,
UHB could not be better placed to deliver as one of the
leading teaching hospitals in the UK. Co-located with the
University’s Medical School, it has consultant staff appointed
as Honorary Lecturers and teaching fellows, allowing students
to benefit from “hands-on” clinical training. The Trust
provides 5,300 medical student weeks per annum, which
means approximately 48 medical students being formally
educated in the hospital at any given time. UHB operates
intensive foundation year medical programmes, core surgical
teaching programmes and core medical teaching programmes
for junior doctors across the region. Currently, we have 552
regional training grade doctors.
“...an active internal junior doctor training
programme...”
The Trust provides 52,000 nursing student days per year
– 250 student nurses at any one time – and is the only
placement provider for UoB student nurses, providing
training for 200 UoB students per annum. Meanwhile, our
consultant staff are involved in the national interviewing,
review and appointment of junior doctors to training posts
across the NHS. We have an active internal junior doctor
training programme which supplies around a quarter of the
staff required at a junior doctor grade. Whereas other NHS
hospitals use a combination of locum and trust grade staff,
UHB has developed an internal career structure for doctors
allowing them to join UHB at a junior level and progress their
careers internally independent of the national system. This
internal training grade of doctors for UHB is known as Junior
Specialist Doctors (JSDs) and is now being adopted by a
number of other NHS Foundation Trusts.
The vetting, interviewing and appointment of JSD candidates
is undertaken by Trust consultant staff and applications to the
scheme come from both UK-based and internationally-trained
doctors. The JSDs are appointed at either standard level or
higher level. At standard level the individual rotates through
a number of specialties every six months within UHB. The
rotations are primarily either surgical or physician. At higher
level the individual can be based primarily in one specialty
to receive focused specialty training. The appointment level
is based on years of experience and clinical competency.
The success of the JSD programme relates to not only the
recruitment aspect but also the ongoing education and
training provided.
“...I make no apology for shouting about
the Trust’s achievements.”
If all of this sounds like a prospectus then I make no apology
for shouting about the Trust’s achievements. However, rather
than simply trading on reputation we are aware of the need
to be progressive to stay one step ahead of our peers to
ensure a continuation of excellence. That increasingly means
harnessing technological advances to keep improving the
quality and convenience of the care we give. The patients
we serve deserve no less. Our staff too deserve no less to
help them deliver the standards we have come to expect.
That’s why our focus now is on embracing and building
new systems that improve safety, efficiency and, ultimately,
patient outcomes.
“...in-house IT systems to tackle challenges
with innovation.”
For the past decade or so the Trust has been developing
in-house IT systems to tackle challenges with innovation.
Our informatics and IT teams have worked alongside
clinicians to an advanced Patient Information and
Communications System (PICS) – made by the NHS for the
NHS – that is now being adapted and used on licence by a
number of other trusts across the UK.
We didn’t stop with frontline buy-in. We are now well
advanced in securing patient and carer buy-in with a unique
in-house designed system called MyHealth@QEHB: a
leading-edge patient portal that supports the delivery of
high quality care through increased knowledge, support
and communication. Using real patient records and with
greater functionality than other large-scale, web-based
health portals, it proved so successful in a liver medicine
pilot that it is now being enhanced and rolled out across
other specialties.
Myhealth@QEHB allows patients in long-term care to
access remotely, via the internet, information held by the
Trust, including test results, letters, medication details,
as well as past and future outpatient appointments. If
they choose, individuals can also interact with each other
within the portal and create their own support networks.
It has the potential to be a social network for the NHS:
giving greater patient satisfaction, improving adherence
and resulting in better outcomes and significantly reducing
geographic barriers around providing care. The principle
of knowledge transfer that has proved so successful
between the technical teams, clinical staff and patients is
one that underpins our role as a leading teaching hospital.
It’s a principle embedded in translational research and
applied to everything we do. We don’t just look at what
works: we look at why it works and how it could work
better. In doing so we involve the people who do it on a
day-to-day basis to ensure we develop systems that best
suit their needs and expectations. It’s the same principle
of collaboration that has worked so well in the past and is
working so well now, between the Trust and the University.
We’d like to think we’re going forward together into a future
that offers even more opportunities to deliver excellence
through trading knowledge.
Aesculapius, Summer 2012 31
Belize Elective
A comparison of the
management of paediatric
cancer care in the
developing country of
Belize with the UK:
Is Belize a candidate for a twinning approach?
Lisa Milverton, Final Year Medical Student
Introduction
I
t has been recognised that in many developing
countries the prevalence of chronic diseases is
increasing. Contributing to this transition are the
advances in the control of infectious diseases allowing
more chronic diseases such as cancer to prevail.
Concerning the paediatric population, International
charities and World Health Organisation have targeted
the reduction of infectious diseases but it has been
recognised that the rate in paediatric cancer is now
increasing and children are receiving inadequate palliative
care and poor survival. In contrast, the treatment of
paediatric cancer in developed countries has led to high
survival rates. Evidence suggests that limited resources
are not necessarily the principal barrier to effective
treatment in developing countries, as some current, well
established effective treatment regimes are relatively
simple and inexpensive. Thus there may be the potential
for the introduction of successful cancer treatments for
children in developing countries.
Belize is an example of a developing country undergoing
transitions in healthcare emphasis from infectious disease
to more chronic illnesses. Belize has a population of around
311,500 with 36, 41% under 15 year olds. Epidemiological
data and information regarding the current situation for
treatment of children with cancer is scarce. The only
specialist services provided by a non government organisation
(NGO) are called Belize cancer society and the Belize cancer
centre. They appear at very early stages of development. It
32 Aesculapius, Summer 2012
is important to acknowledge however, a barrier to detecting
activity in this speciality in Belize may exist due to poor
data collection and lack of registries generally across Central
America. Therefore this study proposes to investigate the
healthcare provision of childhood cancer in Belize as a
developing country. Belize is of particular importance as
evidence exists that the surrounding Central American
countries have implemented strategies with the potential
to increase survival of childhood cancer.
“...developed countries pair with developing
countries’ medical institutions.”
The main reasons for poor survival in developing countries
include death due to toxicity and abandonment of treatment.
The strongest potential for developing countries to increase
survival has been shown by twinning partnerships. These are
initiatives whereby developed countries pair with developing
countries’ medical institutions. The aim is for specialists
from developed countries to guide developing countries in
paediatric oncological care. These twinning programmes
originate from the St. Judes Children’s Research Hospital
International Outreach Program. A large body of evidence is
emerging reflecting the success of these programmes. The
programmes have shown that an effective protocol has the
potential to improve survival in these countries and that an
effective care pathway can be implemented.
2008
80-84
Male
Female
70-74
60-64
50-54
40-44
Figure 1. Population
pyramid showing
the age distribution
of children.
30-34
20-24
10-14
0-4
16.0 14.0 12.0 10.0
8.0 6.0 4.0 0.2 0.0
The most dramatic result for increased survival in developing
countries is seen with the treatment of acute lymphoblastic
leukaemia (ALL). Great success was reported from El
Salvador for children with ALL. Survival increased from 10%
to 60% in 2 years. This is especially important as children
are 80% of the world population and ALL is amongst the
most common cancers for children in developing world. For
this reason ALL is suggested an ideal preliminary focus in
developing countries for cancer care programmes.
In contrast to developing countries, in the UK an extremely
specialised approach is used based on the significant
advances in previous 40 years. This success is reflected by
an overall childhood cancer survival rate of 78%.
Objectives
The primary objective of the study was to gain an insight on
the disease burden of paediatric cancer and to investigate the
current standards of care available in Belize.
A secondary objective acknowledges the success of twinning
programmes and aims to use the evaluation of the current
cancer care provision for children in Belize to determine the
possibility of implementing a twinning approach in Belize,
modelled on the St. Judes’ experience.
Methods
To assess the prevalence of paediatric cancer in Belize, the
National cancer data were obtained and analysed from
Ministry of Health (MOH).
0.0
2.0 4.0 6.0
8.0 10.0 12.0 14.0 16.0
The current standards of care for childhood cancer in
Belize were investigated by conducting a service evaluation
comparing standards in Belize to the UK. Standardised
questionnaires were constructed aimed to interview members
of the healthcare system and evaluate the management
pathway in Belize.
The management pathway for paediatric ontological
care in Belize was constructed from service evaluation
performed collecting qualitative information by observation,
in addition to the questionnaires and the data from
available registries.
“...recent standardised government-set
guidelines in the UK were used
as a benchmark..”
The recent standardised government set guidelines in the
UK were used as a benchmark for the ‘gold standard’ for
childhood cancer. The care pathways from Birmingham
Children’s Hospital with the most common types of
malignancies were available for comparison. To compare
the practice observed in Belize with the standards set in the
UK, care pathways were summarised to construct the general
care pathway in the UK. An additional questionnaire was
used based on concepts of the International Outreach
Programmes (IOP) to assess the feasibility of a twinning
programme in Belize.
Aesculapius, Summer 2012 33
Belize Elective
Results
Discussion
Demographic data on Healthcare professionals who
completed the questionnaire
It can be concluded from these investigations so far that the
standard of childhood cancer care in the developing country
of Belize is very poor compared to the gold standards set
in the UK. A great barrier to improving such care is the
extreme scarcity of cancer epidemiological data. Registries
are fundamental to cancer care as they allow trends to be
identified in the child population and ultimately direct and
monitor services and treatment.
Health care Professional
Number
Consultant paediatrician
1
SHO in Paediatrics/other
3
General surgeon
2
Primary physician/AE consultant
4
Heamatologist oncologist
1
Oncologist specialist nurse
1
Cancer centre administrator
1
Hospital administrator
1
Total
14
The only National data that could be obtained for the
Ministry of Health was 6 years of cancer mortality data
which does not demonstrate the prevalence or incidence of
paediatric cancer in Belize. However is does provide some
insight into the disease burden. Other problems with the
data were that the data collection was recently started and
was often neglected leading to its paucity. The data mainly
concentrated on malignancies common in adulthood. Also
the data number is too small to do statistical analysis to
identify definitive trends, however from the small data sample
provided it can be shown in the child population in Belize
that haematological and lymphatic malignancy are the most
commonly reported cancer mortality. This supports
the notion of targeting treatment of these specific
malignancies initially.
Epidemiological data provided by Ministry of Health of Belize
Cancer mortality: Total number of cases between 2004-2010
for different ages from <1-19. See chart below.
These figures are the only national data available for
childhood malignancy in Belize, obtained from the Ministry
of Health Epidemiology department. This was cancer
mortality data collected from 2004-2010. Thirty eight cases
of childhood cancer mortality have been reported over a 6
year time period. Cancer mortality cases were recorded in
all age groups from < 1 to 19 years old. Data suggest that
cancer mortality maybe more common in 15-19 age group.
Data available are mainly for malignancies more associated
with adults and subtypes are not available. Two out of
11 malignancy types of child cancer mortality have been
reported. Haematological malignancy is the most commonly
reported (48% of cases) cancer mortality, followed by other
malignant neoplasms (42% of cases) and benign neoplasms
(10% of cases).
Therefore it can be concluded the quality of data collection
for childhood cancer data needs to be greatly improved and
this requires many areas to be addressed. It is suggested that
in all hospitals, private clinics and the cancer centre, efforts
should be made to where possible record any cases that are
accurately diagnosed to compile a national childhood cancer
registry. Ultimately registries may then allow identification of
relatively high incidence paediatric malignancy and limited
resources to be optimized to local conditions.
Comparison of the general care pathway in Belize with the
management pathway shows that different stages exist
but many factors prevent a standardised approach as
explained below.
Neoplasm
<1
1-4
5-9
10-14
15-19
Total
Malignant neoplasm of lymphatic and haemopoietic tissue
Other malignant neoplasms
Benign neoplasms, carcinoma in situ and neoplasms of
uncertain behaviour and of unspecified nature
Total
2
1
2
4
5
0
1
5
1
7
0
0
4
5
1
18
16
4
5
9
7
7
10
38
34 Aesculapius, Summer 2012
Figure 2: GENERAL CAREPATHWAY for paediatric cancer care in UK
PRESENTATION (specific or non-specific)
Primary care
Secondary care (A+E or Children’s hospital)
Primary care assessment
Secondary care assessment
REFERRAL to a consultant paediatric
oncologist
Transfer to specialist unit
Diagnostic investigations
Diagnosis of cancer excluded
DIAGNOSIS
MDT review
TREATMENT protocols
Radiotherapy
Chemotherapy
Surgery
SUPPORTIVE TREATMENT
Relapse
End treatment assessment
LONG TERM FOLLOW UP
Alternative
Treatment protocol
PALLIATIVE CARE
Aesculapius, Summer 2012 35
Belize Elective
Figure 3: Belize management pathway for paediatric cancer care
PRESENTATION
Primary care (primary physicians)
Suspected diagnosis
Conservative treatment
Secondary care (A+E)
Tertiary care Belize cancer centre
Primary care assessment
Supportive treatment
Secondary care assessment
Belize Cancer Centre
Haematologist Oncologist
Private clinic/ Belize City
Hospital
Suspected diagnosis
Diagnosis+ Treatment
abroad
DIAGNOSIS
Diagnostic investigations
TREATMENT
Radiotherapy
Guatemala
Chemotherapy
at BCC
Basic surgical
procedures- In hospitals
SUPPORTIVE TREATMENT
BBC/ Hospitals
Relapse
FOLLOW UP
PALLIATIVE CARE
36 Aesculapius, Summer 2012
Belize Cancer Centre.
Presentation and referral
“...patients can present both in primary and
secondary care...”
Similarly to the UK patients can present both in primary and
secondary care, however in Belize due to private clinics or the
cancer centre, patients can also present in tertiary care.
In the UK a standardised referral system is in place in primary
or secondary care to tertiary care, however in the Belize main
regional hospital this referral system is poor with no standard
referral due to lack of specialist, lack of patient finance and
lack of healthcare professional awareness of tertiary services.
Therefore patient will often not progress in the pathway and
symptomatic relief will be offered. Alternatively tertiary care
could be sought directly at the Belize cancer centre, private
clinic, or the patient could travel aboard.
“...the only free treatment specialist centre
in Belize...”
Belize cancer centre is the only free treatment specialist centre
in Belize, thus it is suggested all primary/ secondary health
professionals should be aware of the chemotherapy service,
and it should be a standard to refer.
Above: Paediatric
Treatment Room.
Right:
Chemotherapy
Preparation
Room.
Diagnosis
“Standards do not exist for access to
diagnostic services...”
These studies show diagnosis to be a stage in the pathway
that is extremely problematic in Belize. In the UK, referral
to tertiary ontological care would occur where detailed
diagnostic investigations involving imaging and histological
analysis of biopsies take place in one specialist unit. In
contrast in Belize, the hospital general physicians said they
may diagnose cancer by clinical judgment and exclusion
of infection when there is no access to diagnostic services.
Alternatively if a patient can afford diagnostic services, they
are needed before going to the cancer centre, thus again
finance can be a detrimental barrier to the only available
treatment. Standards do not exist for access to diagnostic
services, however many people are reported to go to Belize
City hospital or private clinics.
Aesculapius, Summer 2012 37
Belize Elective
From these results it is suggested that services that
are available for those that can afford them should be
recommended as a standard approach in the potential of
reducing delay in diagnosis. However to remove this barrier
to the BCC, a free diagnostic service is really needed in
Belize,which could be a standard place of referral if cancer
is suspected. This could be a potential area for either the
government or NGO to direct investment allow for resources
and specialists.
Treatment
In the UK radiotherapy, chemotherapy and surgery are
widely available in hospitals which follow strict protocols
to treat childhood cancer. However in Belize no treatment
is reported to be available in hospitals except for general
surgical procedures, with no protocols to follow. There is
no radiotherapy treatment and the centre sends and funds
patient for treatment in Guatemala. The only specialist-led
treatment is chemotherapy at the BCC. Standard treatment
protocols are followed for chemotherapy regimes based on
National comprehensive cancer network where the cancer
BCC resources were reported to be sufficient to give the
majority of the regimes. This shows promise as haematological
malignancies greatly depend on chemotherapy: it is
suggested this would be a sensible focal point for treatment
of paediatric cancer.
Supportive
“...supportive care available in contrast is far
less advanced...”
Supportive care in the UK care pathways concentrates around
two main areas, being the treatment of febrile neutropenia
and the provision of blood product support. In Belize the
supportive care available in contrast is far less advanced,
possibly due to less rigorous monitoring, however the BCC
reported that they provide antiemetic, growth factors and
analgesia. However similarly to the UK blood products
are available for supportive care at the centre. It can be
concluded therefore that there is good basic supportive
care available, in addition when complications are detected,
patients from BCC can go to the nearby general hospital with
ICU facilities.
38 Aesculapius, Summer 2012
Palliative
In the UK in event of disease relapse or recurrence an
alternative protocol maybe followed as reviewed by MDT or
palliative care pathway will be followed. Currently in Belize,
the BCC provides home visits for psychosocial support
together with analgesia. Additionally a palliative care
service led by Belize cancer society is due to open near
to the cancer centre and patients will be referred in a
standardised approach.
Conclusion
With advancements in the control of infectious diseases in
developing countries, paediatric cancer is rising. Belize is
an example of a country undergoing similar transitions.
It can be concluded from this study that cancer care for
children in Belize is greatly lacking when compared with
a developed country such as UK. Reasons for this include
inadequate registries, lack of finance and the absence of
a uniform care pathway. However potential is shown by
the existence of the BCC which provides protocol guided
chemotherapy. It is suggested Belize will be a suitable
candidate for a twinning programme to help enhance the
existing care available.
“...ALL would be most beneficial for a
twinning programme.”
However to assess the feasibility of twinning with a larger
service more accurately, an evaluation should be performed.
With improvements in registries, they may confirm the
estimated high incidence of haematological malignancy
specifically acute leukaemia. Currently many sources support
the idea of targeting ALL with its high incidence; as the main
treatment in Belize is chemotherapy, it is suggested that ALL
would be most beneficial focus for a twinning programme.
There are multiple areas where twinning could aid care,
such as helping to increase quality of registries, setting
standards in the management pathway and increasing
awareness of paediatric cancer both in the population and
amongst healthcare professionals. Additionally, as shown by
previous twinning programmes, this may stimulate interest in
paediatric cancer to expand care and provoke increased NGO
and Government interest.
C ata r ac t F i lt e r
Monet’s Purple Paintings
and Your Cataracts
Erna Kritzinger (M 1974)
T
he lens in the healthy eye is crystal clear so that
light can be transmitted to and focused on the
retina in the back of the eye. With increasing
age the proteins in the lens undergo change, resulting
in yellow-brown discolouration and opacification to form
a cataract. At the yellow-brown stage the cataract acts
as a filter blocking violet-blue light (short wave-length)
from entering the eye, but still transmits red light (long
wave-length). Violet and blue therefore appear faded and
reds become brighter.
For the past four decades it has been standard practice in
cataract surgery to replace the cataractous lens with a clear
acrylic lens (intra-ocular
implant). This obviates
the need for the thick
“cataract spectacles”
previously required
after cataract surgery.
Following surgery
visual acuity improves
and as an added
bonus, colour vision
recovers – a fact often
commented on by
observant patients.
The rather lurid
colours of Monet’s
later paintings are
thought to have
been the result of his
cataracts. His purples
and blues became
increasingly prominent
as he tried to overcome
his reduced perception
of these colours, by
adding more and more
of these pigments to
his colour palette.
After his cataract surgery, he was reportedly so surprised by
the strange colours of his most recent paintings that he over
painted several of them in an attempt to tone them down.
It is therefore ironic that some cataract surgeons recently
started advocating the use of yellow tinted intra-ocular
implants to replace cataractous lenses. Their rationale for this
is that a yellow implant filters out harmful ultra-violet light
and therefore protects the retina. This somewhat controversial
practice is disputed by those who are concerned that these
permanent “intra-ocular sunglasses” could lead to light
deprivation and the development of the seasonal affective
disorder (SAD) syndrome.
Monet – Water lilies
Aesculapius, Summer 2012 39
A rt at t h e B a r b e r I n st i t u t e
The Barber
Institute
revisited
Andrew Davies, Press and Marketing Manager,
The Barber Institute of Fine Arts
“One of the undisputed gems in
Birmingham’s cultural crown...”
O
ne of the undisputed gems in
Birmingham’s cultural crown is
the Barber Institute of Fine Arts:
the art collection, gallery and concert
hall for the University of Birmingham.
“...key works by most of the
major names in the history
of Western art...”
Like a mini National Gallery, the collection
houses key works by most of the major
names in the history of Western art, with
paintings, sculpture, drawings and prints
by Monet, Manet and Magritte; Rubens,
Rossetti, Renoir and Rodin; Gainsborough
and Gauguin, Turner, Delacroix and Degas
and many more. There’s also a fine coin
gallery, which houses one of the most
important collections of Roman, Byzantine
and Medieval European coins in the world.
Major exhibitions complement the collection,
and this year’s programme boasts a variety
of must-see shows and print displays that
not only explore and put into context works from the
Barber’s own collection, but also feature exciting loans from
collections in Britain and abroad.
40 Aesculapius, Summer 2012
Top: The Barber Istitute of Fine Arts.
Above: Élisabeth Vigée-Lebrun, Portrait of Countess Golovine,
c 1797-1800.
Eugène Boudin,
A Beach near Trouville,
1895.
“...the greatest of the Northern
Renaissance artists...”
PUGIN, DÜRER AND THE GOTHIC (until
24 June), part of the nationwide celebrations of the
bicentenary of the birth of AWN Pugin showcases the eight
prints and a single drawing by Dürer, the greatest of the
Northern Renaissance artists much admired by the great
architect and designer. It also features stained-glass window
designs, a fine early Netherlandish triptych, a late medieval
wood-carving and solid oak table designed by Pugin.
THE AGE OF LEONARDO: CHRISTIAN
THEMES IN ITALIAN RENAISSANCE PRINTS
(until 24 June) – timed to complement the Leonardo
drawings exhibition at Birmingham Museum and Art Gallery
– features ten works by some of the most accomplished
16th-century Italian printmakers, including Marcantonio
Raimondi and Agostino Carracci.
“...the city’s artistic tradition applied
to currency.”
CITYSCAPES: Panoramic Views on
Coins and Medals (27 April 2012 – 6
October 2013) celebrates the built and
cultural heritage of early modern European
cities through the most circulated art
medium – coins and medals. It focuses on
the 16th to the 18th century, when many of
the great cities of Europe applied the city’s
artistic tradition to their currency.
Silver medal of Amsterdam, 1655 (detail).
The British Museum.
Aesculapius, Summer 2012 41
A rt at t h e B a r b e r I n st i t u t e
FACING THE MUSIC: 20TH-Century Portraits of
British Composers (25 May to 28 August)
Art and music have always been partners at the Barber. An
exhibition of paintings, drawings and photographs from the
National Portrait Gallery is therefore extremely appropriate.
Indeed, Edward Elgar was the University of Birmingham’s
first Professor of Music, a position later filled by Granville
Bantock. Luminaries such as Delius, Vaughan Williams,
Birtwistle and Adès are also celebrated by a coterie of artists
no less significant, as the show features paintings and
photographs by John Singer Sargent, Christopher Wood,
Cecil Beaton, David Hockney and Tom Phillips, among
others. This exhibition is co-curated with postgraduate
history of art students from the University of Birmingham,
and is the first in a series of partnership exhibitions with
the National Portrait Gallery.
Left: Barry Marsden, James Loy MacMillan, 1994.
© Barry Marsden (photograph).
Above: Michael Taylor, Sir John Kenneth Tavener, 2001.
© National Portrait Gallery, London.
“80th anniversary celerations”
Information about all the Barber’s exhibitions, concerts
and events can be found on the Barber website at
www.barber.org.uk.
The Barber Institute of Fine Arts celebrates the 80th
anniversary of its foundation in December this year, and a
year-long programme of special exhibitions and events will
be announced shortly.
42 Aesculapius, Summer 2012
Images reproduced by permission of the Barber Institute
of Fine Arts except where specified
IN FRONT OF NATURE: The European
Landscape of Thomas Fearnley (19 October
2012 – 27 January 2013) features the work of
a Norwegian artist, little known in the UK, whose
jewel-like oil study of Ramsau (1832) hangs in
the Barber gallery. It is one of just a handful of
his paintings in this country. His low profile is
particularly surprising, since not only was Fearnley
an artist of the highest calibre, but he had strong
connections with Britain. Leaving his native Norway
(his parents were from Yorkshire, but emigrated to
Scandinavia) to learn the art of painting landscape,
Fearnley embarked on a career that took in stays
in Dresden and Munich, where he mixed with the
most important Romantic artists of the day, including
his compatriot Johan Christian Dahl and Caspar
David Friedrich. Via the Bavarian Alps, Italy, the
Swiss Alps and the Lake District, a tour of Norway
in the summer of 1836 resulted in a series of major
compositions that capture the drama of his native
The exhibition features major oil paintings, oil sketches
and drawings from public and private collections in Britain
and Norway, and will be accompanied by a fascinating
programme of varied events for all ages.
Left: Thomas Fearnley, Romsdal with Romsdalshom in the
background 1837. Private collection: reproduced with permission.
Above: Thomas Fearnley, Ramsau, 1832.
scenery and saw the emergence of a new strain
of Romantic nationalism in his work. The Barber
Institute’s exhibition consequently faces a stiff double
challenge: to introduce the work of a major artist who
has been neglected in this country, and to illustrate
the full range of an artist who travelled the continent
to capture the stormy skies of the north and the
bright light of the south.
Thomas Fearnley, Fisherman at Derwentwater, 1837,
Private Collection: reproduced with permission.
Aesculapius, Summer 2012 43
Australian Archaeology
Looking back in the
Outback
Harry Wooller (M 1956)
Murrumbidgee River.
M
y first serious involvement with the discipline
of archaeology began in 2002 when I attended
an Archaeological Field Workshop, part of the
University of Sydney’s continuing education programme.
In an unusual example of university cooperation it was
held at the Kioloa campus of the Australian National
University (ANU).
Balranald and surrounds
In 1975 the ANU had been gifted 860 acres of land behind
the sand dunes at Kioloa, a small village on the south coast
of NSW. It had previously been a sawmill and mixed farm.
The excavation of its rubbish dump became the focus of
the course interspersed by lectures and tutorials. From this
beginning a group of enthusiasts continued to meet, learn
and indulge in further training for more serious archaeological
investigations. We are a diverse group. Led by two
professional archaeologists we can muster a nuclear physicist,
a civil engineer, an expert in parasitic worms found in sheep,
a librarian, a dietician, a nurse and a medical practitioner.
Visiting archaeologists are somewhat bemused when they
realise their profession had been taken over by amateurs.
Over the past 5 years we have participated in an
archaeological study within Waldaira-Juno Station, a
35,000 ha (86,000 acre) privately owned working property
situated some 20 km west of Balranald (population 2,500)
in southwest NSW. Located on the Murrumbidgee River,
European settlement at Balranald began in 1840 and by 1853
it had become a thriving inland port on the Murray, Darling,
Murrumbidgee river system.
44 Aesculapius, Summer 2012
“...European settlement at Balranald
began in 1840...”
“...continuous human life for at least
40,000 years.”
Some 128 km north of Balranald is the Lake Mungo National
Park and the Willandra Lakes World Heritage region where
studies have demonstrated the presence of continuous
human life for at least 40,000 years. There is abundant
evidence of Aboriginal occupation over the last 10,000 years
and the culture and lifestyle of the Mungo people has been
well documented in these studies. Although the region is
now characterised by dried out Pleistocene lakes, between
50,000 and 19,000 years ago they were full of deep, relatively
fresh water. During that time the climate was cooler and
vegetation more abundant, unlike the hot and semi-arid
conditions of the region today.
Waldaira–Juno Station
This property has an extensive frontage to the Murrumbidgee
River with a narrow strip of River Red Gum forest on its
northern bank. It has been extensively cleared to a line
parallel to the river 17 km north to allow sheep and cattle
grazing. On the flood plain there is irrigated intensive
agriculture whilst on the drier periphery cereals are grown.
At 60 metres above sea level the terrain is generally flat.
Travelling north over the flood plain there is an imperceptible
rise of 5-10 metres. In the centre of the property is Lake
Waldaira, a dry lake similar in structure to those found in
Mungo National Park complete with ‘lunette’, a raised sand
and clay hill on the eastern bank caused by the prevailing
westerly winds. It was last filled within the lifetime of the
traditional owners. Box Creek runs north from the lake
crossing the Sturt Highway to the northern boundary.
“...Murrumbidgee supported a vibrant
Aboriginal culture.”
We know from previous studies that the Murrumbidgee
supported a vibrant Aboriginal culture. In the Balranald
area a small number of studies associated with proposed
developments such as roads and bridges found evidence of
scarred trees, middens and stone artefacts. There has been
no long-term systematic investigation in this region and so
the opportunity to conduct such a study on Waldaira-Juno
Station was approached with enthusiasm.
Archaeological methods
Our aim is to describe the extent of occupation by the
traditional owners and how they used the river, lake and
associated creeks. We also hope to be able to document
a way of life that was changed so much by European
settlement.
Medicine is not the sole preserve of bureaucracy and
archaeology is equally well endowed. With permission from
the traditional owners (Mutti Mutti), the NSW Cultural
Heritage Branch, the Department
of Environment and Conservation
and the NSW Heritage office we
were able to start. It was agreed that
we would be able to find and map
suitable sites and carry out systematic
surface surveys locating and recording
artefacts. A preliminary report of the
findings will need to be presented to
the controlling agencies with proposals
for further research including any
recommended excavations.
With such a huge area to explore
where to begin? Using information
gathered from the aboriginal
community, the owner of the property,
historical research and knowledge of
Lake Mungo from Lunette.
Aesculapius, Summer 2012 45
Australian Archaeology
experienced archaeologists we decided to concentrate on the
bank of the Murrumbidgee, the shoreline of Lake Waldaira
and in the region of Box Creek. It was unlikely that useful
information would emerge from the intensively farmed areas.
“Initially a general visual survey was
performed.”
On a typical day we would use four-wheel drive vehicles to
reach the proposed area for exploration. Initially a general
visual survey was performed. By walking slowly in a straight
line some 3 to 5 metres apart, a search was made for evidence
of aboriginal occupation including stone artefacts, middens,
fireplaces and scarred trees. The position of surface artefacts,
principally stone tools, was indicated by the use of small red
flags on thin steel rods. Any major areas of interest would
undergo further surface surveys and mapping. The position
of all artefacts was plotted using a global positioning system
(GPS) device and their structure, size and nature recorded
and photographed before leaving them undisturbed.
“...our study is in its sixth year.”
Unlike the three-day blitz by the ‘Time Team’ of television
fame, our study is in its sixth year. We have spent a week
each year living in shearer’s quarters or camping on the
property. There is now sufficient information to estimate
the extent of aboriginal occupation on this property and a
number of important sites require more detailed examination
including excavation. This article describes and illustrates
some of the findings to date.
Stone artefacts
“...‘Australian core tool and scraper tradition’.”
The use and development of stone tools was a fundamental
technology for the indigenous people of Australia and were
made by a process known as ‘knapping. A suitable piece of
rock or large pebble (‘core’) is held in one hand and struck
46 Aesculapius, Summer 2012
Top: Silcrete core.
Below: Hand held axe.
briskly with a hammer stone. The flakes produced may
be discarded or, if suitable, fashioned into scrapers used
to fabricate and maintain wooden tools. The core, after
further retouching, could be converted into a hand-held axe.
Archaeologists have called this process the ‘Australian core
tool and scraper tradition’.
Over their long inhabitation there has been a progression
from heavier to lighter more specialised tools. For instance
the production of backed blades, spear points and hafted axes
seem to date from circa 5,000 years ago. This more modern
approach is known as the ‘Australian small tool tradition’.
that that the majority of the stone artefacts were made
from silcrete despite there being no deposits in the
region. The nearest deposits are in and around Lake
Mungo suggesting there was active trading between the
tribal people.
“...the area was used for stone tool
manufacture.”
Flakes: Many flakes were found in close proximity,
which usually indicates that the area was used for stone
tool manufacture. Natural events such as rain, flooding
and erosion can disperse the discarded fragments and
we found isolated flakes and flaked pieces throughout
the property.
Axes: This hand held axe was fabricated from a large
pebble. The retouched cutting edge is serrated from
frequent further sharpening. It would have been used for
cutting notches in trees when out possum hunting and
for removing bark.
“...relatively complete ‘millstone’ used for
grinding wild millet.”
Top: Millstone with muller.
Below: Glass core and flaked pieces.
Stone artefacts are the most frequently found remains of
indigenous activity and this has been the case in our study.
Not only have we found isolated cores, flakes, and scrapers
but also ‘artefact scatters’ consisting of numerous artefacts
and usually evidence of intensive tool making.
Cores: This silcrete core shows the characteristic concave
facets as a result of knapping. Silcrete is formed from quartz
particles in a silica matrix and has properties that make
it particularly useful for the manufacture of stone tools.
Depending on the nature of additives it varies in colour
from light fawn and grey through to a deep red. We found
Millstones: We were lucky to find this relatively complete
‘millstone’ (lower) and ‘muller’ (upper) used for grinding
wild millet. This millstone has a typical flat surface whilst
those used to grind fruit and nuts have a depressed surface
reminiscent of a mortar. It is possible that cereals became an
important part of the diet as the area dried out.
Glass
“...glass could be knapped...”
Following settlement new materials were made available.
In particular glass could be knapped producing sharp and
durable tools. This collection found in the vicinity of a
19th century earth stockyard shows the knapped base of a
bottle with associated flaked pieces.
Aesculapius, Summer 2012 47
Australian Archaeology
Scarred trees
“...tree bark was used to fabricate
canoes, containers, shields and
medicine.”
We know that tree bark was used to
fabricate canoes, containers, shields and
medicine. This large River Red Gum
(Eucalyptus camaldulensis) is on the eastern
lunette of Lake Waldaira. The main trunk
has a circumference of 6.5 metres. The
height of the scar is 2.8 metres with a width
at its mid-point of 1.10 m. The bark from
this tree would be large enough to fabricate
a canoe. These generally measured between
2.4 - 4.5 metres in length.
Hearths/ovens
“...the age of the fireplaces will
be estimated from radioactive
carbon dating...”
Cooking was either carried out on an open
fire (hearth) or in a shallow depression
(oven) in which stones or clay balls were
first heated by fire. The embers were
removed and covered with grass on which
food was placed. The oven was then covered
with soil and litter allowing the completion
of the cooking. The ovens found in the
vicinity of Box Creek were characterised by
remnant hard baked clay balls. Following
excavation, the age of the fireplaces will be estimated from
radioactive carbon dating of charcoal remnants.
Middens
A midden can be considered a prehistoric refuse site where
countless meals have been prepared and eaten over many
centuries. They were found on the north bank of the river and
48 Aesculapius, Summer 2012
River red gum with canoe scar.
were characterised by the presence of fresh water mussel shell
and small fish bones frequently associated with fragments of
charcoal and baked clay. Typically they were usually some 0.5
to 1.00 m deep and 5 to 15 m in diameter. They often had
large eucalypts growing through them. Careful excavation of
a midden associated with carbon dating will provide a dietary
history over the changing climatic conditions.
Conclusion
“...we have found at least one ceremonial site...”
I hope I have given you a flavour of the archaeological interest
that has kept us stimulated over the years. In addition to
artefacts we have found at least one ceremonial site and
evidence of settler activity from the eighteenth century. An
interim report has been presented to the traditional owners
and the various regulatory agencies. We hope we will be given
permission to continue the study and carry out intensive
surveys and excavations on selected sites.
We have made a start on describing the human, cultural
and climatic changes on a small part of Australia known
as Waldaira–Juno station. The conclusion of this ambitious
vision seems a great way off and I sometimes wonder
whether we will all be alive to see the end! A number
of people have asked what attracts me to this project.
At the very least it provides a good walk with congenial
companions in very interesting country. It is of course
much more than that. There is the intellectual stimulation
and the excitement of the chase. I am the least qualified
member of our group and have to play ‘catch up’ in a
new discipline. It is not dissimilar to walking into the
anatomy room for the first time all those years ago. I can
recommend it.
ARTHUR THOMSON LECTURE
4.30pm: Thursday 6 December 2012
Arthur Thomson Lecture Theatre, The Medical School, University of Birmingham
Professor Mark Jackson BSc MB BS PhD, Centre for Medical History, Exeter University
The age of stress: myth
or reality?
Mark Jackson is Professor of the History of Medicine at the University of Exeter. Following qualification in both immunology
and medicine, he pursued research on the social history of infanticide and the history of `feeble-mindedness’. More recently,
he has been researching and writing on the history of allergic diseases, such as asthma, hayfever and eczema, in the modern
world, and on the history of stress. His publications include New-Born Child Murder: Women, Illegitimacy and the Courts in
Eighteenth-Century England (1996), The Borderland of Imbecility: Medicine, Society and the Fabrication of the Feeble Mind in Late
Victorian and Edwardian Britain (2000), Allergy: The History of a Modern Malady (2006) and Asthma: The Biography (2009).
He has also edited the Oxford Handbook of the History of Medicine, and is writing a monograph on the history of stress, entitled
The Age of Stress: Science and the Search for Stability (OUP).
Please contact Jonathan Reinarz for more information: [email protected] or 0121 415 8122
Aesculapius, Summer 2012 49
Photography
Photo Commentary
Erna Kritzinger (M 1974)
D
r Richard Harding (Ph.D. Sheffield University)
took these photographs on what he calls one
of his “back garden safaris”. A distinguished
metallurgist and Chartered Engineer, he recently retired
as a Senior Research Fellow from the Department of
Metallurgy and Materials at the University of Birmingham.
In the course of his career he has travelled to and worked
in several countries. His interest in wildlife photography
similarly led him to visit many exotic locations abroad. He has
won several trophies for his photographic work, which has
been published widely in photographic journals. He regularly
lectures and judges at photographic clubs throughout the
West Midlands.
Dr Harding nonetheless feels that exotic travel is not a
prerequisite for producing exciting wildlife photography
– a point which is well illustrated by these
photographs, which were all taken in or near his home
in Worcestershire. They further show that it is not
necessary to use elaborate photographic equipment to
produce quality images, if you are a skilled (and patient)
photographer. He stalked these small creatures in his back
garden with a hand held camera and basic macro lens,
often being only a few inches away from his subject.
Top: Newly Emerged Female Emperor Dragonfly. The opened
wings are held at right angles to the body. In contrast, damselflies
at rest mostly fold their wings together above and in line with
the body.
Above: Speckled Bush-Cricket. This flightless cricket is often found
on vegetation and sometimes on windowsills or in porches.
Right: Hoverfly. Typically perched on a flower to drink nectar, this
fly looks like a bee or wasp, but does not sting. This example of
“Batesian mimicry” protects against predators – a phenomenon
first described in 1862 by H W Bates, a contemporary of Darwin.
50 Aesculapius, Summer 2012
Right: Fly Feeding on Ivy. The mouth part of this fly form a tubular
proboscis to suck up nectar.
Below: Wasp Feeding on Ivy. Attracted by the nectar, this wasp uses
its mandibles to chew the juicy ivy seed head. In contrast, bees, flies
and butterflies use a tubular proboscis to suck up food.
Right: Common
Garden Frog. Sadly
now less common
because of loss of
habitat (garden
ponds and hedges).
Furthermore,
infection with
Ranavirus has
reduced the frog
population in some
areas by as much as
80% during the past
decade.
Aesculapius, Summer 2012 51
WHO Student Elective
For WHO’s Benefit?
An Elective at the World
Health Organisation
Jennifer Devereux, final year medical student
I
have been interested in Public Health since starting
medical school and after completing a four week
placement at Wolverhampton PCT, I was excited to
further explore this career path during my elective. Having
been fortunate enough to travel to developing countries
before and witnessed public health needs, I was not keen
to return until I had more to offer. As I was unsure about
what form this might take, I applied and was accepted for
a WHO internship advertised through the International
Federation of Medical Students Association (IFMSA).
As my colleagues packed flip flops for idyllic beaches, I
packed winter woollies for mountain climbs and headed
to Geneva for my elective.
My Easyjet flight was a far cry from the luxury of designer
watches and labels that was hinted at in the airport. Once
in the centre of Geneva, it became apparent that living
standards were indeed a complete contrast to Selly Oak.
Grand lake-front hotels replaced cramped student houses,
Travelling to Montreux.
52 Aesculapius, Summer 2012
Michelin star dining curry houses and classy wine bars the
Bristol Pear! Fitting in with the style of the city and with
spectacular views of Lake Geneva, the United Nations was
hard to miss. Less grand and with little fuss, the World
Health Organisation headquarters sat at the tip of the UN
complex. Being 60 years old, it resembled a tired Ford Fiesta
on the edge of a parking lot, scruffy in comparison to the
Ferrari which had recently parked alongside – the UNAids
marble headquarters.
“WHO has 6 regional offices responsible for
staff in over 150 countries”
However unimpressive, it was still incredibly imposing –
a feeling confirmed by the thorough security clearance on
arrival. I was interning under Dr. Gamhewage who leads the
WHO’s Flagship communications team which manages all
major World Health Day campaigns. Part of the Department
of Communications (an office of the Director-General),
the team are responsible for controlling and monitoring all
WHO communication, including disease outbreaks. As part
of their work and to build capacity, the department also
trains WHO staff in health risk communication. This is no
small feat: WHO has 6 regional offices responsible for staff
in over 150 countries who have the challenge of creating
training programmes which are suitable for all amongst
different health beliefs, structures, policies and economic
developments. To complicate matters further, all corporate
materials have to be made available in the 6 official languages:
French, Spanish, English, Arabic, Chinese and Russian.
“...patient education is a key tool in decreasing
risk and increasing access.”
Having studied medical anthropology as part of my
International Health BSc, the social scientist within me
wondered how this training could ever be appropriate in such
a variety of contexts. In the field of public health, patient
education is a key tool in decreasing risk and increasing
access to other risk-reducing services. A recent study in the
European Journal of Public Health examining communication
of risk showed that patient understanding of health impacts
health outcomes and policies. This is illustrated in 15 case
studies in Hahn’s Anthropology in Public
Health: Bridging differences in culture and
society. His descriptions are cautionary
warnings about the effectiveness of
interventions and health campaigns
which are not tailored to their target
population.
issues in two major ways. Firstly, although resources and
materials are created centrally, there is liaison with regional
offices to finalise session content and lesson plans. Wherever
possible trainers who speak the most appropriate WHO
official language travel to the country to run the course.
Secondly, the training sessions and handbook contain a
chapter on audience analysis. Although this is related to the
level of support shown by your potential audience to the
cause you are championing, it creates space to set health risks
within belief frameworks.
“...local threats can quickly escalate to
global pandemics.”
However, as was the case with swine flu, local threats can
quickly escalate to global pandemics. This then reinforces
the opposite problem of making tools generic enough to
be used in different situations. As health threats increase
and there is wider media coverage, doctors are often called
upon to be spokespeople to their communities. Although
communicating risk is an important part of a healthcare
professional’s job, the emphasis in medical training is placed
on the individual patients. Few healthcare professionals
will have had any formal training in efficient and effective
Based in Geneva it would be impossible
for staff at headquarters to represent
every health belief and cultural context.
There is obviously a threshold at which,
in practice, public health departments
can explain and support the health beliefs
of their communities or have time to
understand them (such as in the H1N1
outbreak). This is a recurrent dilemma
and the department has addressed these
The Jet d’Eau from the shores of Lake
Geneva.
Aesculapius, Summer 2012 53
WHO Student Elective
communication to the larger public or media to achieve
a desired outcome. For this reason, the department is
keen that they receive training similar to their staff on risk
communication. Deciding that one way to address this was
to broaden training for medical students, my task was to
adapt the existing training programme into a certified course
for medical school curriculums.
The training programme consists of taught sessions
supported by a Powerpoint presentation and a handbook.
The key points covered are:
1. Creating a single overarching communication objective.
2. Getting to the point – quickly!
3. Audience analysis – who are the active & passive
supporters/opposes of the issue.
4. How to communicate a message effectively.
5. Risk analysis – how serious the hazard and how great
the public outrage is in relation to it.
6. Creating communication products.
7. Media tips.
“...I was able to attend a training session
of administrative staff...”
Having attended many communication skills training sessions
from the medical school, I was initially sceptical about what
additional benefits the programme would bring. Early on
in my placement I was able to attend a training session of
administrative staff at WHO headquarters. This provided
a brilliant opportunity to witness the materials being used
first hand and to learn the value, both professionally and
personally, of the tools taught. Convinced of the merit, my
next challenge was how to engage such a large number of
students given the range of enthusiasm often professed about
communication skills.
“...online survey which was sent to medical
student representatives...”
My cohort of interns with WHO’s Director-General Margaret Chan inside HQ.
54 Aesculapius, Summer 2012
I therefore began by creating an online survey which was sent
to medical student representatives through the IFMSA. 94
students representing 38 medical schools in all WHO regions
responded. Their information about existing education
on this subject and perceived learning needs shaped my
perception of what was required. Although most had
received communication training, very few had received any
training in risk communication even on an individual patient
basis. One of the areas, perhaps surprisingly, that students
highlighted as a learning need was how to make public health
campaigns themselves. Familiar with the use of social media
for personal communication this seemed an appropriate
place to start. Social media is a growing tool for health
communication and WHO has official Facebook, YouTube,
Google + and Twitter pages. Since the training sessions
already contained advice on engaging with the press through
interviews or news releases, it seemed appropriate to update
the handbook to include social media. I wrote this additional
chapter as I felt that practical application of the key concepts
of risk communication would be reinforced.
“...how quickly a health rumour can gain
momentum...”
Part of engaging in social media is ensuring fast responses to
questions asked or comments made. As part of my elective
I spent a week monitoring WHO social media channels to
understand more about this. I was surprised at how quickly
a health rumour can gain momentum, especially through
Twitter. There was at least one conspiracy a day which
seemed completely ridiculous in most cases. Perhaps more
upsetting however, was the promise of false healing. During
my time, there was a popular belief amongst social media
users that geckos were a cure for HIV despite the lack of a
medical basis. It was clear that it was necessary to respond
and quash rumours before they grew out of hand and before
vulnerable people could be exploited.
“...I needed more experience in media
communications.”
Another area that I felt I needed more experience in as a
medical student was media communications. My only real
experience of using audio-visual equipment was dreaded
recordings of GP consultations! Imagining that this would
be similar for most of my colleagues, I decided that it would
be helpful to research the media tips chapter in more detail.
I was kindly taken under the wing of the departments’
photographer and videographer who let me film, edit and
take pictures at WHO interviews. Based in the WHO studio,
I was also able to watch pre-recorded announcements,
adverts and live broadcasts take place. This was a brilliant
experience as I met a wide range of senior WHO personnel
and got to hear about cutting edge developments.
“...I kept familiar theory and techniques
concise.”
Having become more enlightened about two subjects that
have nothing to do with medicine, I went back to the
handbook to pull it all together. To avoid patronising students
I kept familiar theory and techniques concise. Knowing the
volume of material each student is expected to retain, I made
the handbook to a note-style format as most of the content
is repeated in the training sessions. I also added explanations
and diagrams to the newer concepts that I thought were
more confusing.
“...re-design introduced me to WHO
bureaucracy...”
Finding the Powerpoint presentations dated and
unprofessional I also re-designed these to make them more
visually engaging, including comical video clips to illustrate
points in a practical way (even if very loosely related to public
health!) The re-design introduced me to WHO bureaucracy
in the form of brand guidelines. To ensure consistency of
style and to maximise branding, the colour schemes, font
and layout are all specified which was confusing and felt
restrictive to begin with, but once I had become familiar
with them became much easier. Since the average age of
headquarter staff is 54 it was perhaps not too surprising that
I was easily identifiable as an intern and that my relative
ability to use Powerpoint was shared amongst staff. I was
soon asked to update several core presentations and another
training set for the Health and Human Rights Team. Those
Aesculapius, Summer 2012 55
WHO Student
Elective
who have witnessed my embarrassingly poor use of design
programmes to make leaflets for Medsoc events will no
doubt find this amusing!
“...medical schools from each WHO region
to pilot the project.”
Having completed the module and resources, the next
step was to plan how the module would be implemented.
Using students who answered the surveys as contacts,
Dr Gamhewage picked medical schools from each WHO
region to pilot the project. Keen to try the programme in a
variety of contexts, I suggested Birmingham for the European
region. Sending out letters was an experience in itself in
terms of WHO process and yet more bureaucracy. By this
point my tolerance was weakening and I found the delays
frustrating. I was also disappointed as it meant I was not able
to see the planning stages to completion before I finished my
elective. However, I am still in contact with the Dean and
Mr Gammage and we are looking forward to WHO visiting
the medical school to pilot the training later this year.
“...valuable insight into the role of
communication teams in Public Health.”
Dr Gamhewage has experience working in conflict zones
and was part of the global initiative to improve WHO’s
performance in crises, disasters and emergencies. Having
someone well established in the field of public health as
my mentor allowed me to gain an understanding of the
practicalities coordinating public health responses centrally.
I received valuable insight into the role of communication
teams in Public Health and how large scale health campaigns
are constructed. The Public Health Risk module I worked
on will provide an educational resource for medical schools
all over the world. Birmingham University will be the
first to pilot this module which will be conducted by Dr
Gamhewage and her team – a great privilege for the medical
school. This was possible due to my link to the university,
which in turn was facilitated by your generosity in funding
my elective. Thank-you very much.
56 Aesculapius, Summer 2012
D
espite the romanticised descriptions of
authors, it is difficult to see why anyone
wished to become a doctor. It was certainly not
for money! One soon saw that it would be an arduous
life with little free time for amusement or leisure. The
medical course would be twice as long as any other
and several times as arduous yet we still joined! By
the end of the pre-clinical course we would work far
harder than graduates in other disciplines, yet have no
dergree to show for it! Like the students of today, our
problems began with money. The cheapest way to pay
for the course was to pay ahead – nearly £400. This was
almost twice an ordinary artisan’s annual wage and that
was the beginning. One had to allow for one’s bodily
needs – Lodgings cost at least £1 weekly without food
(for £1=5s. one got one meal a day added). Then there
were other expenses. A skeleton cost £10, a microscope,
£20 and of course there was the price of textbooks.
We also had to pay ten guineas(£10=10s) to be taught
vaccination.
“...it is difficult to see why anyone wished
to become a doctor.”
Life began with the pre-clinical years and the 2nd M.B.
–the first hurdle which seemed to bear no relevancy to
one’s future life. Life in the dissecting room only taught
anatomy if one had read the subject before the pertinent
dissection. The tutors seemed to live in a vacuum un-related
to medicine! Few of them were as informed as we ourselves
soon became. For those of us who had already chosen
surgery as our future, this was not important as we aimed to
take the Primary F.R.C.S. exam as students! We could not
wait to escape the department! Here in Birmingham there
was one bright spot – a German refugee named Bauer (his
wife was Jewish) who taught both anatomy and embryology
superbly – the latter being an invaluable asset still too
little recognised. On the other side, the physiologists
1940s Student Life
Life as a student
before the NHS
George Watts (M 1944)
taught as well as they could the limited knowledge of the day.
We were later to discover how inaccurate that was!
“...the real horrors which awaited us.”
The bright spell was on Saturday mornings when we had
clinical demonstrations in the hospitals. Everyone attended
these. For most it was a shock to see at first hand the real
horrors which awaited us. It was the era before antibiotics
or inoculations! But after the drudgery of the pre-clinical
years we were full of enthusiasm. We could not see enough!
We were attached to firms in three month units. There were
two on surgical in-patient firms and one in Casualty. On the
medical side we spent nine months on a single firm. In the
surgical firms the Chief did a formal round once a week and
we presented our histories etc. for his approval. The rest of
the teaching was in theatre where we were fourth assistants
at operations. We learned asepsis well for there was no
recourse if a wound was contaminated (a lesson which
has nowadays been too often forgotten) and saw pathology
in real life.
“On the medical side teaching was
more formal...”
On the medical side teaching was more formal and the
‘Honoraries’ (they were not paid to teach us) usually did a
round most days. Diagnosis was the prominent feature as
there were very few truly effective therapies available.
Casualty was the highlight of the early clinical part of our
course. We saw every type of illness and injury and did much
of the treatment ourselves. We learned to suture wounds,
drain abscesses, reduce fractures and apply plasters. Under
the eye of residents and experienced sisters we were allowed
great experience. W even gave anaesthetics – although
anaesthesia was more a case of nitrous oxide suffocation than
anaesthesia – patients were strapped to the table!
The next phase was the ‘Specials’ when a student spent
time with different specialist firms. There were also visits
to specialist hospitals. Every town had Infectious Disease
hospitals where patients died in droves from un-treatable
infections such as diphtheria and there were the Sanatoria
for the tuberculous who also regularly died. Treatments
were rarely logical and often did more harm than good.
We students had to bow to the ‘Wise’!
“If the midwife was late, we did the
delivery alone.”
The most exciting was ‘Midder on District’ We had been
taught delivery using cloth dummies which we learned to
pass through a hole in a pottery basin. At the maternity
hospital we saw it for real. After one or two deliveries we
went ‘on District’ with the local midwives. We saw the
squalor of the lives of most of the population in reality
with our own eyes. If the midwife was late, we did the
delivery alone. We had little equipment and the delivery
took place on used newspapers as the cleanest surface
available. To our great embarrassment these people called
us ‘Doctor’ and showed us an un-beliveable degree of
gratitude. On return to the hospital one had to submerge
in a bath as long as possible in the hope that the ‘bugs’
would all float off.
“I have never regretted my choice of career.”
Life as a student was hard and that as a resident even harder,
but when after the finals one was everywhere called ‘Doctor’
it all seemed worthwhile. I have never regretted my choice
of career.
Aesculapius, Summer 2012 57
Obituaries
Russell Cherry
(M 1980)
After house jobs and vocational
training, Russell Cherry worked
in general practice in Hall Green,
Birmingham, before joining Jiggins
Lane Medical Centre, the practice
that became his passion. His
enthusiasm ensured the practice was
at the forefront in technology and
quality. He was prescribing adviser in
South Birmingham and was active in
commissioning groups where he was
sought after for his wise counsel.
A GP trainer for many years, he inspired
many future GPs. Before his illness
became too disabling he was able
to enjoy his retirement party where
almost all his registrars came to pay
tribute to him. He was an outstanding
undergraduate GP tutor at Birmingham
University, then an excellent clinical
subdean, working with fifth year tutors.
A superb general practitioner, he was
able to communicate easily with people
from all backgrounds. After starting
treatment for his tumour he warmly
encouraged patients to greet and talk
with him in spite of his own concerns.
He was wise and kind, the latter
observation made many, many times
by patients. Aware of the grimness of
his prognosis he bore this with great
dignity and courage, his concerns
continuing to be only for the welfare
of his family and practice.
His love of sailing inspired his sons to
compete internationally; one is now a
professional sailor.
He is survived by his parents Barbara
and Rod, and he leaves his second wife,
Sandy, and two sons, Alex and Nick.
Sylvia Chudley, Jim Parle
58 Aesculapius, Summer 2012
Elizabeth Jocelyn
Clements (M 1980)
General practitioner Silsden (b 1957;
q Birmingham 1980; MMedSc,
DCH, DRCOG, FRCGP), died from
a glioblastoma on 6 July 2011.
Elizabeth Jocelyn Clements (“Liz”)
completed her general practitioner
training in Birmingham and moved to
Cardiff before becoming a partner in
Silsden in 1995. A sound clinician with
wide ranging expertise, she developed
her consultation skills and particular
interest in palliative care, patient
participation, and self efficacy. She
became a GP appraiser, trainer,
training programme director, and
clinical skills assessment (CSA)
examiner. Always diligent and caring,
she helped many with her empathy,
compassion, and encouragement as
she was consistently selfless, positive,
and fun to work with. Liz’s inoperable
tumour was diagnosed only in March
and she was cared for at home by her
family. Genuinely concerned for others
and modest, she received her fellowship
in recognition of her contributions.
Liz leaves her husband, David, and
three children.
David Clements
corps as a subaltern infantry officer,
subsequently becoming its regimental
medical officer. Thereafter he joined
the regular army via the Mons Officer
Cadet School, Aldershot, becoming a
member of the 23rd Parachute Field
Ambulance, an association of which
he was always very proud. He soon
thereafter started specialty training in
anaesthetics. Military hospital postings
subsequently included Hanover,
Catterick, Nepal, Woolwich, Belize,
Iserlohn, the Falkland Islands, Lisburn,
and Aldershot, with non-clinical posts
at western district headquarters in
Shrewsbury and Washington, DC. His
latter appointments included those of
commanding officer of British Military
Hospital Iserlohn, Musgrave Park
Hospital in Belfast, and the Cambridge
Military Hospital in Aldershot. In 1992
he was promoted to brigadier and duly
appointed to colonel commandant of
the Royal Army Medical Corps (RAMC).
1994 saw his appointments as honorary
surgeon to the Queen (UK) (QHS)
and consultant adviser to the army
in anaesthetics and resuscitation. In
retirement he was the deputy chairman
of the BMA armed forces committee
and the honorary colonel of 204 (NI)
Field Hospital (V). He leaves his wife,
Patricia; three sons (one a doctor); two
daughters; and 10 grandchildren.
Richard Daly
Martin Hugh Daly
(M 1960)
Martin Hugh Daly was the son of a
general practitioner in Birmingham,
and, like his father, read medicine
at the University of Birmingham.
While at medical school Martin
joined the Royal Warwickshire
Regiment from the officers’ training
Gwynneth June Davey
(M 1947)
Former general and hospital
practitioner, Box, Corsham, Wiltshire
(b 1924; q Birmingham University,
1947), died of the complications of
Alzheimer’s disease on 10 April 2011.
After qualifying Gwynneth June
Pearson (“June”) married a fellow
student, Jim Davey, and they moved
to Box in 1950, where her husband
set up in general practice. She
worked in various capacities as a
doctor: in family planning in Bath
(becoming a trainer), in general
practice in Box and Corsham, and
in genitourinary medicine at Bristol
Royal Infirmary. Being a general
practitioner’s wife and a doctor herself
inevitably meant, that in addition to
being on permanent telephone duty,
she was offering advice on all sorts
of medical emergencies and other
complaints. June was a regular church
goer, a keen bridge player, and a
supporter of all village activities. She
retired with her husband in 1984 and
stayed on in Box after his death in
2001, until her memory deteriorated
such that she had to move to a home
in Birmingham in 2008 to be near her
daughters. She leaves three daughters
(two of whom are doctors) and five
grandchildren.
Griselda Cooper
Mary Ducrow
(M 1965)
Those who knew me well knew that
I was cussidly independent, so it will
be no surprise to you that I decided to
write my own piece to be read at my
funeral, rather than give someone else
the job of finding something to say!
I was born on 31st August 1930 in
Birmingham, the 1st child of Stanley,
a master silversmith who worked for
the family firm of “T. Ducrow & Sons”,
& his wife Dorothy. I was educated at
a King Edward 6th Grammar School
in Birmingham, leaving with an
unremarkable school certificate, as it
was at the time.
The next few years were unsettled, as
Mother had died when I was 15. It
was not until 1948, when we moved
to live with my grandfather & 2 of his
daughters, that I was able to get the job
I wanted, working in a library. After 2
years I got the urge to train as a nurse
& did my training at Birmingham
General Hospital, qualifying in 1954
as a gold medallist for the year. I
eventually became ward sister of a
metabolic ward. Wanting to learn more,
I decided to study medicine. For this I
had to leave & spend 2 years studying
for A levels. I was accepted as a student
at Birmingham Medical School in 1960.
After qualifying, I decided to specialise
in Anaesthesia.
My life has been singularly
unadventurous. I never made time for
hobbies or developed other skills. My
main passion was music, although I did
not play an instrument.
I retired a year early because my father
had a stroke, so my sister and I had him
home to end his days, which is what he
wanted. He died in the house he had
been born in 89 years earlier.
In 1992 Ruth and I moved to our
bungalow in Solihull. I undertook
some charity work, 1st as a lay assessor
of care homes, until the system was
victim of one of the many reshuffles &
the headquarters moved to Coventry.
Abbeyfield was the other organisation
I was involved with, 1st on the house
committee, & then as chairman for a
short time.
If there were such a thing as an “end
of life report” mine would read; “about
average, could have done better”!
Finally, thank you all for coming along
to say “farewell”. If I have inadvertently
offended anyone by word or deed,
I am sincerely sorry & hope you will
forgive me.
Mary Ducrow
Elizabeth Heitzman
(M 1965)
Elizabeth (“Liz”) Heitzman (née
Bingham) entered general practice
after completing her house jobs,
setting up a practice in the rural
village of Compton, Berkshire, where
her husband Ray Heitzman worked
at the Institute for Animal Health.
Over the next 20 years she developed
the practice, taking on new partners,
and eventually joined forces with a
neighbouring partnership to form
the Downland Practice. Renowned
among her patients for her personal
and holistic care, Liz took her own
personal development seriously,
becoming increasingly involved
with education and training as
both a GP trainer and a vocational
training scheme (VTS) course
organiser in Reading. The
apprenticeship model of GP training
played to Liz’s strengths, and her
many past registrars are testament
to her mastery of her profession.
Invariably setting the highest
standards, she was unstinting in
giving of herself both to patients
and to colleagues, many of whom
were helped in their own career
development by her mentorship.
Always keen to explore the
doctor‑patient relationship to the full,
Liz was instrumental in setting up
a local Balint group, which proved
successful for all of the members and
lasted for at least eight years.
Aesculapius, Summer 2012 59
Obituaries
Education and learning were always
passions for Liz. She had an important
role in the hugely influential “New
College course” in Oxford and was
involved in the Thames Valley Faculty’s
leadership and management course.
Liz was an exemplar long before the
medical leadership framework was
articulated. As an examiner for the
Royal College of General Practitioners,
Liz developed the use of simulated
patients as a teaching and assessment
tool, and the development of the
simulated surgery module of the
membership exam of the RCGP
(MRCGP) was another testament to
her vision and leadership. That this
method was the fore-runner for the
clinical skills assessment of the new
MRCGP and was a source of quiet
pride to someone for whom modesty
was a watchword.
After leaving her practice in 1996
Liz became a medical adviser to the
parliamentary ombudsman as well
as a council member of the General
Medical Council – both roles drew
on her analytical ability and strong
sense of justice. She filled her
retirement with many friends as
well as embroidery (in which she
obtained a City and Guilds diploma),
gardening and golf. General practice,
however, remained dear to Liz’s
heart. She was provost of the Thames
Valley Faculty, demitting office only
two weeks before she died, at the end
of her three year term. In this role she
continued her encouragement and
support of colleagues in the quest for
continually improving the quality of
family medicine.
She leaves her husband, Ray, and two
daughters.
Sue Rendel
60 Aesculapius, Summer 2012
Charles Geoffrey Lloyd
(M 1952)
George Adam
Newsholme
Former consultant anaesthetist,
Derby Hospitals (b 1928; q 1952
Birmingham), died after a ruptured
aortic aneurysm on 15 July 2011.
Former consultant radiotherapist
Birmingham (b 1921; q Cambridge
1945; MD, FRCP, FRCR),
d 1 September 2011.
After qualifying Charles Geoffrey Lloyd
did a couple of house jobs and was
then called up for National Service,
which he spent as a medical officer in
the Royal Army Medical Corps (RAMC).
George was the son of Henry
Newsholme, medical officer of health
for Birmingham and professor of public
health at the university. His grandfather,
Sir Arthur Newsholme, had been
one of the pioneers of public health.
Having qualified as an exhibitioner
at Cambridge, George completed his
clinical medicine in Birmingham and
intended to train as a physician. He
served in the Royal Army Medical
Corps in Germany during and after
the war and obtained his membership
of the Royal College of Physicians
at this time, studying for it during
the bitterly cold Hamburg winter of
1946-47. On his return he worked as
a registrar on the medical professorial
unit at the Queen Elizabeth Hospital in
Birmingham and gained his MD doing
research on the uptake of radioactive
material by the thyroid gland. As a
senior registrar at the QE he agreed,
unusually for the time, to go to the
Royal Hospital, Wolverhampton, to
widen his experience. It was there
that he caught tuberculosis which was
nearly fatal. On returning to work a year
later he was given a more junior job.
Competition for consultant posts was
fierce as many doctors had returned
from war service and were several years
ahead of him. He decided at this time
to move into radiotherapy. He obtained
his Diploma in Medical Radio-Therapy
in 1957 and the following year was
appointed consultant radiotherapist
to United Birmingham Hospitals. He
realised from the beginning that treating
cancer needed more than just the use of
After demobilisation he joined the
Territorial Army and served with a field
ambulance between 1955 and 1964,
eventually leaving with the rank of
major. His professional training was
undertaken in Liverpool University’s
department of anaesthetics.
He was appointed as a consultant
anaesthetist to the Derby Hospitals
in 1962, one of four consultant
anaesthetists sharing the work of
all departments, with a catchment
population of over half a million. As
the number of consultants gradually
grew, he played a leading part in
developing his division. He was the
divisional chairman, a member of the
regional medical advisory committee,
and the chairman of the anaesthetic
subcommittee. He played an active part
in the various consultant led appeals,
such as the scanner appeal, the laser
appeal, etc, which funded much of the
new equipment available in Derby.
He had a leading role in the appeal
that led to the funding and establishing
of the Nuffield Hospital in Derby. As
a man he was courteous, caring, and
generous. He had a delightful sense of
humour. He leaves his wife, Sheila, and
a son, Jonathon.
A.F. Busby
radiotherapy and was in the forefront
of the development of a more
comprehensive service for treating
patients with cancer in the Midlands.
He was, above all, a good physician.
He was a gentle, unpretentious man
with a wide understanding of human
nature and a wonderful ability to give
hope to his patients. He leaves a wife,
Rosemary; three children; and seven
grandchildren.
Dorothy Davies
Paul Rayner
(M 1960)
Former reader in paediatrics and child
health University of Birmingham, and
honorary consultant paediatrician
Birmingham Children’s Hospital
(b 1936; q Birmingham 1960;
BSc ,(FRCP), died from aspiration
pneumonia associated with Parkinson’s
disease on 26 April 2010.
Paul H.W. Rayner pioneered home
care for children with diabetes. Many
children throughout the world now
benefit from the adoption of Paul
Rayner’s philosophy of the management
of diabetes, whereby all but the most
serious aspects of the condition can
generally be managed at home. The
provision of effective home care services
reduces the stress to affected children
and their parents, particularly at the
time of the initial diagnosis and during
inter-current illnesses. It also greatly
reduces the need for hospital admission
and allows diabetic children to lead a
more normal life.
At Birmingham Children’s Hospital he
worked as registrar and then lecturer
in paediatrics and child health with
Professor Hubble, who stimulated and
encouraged Rayner’s interest in growth
disorders and paediatric endocrinology.
He also gained experience in
laboratory methods and hormonal
assay procedures in the Department
of Clinical Endocrinology under the
direction of Professor Wilfred Butt, and
in the Institute of Child Health, where
he established a longstanding research
collaboration with Dr Brian Rudd.
After Hubble’s retirement in 1968,
Rayner became senior lecturer
with honorary consultant status to
Hubble’s successor, Professor Charlotte
Anderson, and took over the clinical
service for children with growth and
paediatric endocrine disorders. He
later became the honorary consultant
paediatric endocrinologist to the
whole of West Midlands Regional
Health Authority (population some
5.5 million people). As one of the
first paediatricians specialising in
endocrinology in the UK, Rayner
participated in the early studies of
growth hormone treatment. His
endocrine clinic was designated an
investigation and treatment centre
for children with growth hormone
deficiency by the Department of Health,
and he personally supervised this work.
In the latter years of his career he had
almost 200 patients under his care who
were receiving growth hormone.
In the 1970s the treatment of diabetes
often entailed repeated and prolonged
admission to hospital. Rayner was
concerned by the disruption that this
caused to the children’s lives, which
included emotional stress to the child
and parents, loss of schooling, and
financial problems for the family. In
1967 Rayner had been awarded a James
Smellie bursary from the University of
Birmingham to allow him to study the
community care services for children
with long-term disorders in Edinburgh.
In 1981, inspired by this experience,
he set up a Diabetic Home Care Unit
(HCU) for children, based at the
Children’s Hospital.
The HCU was to become the first
such facility in the UK and probably
in the world. The aims were to reduce
the emotional impact caused by the
onset of diabetes, by undertaking as
much as possible of the initial and
subsequent investigation and treatment
at home. This would entail enrolling
the family in delivering the child’s
treatment from the start, and creating
liaison between the hospital staff, family
doctor, community health services,
and schools. The HCU provided a
domiciliary visiting service and was able
to undertake the care and treatment
from the time of diagnosis of diabetes,
including the management of many
inter-current illnesses, and teaching
the children, their parents, and carers
to inject insulin and monitor blood
glucose concentrations. The HCU
nurses also discussed at home any
behavioural or emotional problems
affecting the children.
Towards the end of his career, which
was tragically curtailed by increasing
disability from Parkinson’s disease,
Rayner was promoted to reader. He
took early retirement in 1994 and died
in 2010, leaving a widow, Elaine; three
children; and five grandchildren.
Jillian R. Mann, A.S. McNeish
David Roberts
(M 1973)
Former general practitioner Teifi
Surgery, Llandysul, Ceredigion
(b 1949; q Birmingham 1973),
d 15 October 2011.
Aesculapius, Summer 2012 61
Obituaries
David Roberts joined the Teifi Medical
practice in Llandysul in 1981. He
was chairman of Dyfed Powys local
medical committee from 1996 until
he stood down in March 2011; he
had previously been chairman of
Dyfed LMC from 1986 to 1996. He
continued to be an active member of
the committee and was the local health
board liaison officer. David represented
the best interests of patients and
the profession in Ceredigion and
throughout mid and west Wales.
A member of the Welsh Medical
Committee, he chaired the GP national
specialty advisory group in Wales.
He was a role model to many GPs.
His many interests outside medicine
included rural pursuits and issues; he
loved the local countryside and made
a huge contribution to many local and
national organisations.
Janet Powell
Robert Charles Smith
(M 1957)
Former general practitioner Shrewsbury
(b 1933; q Birmingham 1957;
DRCOG), died from congestive heart
failure on 9 September 2011
Robert Charles Smith retired in 1996
after nearly 40 years’ service. As a
junior he took on extra hospital jobs
including paediatrics and anaesthetics
at Birmingham Accident Hospital.
To celebrate the end of finals exams
the new doctors got up to many
pranks, including transporting a piano
miraculously from one hospital to
another in Birmingham.
He decided against a hospital career
as being too expensive for his parents
and also turned down jobs in Australia.
62 Aesculapius, Summer 2012
Instead he trained in Leamington as a
general practitioner, offering to make
visits by bicycle.
Family ties brought him to Hodnet,
Shropshire (a seat of the Northumbrian
Percys), where the village doctor knew
his patient the moment they put their
hand on his surgery door. He stayed
seven years and then followed Mick
Shirley at Shawbury, an RAF helicopter
base recently famous for training Prince
William. He counselled his patients
through family tragedies, the Asia Flu
epidemic, road accidents, sudden
death, and the foot and mouth plague
affecting farmers’ livelihoods. He joined
his psychiatrist friend, Roger Bennedy,
in the Child and Family Service,
which supplemented his income to
educate his four children, investing
in their future.
After 10 years in Shawbury he moved
to a Shrewsbury practice with John
Ryle, whose brother was Astronomer
Royal. This was a small surgery in
the town centre, next to the half
timbered Draper’s Hall. The waiting
room once witnessed the relative of a
murdered victim and on the opposite
bench a relative of the murderer,
who was hanged at the Dana prison
in Shrewsbury. Like all town centre
services, the St. Mary’s Place practice
moved out to the communities in the
suburbs, to Belvidere, where Robert
gradually took retirement.
He was an enthusiastic member of the
BMA, serving on national committees
and tribunals as well as local ones
back in Shrewsbury. He was a fervent
antismoker, campaigning for greater
restrictions. He also took part in debate
on radio with a local priest, in support
of doctors giving out the birth control
pill to teenagers. He campaigned with
the BMA for commissioning, taking
politicians out of the NHS.
Friends will remember him as an
athlete until arthritis set in. He enjoyed
rugby, squash, swimming, jogging, rock
climbing, the marathon he ran, and hill
walking. His wit, repartee, and lateral
thinking gave him an advantage in both
work and play. He certainly practised
what he preached in his reverence for
the body, but he would also enjoy
acting the fool and so we celebrated
his life with a fancy dress funeral on
Friday 7 October.
He was married to Janis Smith for more
than 50 years. He leaves four children
and five grandchildren.
Kevin Chandler
Helen Street
(M 1945)
Born in Glasgow, Helen Street trained
under her father, Professor Haswell
Wilson. Her career as a general
practitioner was interrupted by
her husband Peter’s career moves.
During 10 years in Buenos Aires
she volunteered in both planned
parenthood clinics and the National
Burns Institute. After returning to the
UK she was active as a teacher in family
planning clinics across Oxfordshire and
started new family planning clinics in
Putney and Teesside. In retirement she
was deeply committed to bereavement
counselling. She is survived by
three sons, seven grandchildren,
and an increasing number of great
grandchildren.
Simon Street
Most of the obituaries are reproduced by
kind permission of the BMJ
Uganda
T int lEel e c t i v e
A Service Evaluation
of Obstetric Forceps Sizes
in Uganda
Hannah Boyd-Carson and Faye Newport, Final Year Medical Students
Introduction
T
he use of forceps, as an adjunct to birth, has been
in place for several hundred years. Their use is
indicated in cases of fetal compromise, prolonged
labour and contra-indications to the Valsalva manoeuvre.
It is considered that this intervention is a vital component
of Emergency Obstetric Care which should be available to
all women, as defined by the World Health Organisation.
This is especially pertinent in Uganda where prolonged
labour accounts for 8% of maternal deaths.
There are three main types of forceps which are commonly
used: Wrigley’s Forceps, Anderson’s Forceps and Kielland’s
Forceps. The differences between these forceps groups can be
accounted for, not only by design, but also variations in their
indications for use. Complications with forceps use can arise
if not used properly; specifically fetal and maternal injury.
“...wide variations between the measurements
of pairs of forceps.”
A study undertaken in the UK in 1990 by Hibbard
demonstrated wide variations between the measurements
of pairs of forceps. It was concluded that there were many
unsuitable pairs of forceps in circulation, in particular ones
which would cause unnecessary complications to both
mother and baby.
As there were no comparable data available for Uganda, we
felt it would be both interesting and beneficial to investigate
these issues in a resource poor setting.
This project was carried out in Mulago and Kawolo hospitals
in Uganda over a 4 week period in April 2011. These are
both Government funded hospitals, run by the national
Ministry of Health. Mulago hospital, in the capital, Kampala,
Faye (left), Hannah (right) in Kampala.
Aesculapius, Summer 2012 63
Ugandan Elective
quotes a figure of 27,000 deliveries annually. During the
period of the study, there were approximately 80 births each
day. In contrast, Kawolo hospital is a 90 minute drive outside
the city, in a much more rural setting. By comparison, the
hospital had fewer patients and resources.
“Forceps were kept in unsterile conditions and
were not evidently in regular use.”
After collection of the results, we spent the remainder of the
time on the labour ward. This allowed us to experience the
practice of obstetrics in Uganda first hand. From this, it was
possible to gain a greater understanding of the availability
and implementation of emergency obstetric care. The most
pertinent observations were:
Method and Results
“The forceps were measured using
vernier callipers.”
• Forceps were kept in unsterile conditions and were not
evidently in regular use.
• Lack of provision of other assisted delivery methods.
The forceps available in both hospitals were measured using
vernier callipers. These measurements included: the lengths
of the handle, shank and blade and the maximum distance
between the curves of the blades.
• High rates of Caesarean sections, with waiting times for
emergencies in excess of three hours.
There were found to be 4 pairs of forceps in Mulago hospital,
and none in Kawolo hospital. The forceps in Mulago were
stored together, in a tray. They were not arranged in pairs and
were kept alongside other equipment: Ventouse suction cups
and a Denman’s perforator.
Discrepancies in measurements were found across the entire
sample size in all dimensions measured. These results can be
seen in table 1.
From the results, the following were noted:
•A severe lack in provision of obstetric forceps: only
four pairs.
•No pairs of forceps in Kawolo hospital.
•Variability of size in all pairs across all dimensions measured.
Discussion
It is clear that the provision of these obstetric forceps is
extremely inadequate, and those which are present are
not in active use. An explanation for this may be the lack
of formalised training in this area for medical staff. After
discussion with the head of the department, it was clear
that the trainees in obstetrics and gynaecology received no
training in the use of forceps, and thus were not competent
in this skill. In addition to the lack of training in forceps use,
it was concerning to see that there was a lack of awareness of
the availability of forceps within the hospital amongst a large
proportion of staff.
The most concerning situation was in Kawolo hospital,
where no obstetric instruments were identified and there
was no provision for assisted vaginal deliveries in the hospital.
Table 1: Dimensions of obstetric forceps pairs, (mm).
Pair
Right
1
Left
Right
2
Left
Right
3
Left
Right
4
Left
Blade Length
Shank Length
Handle Length
Total Length
143.9
146.7
162.8
166.2
157.2
161.7
180.2
184.6
47.8
47.8
81.4
82.6
61.7
59.4
37.2
38.8
78.5
79.4
138.9
138.9
137.1
140.6
147.1
148.8
270.2
273.9
383.1
387.7
356.0
361.7
364.5
371.7
64 Aesculapius, Summer 2012
Maximum Distance
Between Curves
85.2
87.8
92.1
85.5
forceps; it is recognised that the final choice is made by
the individual practitioner. As such, it is not possible to
definitively decide whether the forceps in Mulago were
suitable or not.
It was also possible to see discrepancies in each pair of
forceps when looking at the right and left components
individually. It can be sensibly assumed that forceps were
originally designed for each component of the pair to be a
mirror image of the other, and any differences can be seen
to be substandard. It is possible, that over time forceps
have become lost, mis-matched or distorted due to previous
over-use and poor storage. In some cases, the discrepancies
were clearly evident to the naked eye, suggesting gross
misalignment. This may lead to the forceps failing to be fit for
purpose and leading to inadequate assistance in the delivery.
“...now being kept in a non-sterile
environment...”
The storage box of forceps.
Additionally, the location of the hospital, 40 kilometres –
approximately a 90 minute drive – from Kampala meant
that emergency transfer to more specialised care was not
an option for the women in this area. This was further
compounded by a deficiency in specialist ante-natal care
and as such failure to identify women who may require extra
intervention during labour.
It is possible that the lack of forceps is due to the resource
poor setting of both hospitals. This lack of resources was also
evident in other areas of care, namely deficiencies in basic
medical equipment.
“The discovery of variation in forceps size
was concerning.”
The discovery of variation in forceps size was concerning.
There is no written guidance on the suitable sizes of obstetric
The forceps were kept in a surgical tray in an overcrowded
and untidy side room on the ward . Whilst they may have
been sterilised after their last use, they were clearly now being
kept in a non-sterile environment; this posed an obvious
infection risk, specifically with a high prevalence of HIV
positive patients on the wards.
In addition to the lack of forceps use, there were also
deficiencies in the provision of Ventouse and Caesarean
deliveries.
Caesarean section was the intervention to help achieve a safe
birth provided by Mulago and Kawolo hospitals instead of
assisted vaginal delivery. This placed considerable strain on
the system: the average time from decision to deliver until
delivery was 3 to 4 hours. The fact that some of these women
could have safely delivered with either forceps or Ventouse
increased the risk for those who were in greater need of
a Caesarean section. On several occasions, doctors and
midwives were told that there was no room on the surgery
list for extra women. Anecdotal evidence stated that this
was an important contributory factor to both maternal and
perinatal mortality.
“...below the World Health Organisation
standard.”
Aesculapius, Summer 2012 65
Ugandan Elective
It is evident that the provision of emergency obstetric care
clearly falls below the World Health Organisation standard.
This can lead to significantly increased risks of maternal and
fetal morbidity and mortality.
Recommendations
As a result of the findings, a number of recommendations can
be made:
• Practical training: educating staff in the department in the
indications for use of forceps and their practicalities of use.
• Increased numbers of forceps: once the issues surrounding
knowledge and training have been addressed, it is
important to have many more forceps available within
the hospital.
• Proper sterile storage of forceps.
• Ultimately, develop a protocol for assisted vaginal
deliveries and audit the use of forceps.
Conclusion
“...lack of training and education in
this specialised area...”
There was found to be a variation in size of each forceps pair
and mismatching within the pairs. In addition, there was
found to be a severe lack in the provision of obstetric forceps
available for use. Factors which contribute to these findings
have been identified as a lack of training and education in
this specialised area and inadequate upkeep and storage of
the current forceps stock.
Secondary conclusions were drawn, including: high rates of
emergency Caesarean sections, long waiting times and a lack
of alternative assisted delivery methods.
“...mattresses placed on the floor for women in
earlier stages of labour.”
Successfully addressing these issues will help the hospitals
in this resource poor setting meet the World Health
Organisation criteria for basic, emergency obstetric care. This
will ultimately have an impact on both maternal and fetal
morbidity and mortality.
66 Aesculapius, Summer 2012
The labour ward in Mulago consisted 25 beds, all of which
were occupied. In addition, there were mattresses placed on
the floor in the middle of the ward for women in earlier stages
of labour. There were no curtains separating the beds and as a
result, there was no privacy for the women at any stage. The
ward round was carried out once in the morning; intimate
examinations and confidential discussions were undertaken
in full view of the ward.
“Patients were expected to provide their own
clinical equipment...”
Patients were expected to provide their own clinical
equipment, specifically plastic sheeting for the beds, sterile
gloves, cotton wool and a surgical blade. This was primarily
used for cutting the umbilical cord, but there were also
situations where they were used for performing episiotomies.
There was no analgesia available for women at any stage. After
delivery, women did not spend time with their baby, instead
they were encouraged to get dressed and leave the ward
within half an hour.
“...delivering in excess of 70 babies every day...”
The full reality of delivering in excess of 70 babies every day
became evident after spending our first day on the ward.
We had not previously appreciated the amount of work
that this would involve: performing the delivery, providing
immediate care to the newborn and dealing with any post
partum complications.
Initially, we perceived the situation to be highly unorganised,
in a system which was failing the patients. Women were
often left alone with no support from a friend or relative
and relatively little from trained practitioners. As our time
progressed, it became apparent that the midwives were
very experienced and did always attend to those most in
need. This experience highlighted the importance of not
judging clinical situations at first glance, but instead taking
a thorough view of the working environment.
“...we found ourselves delivering several babies
independently.”
During our time on the labour ward, we were afforded a
lot more freedom than we had previously been given. This
specifically related to performing deliveries. There was a
staff shortage on the ward, and several women were left
completely on their own. We were strongly encouraged by
staff on the ward to assist these women during their labour.
On several occasions women would labour quickly, and
their baby would start crowning before assistance had arrived
at the bedside. This proved to be a dilemma: we had
received no formal training in practical obstetrics and so
did not feel comfortable to be the sole support for mother
and baby. On the other hand, it would be impossible to
stand by and watch this unfold with a
woman having no support. In reality,
we found ourselves delivering several
babies independently. Whilst this was
extremely rewarding, and a special
moment to be involved in, a number
of women had complications. These
mainly comprised post partum
haemorrhages and perineal tears. These
situations were difficult to manage,
especially knowing the potential
outcomes associated with them. In
these cases, it was important to step
back, and insist that trained staff
manage the situation.
experience for us, and is one which we will remember forever,
not only in relation to our professional development, but also
on a more personal level.
We would like to extend our thanks to the Sands Cox Society
for helping us to complete this project and the amazing
experience it has afforded us. In addition we would like to
thank our supervisor, Mr Jonathan Pepper for his expertise
and advice.
One of the many deliveries on the ward.
“...the ward staff still
provided good levels
of care for patients...”
Our time spent on the labour ward
provided us with a further insight
into not only the provision of care
for patients, but also the stark
contrast between care in Uganda
and the United Kingdom. Whilst
it was expected that the clinical
environment would differ, it was
shocking to see the extent of this
disparity. Despite this, the ward
staff still provided good levels
of care for patients and support
during their time on the ward. This
was a fantastic and unforgettable
Aesculapius, Summer 2012 67
D e n ta l N e w s
News from the
Dental School
Damien Walmsley, Professor of Restorative Dentistry, School of Dentistry
T
he School of Dentistry never stands still and
this year has brought about more successes
from our students both past and present.
We start off this annual review from the School with
congratulations to one of our dental graduates, Janet
Clarke who assumed the Presidency of the British
Dental Association. Janet is Clinical Director of
Birmingham Community Healthcare Trust Community
Dental Service (CDS) and Honorary Clinical Lecturer
at Birmingham Dental School. She became the 125th
President of the British Dental Association (BDA) in
May 2011 at the annual conference held in Manchester.
Janet qualified from Birmingham in 1981 and also
has a Master of Community Dental Health, which she
received in 1989. Her outstanding local and national
contributions to dentistry were recognised in 2010 when
Janet was awarded a MBE in 2010 for services
to dentistry. Well done, Janet!
68 Aesculapius, Summer 2012
Graduation Events for the Year of 2011
Graduation Ball
The 2011 Graduation Ball was held at Wroxall Abbey in the
glorious surroundings of the Warwickshire Countryside.
The morning weather was not promising and there was
plenty of rain but by early evening the clouds parted and the
sun shone. This allowed time for a group photograph and
pre-dinner drinks in the grounds of this picturesque hotel.
There were lovely touches to the meal including beautifully
decorated cup cakes with individual names on. During the
meal there was a speech by Professor Iain Chapple, literally
singing the praises of the final year. This was followed by a
thank you by Rima Patel and Meera Pajpani who led the final
year organising committee. After dinner there was a chance to
try out the ice sculpture vodka luge or, if you wished to use
up your energy, take to the dance floor. For the less active,
there was lots of conversations to be found in the bar. This
was almost the last time that the students would be together
as a year, as after graduation day on Monday they would all
be going their separate ways. But for the time being there
prizes were awarded by Dr Janet Clarke, President of the
BDA who herself was a prize-winner 30 years ago. Professor
Lumley then gave his Annual Report to the assembled
audience. There were photographs of the Prize winners and
people then slowly made their way to the University campus
for the afternoon graduation ceremony.
Graduation Day
Graduation ceremonies are always memorable events. It does
not matter if you have been to only one or many of them;
they never fail to move you.
was still much to enjoy and the evening went into the early
hours of the next day.
Prize giving 2011
As you will have gathered, this year all the graduation events
took place in reverse! Usually the Graduation celebrations
begin at the University followed by Prize giving. The
Graduation Ball then follows on closely at the weekend. Well
as you already gathered we have already had the Ball so on
a rainy Monday morning it was the Prize giving ceremony at
the Dental School. In spite of the weather, there was much
excitement and enthusiasm before the ceremony. It is an
enjoyable experience as a member of staff to mingle with the
parents, partners and other supporters of our dental students
before the prize giving to exchange differing success. The
Aesculapius, Summer 2012 69
D e n ta l N e w s
Social activities
Talent Night
The School is very good at social functions and the following
pictures provide a story of the ‘Dental Hospital has Talent’
night and the official photographs for the night of the year.
You can see how much fun the School had and the vast array
of talent our students possess outside dentistry. Thanks to
Steve Duttine from the Photography unit and others for these
pictures. I am sure you will agree that they tell the story
of the night!! And the winner was Iram who is a student
Therapist in the School of Dental Hygiene and Therapy. Her
winning rendition of Ave Maria brought the house down.
Today was no exception and the pictures tell the story of
many happy qualified dentists who are about to set off on
life’s journey. They are have been well prepared by their
teachers and other staff and whilst everyone is sad that they
are leaving Birmingham, they will be great ambassadors for
the school.
70 Aesculapius, Summer 2012
Wine and Cheese
The Annual Wine and Cheese is another highlight
and provides a fun and enjoyable evening. The use of
mobile phones does have to be banned, to prevent any
gamesmanship (i.e. looking up answers on Google). In the
music round some contestants danced to the songs for the
rest of us to enjoy. Hurjoht and the entertainment team at
BUDSS are congratulated for making it so successful.
Aesculapius, Summer 2012 71
D e n ta l N e w s
BUDSS Annual Dinner
The BUDSS Annual Dinner was held at Edgbaston Cricket
ground and the theme was based around the Chronicles
of Narnia. The night was cold but on arrival there was a
warm greeting at the door. A large ice gateway served as an
entrance, which we passed through before receiving our
welcome drinks. The evening was a great mix of magicians,
dancing and very smartly dressed people. The Edgbaston
catering staff put on a nice meal and we were treated to some
special ‘Strictly Come Dancing’ Ballroom dancing. There
were also several volunteers who agreed to take part in the
dancing. Our very own Hurjoht took up the drums and by
the end of the evening everyone was on the dance floor.
72 Aesculapius, Summer 2012
As the pictures show there was the opportunity to meet
and discuss life away from the dental hospital. Whilst the
evening finished late, many students went onto Oceania to
make sure the evening finished even later. Congratulations to
Hurjoht and the BUDSS committee for making the evening
both successful and enjoyable.
Staff News
Success for Owen
The School is very pleased to report on the success of
Owen Addison who has recently been awarded a prestigious
National Institute of Health Research Clinician Scientist
fellowship. The NIHR Clinician Scientist award is open to
“all researchers working in medicine and dentistry who are capable
of leading research in their discipline”. The award is aimed at
post-doctoral registrars and Consultants and provides salary
and research costs, including personnel, for up to 5 years.
The fellowship which constitutes over £900,000 of research
income to the School will strengthen interdisciplinar y
research between Biomaterials and Tissue Injury and Repair
and will focus on the inflammatory response to indwelling
and skin/mucosa penetrating implants.
attended the lecture following which Iain was presented
with the Charles Tomes medal. The Charles Tomes Lecture
was founded in 1941 following a bequest left by Sir Charles
Tomes who was a former member of the Board of Examiners
in Dental Surgery.
The pictures show Iain delivering the Charles Tomes Lecture
“Genes, Greens and Inflammatory Scenes” and receiving the
Charles Tomes Medal from the Dean of the Faculty of Dental
Surgery Professor Derrick Willmot.
Charles Tomes Lecture 2011
Professor Iain Chapple was invited to give the prestigious
Charles Tomes Lecture at The Royal College of Surgeons of
England on Friday 25th March 2011. The lecture was entitled
“Genes, Greens and Inflammatory Scenes” during which Iain
presented the current evidence regarding the pathogenesis
of periodontal disease with emphasis on dietary and genetic
risk factors. Many of the staff at the School of Dentistry
Aesculapius, Summer 2012 73
D e n ta l N e w s
BSSPD at Birmingham
Her entertaining style included pictures and designs of
the latest jewellery. Speakers from Birmingham followed
including Deborah White, Trevor Burke, Philip Lumley, Iain
Chapple and David Attrill. The speakers enjoyed being on the
same platform as each other and remarked how good it was
to hear others speak.
Birmingham was represented in the open papers covering
Cleft palates (Naveen Karir), eLearning (Upen Patel).
In the posters many of the SHOs took part and our own
4th year student Anusha Patel won the student prize and
received a commendation on her project in the main
competition.
Professor Giles Perryer
Past dental student Giles Perryer has been promoted to the
position of Associate Professor. This is an excellent example
of the University recognising and rewarding educational
innovation, in particular Giles’s exceptional leadership in
the area of eLearning. Giles is also President of the Central
Counties Branch of the BDA. His interest for many years has
been in dentistr y eLearning, and in 2007 he led the team
that won the Times Higher award for “The Outstanding ICT
Initiative of the Year” for his work in creating the Birmingham
University Ecourse. In the same year he won the DDU
“Dentist Teacher of the Year” award. Outside of dentistr y
Giles can play a mean tune on the Accordion and is always
asked to preform at Student’s revues.
The BSSPD conference was held in Birmingham under the
presidency of Professor Damien Walmsley. The venue was
Austin Court conference centre, which sits between the
International Convention Centre and the National Indoor
Arena, and behind the Malt Shovel pub. It is a hidden gem
and those people who had difficulty locating it were from
Birmingham! The conference was opened by Professor
Lawrence Young, Pro-Vice Chancellor & Head of College
(Medical and Dental Sciences). In keeping with the title of
the conference “Jewels of Restorative Dentistry”, Gay Penfold
from the Jewellery Industry Innovation Centre (JIIC) gave a
fascinating talk on “Jeweller or Dentist – spot the difference!”
74 Aesculapius, Summer 2012
Reunions
Year of 1991 Reunion
The Mint Hotel was the setting
for the reunion of the Year of
1991. Twenty years on and many
people were trying to remember
what others looked like. Many
people had not changed and
were enjoying dentistry and life
in general. Stories were swapped
how many children, how many
marriages and what were they up
to!! Professors Lumley, Walmsley
and Chapple gave the speeches.
The organisers were Simon Ellis
and Andy Towlerton who had
done a great job on getting the
majority of the year together.
Year of 1991 Reunion.
Year of 1981
Do you remember 1981 and the start of the Eighties? The
dental year of 1981 got together courtesy of the Sir Arthur
Thompson Charitable Trust. The night fell into a familiar
pattern starting off with dentists trying to recognise each
other 30 years on. Then everyone sits down to a very nice
meal at Staff House. Speeches follow, the first by the Head
of School, Philip Lumley and then Peter Rock who reminisces
on past times at the School. Everyone is brought together for
a group photograph and then it is time to keep on talking
finding out what has happened between 1981 and 2011. A
great evening of memories and renewing old friendships. A big
thank you to Carinna Chilton in School Office for her excellent
organisation of the evening.
Year of 1981 Reunion.
Aesculapius, Summer 2012 75
D e n ta l N e w s
Saying goodbyes and celebrating events
Kathy Porter retirement
Kathryn Porter, Senior Dental Nurse on Clinical Practice,
Floor 5 is retiring from the Dental Nursing Department after
over 40 years of exemplary service. Over the years Kathryn
has made a wonderful contribution to the Dental Nursing
Department, particularly Clinical Practice. There are many
dental and nursing students on whom Kathy will have
made a big impression during their time at Birmingham.
Tessa Meese, Dental Nurse Manager gave a short resume of
Kathy’s extensive contribution to the Hospital and School
since she joined in 1968. Phil Lumley, Head of School, gave
an appreciation on behalf of the School of Dentistry. There
were many friends and colleagues at both the Hospital and
University who gathered in the Boardroom to wish her all
the very best.
Sue Fisher and Anna McDonagh.
Figure 1. Lower Ballingham Fishery – beat map.
Clinical Practice and then moving onto Oral Surgery. She
was a popular member of staff and was a past Staff President
to the Dental Student Society. She is taking up a career in
general practice and spending more time with her young
family. We wish her all the best.
The last week of term saw the retirement of several key
members of the part time staff, Richard Caddick,
Sue Fisher and Anna McDonagh
Sue Fisher retired from the School of Dentistry after more
than 40 years of dedicated service. During this time, Sue has
made a wonderful contribution the School, particularly in
Biomaterials where she looked after the microscopy research
area. She was also a mentor to many Biomaterials students
who came through the department. We wish her a happy
and long retirement.
Anna McDonagh (née Jephcott) also has left the School of
Dentistry. Anna has been with us for 7 years. She started in
76 Aesculapius, Summer 2012
Roger Mosedale, Roger Pearson and Peter Neal. It is difficult
to single any one of them out as all of them have given
tremendous service to the school over the years. Calculating
the total years of service all four have given is the region of 70
plus years. There was a presentation in the board room where
their achievements were recognised.
Professorial Wedding Celebration
s
Here are the pictures you have been wait
ing for. Professor
Deborah White marries Professor Gile
s Perr yer. The wedding
and reception took place over the Aug
ust Bank Holiday.
Pictures show Deborah’s Mum and dau
ghters of Deborah
and Giles with the happy couple.
So that is a whistle stop tour of a year in the life of the School
of Dentistry. If you wish to learn more and want to receive
up-to-date news from the School then please visit our Web
site www.dentistry.bham.ac.uk
Aesculapius, Summer 2012 77
Th e J e w e l l e r y Q ua r t e r
Some Notes on the
Development of
Birmingham,
with particular reference
to the Jewellery Quarter
John Davis (D 1955, M 1964)
I
n previous articles the Jewellery Quarter has been
mentioned, but only in passing, and now it’s time
to write about it in more detail.
“...a truly rural landscape.”
If you walked up the hill from Digbeth to Thomas Archer’s
new church of St. Philip in the early18th C. you would
find yourself at the northern limit, and highest point of the
town. Before you, in the valley and beyond, were fields and
meadows – a truly rural landscape. To your left was ‘New Hall
Manor’ the imposing Jacobean home of the Colmore family,
with an avenue of Elm trees running south, and up the hill to
Ann Street, better known now as Colmore Row. To the right
was the Great Pond at the bottom of Snow Hill.
The Colmores had been around in Birmingham since the mid
1400s, making their money as cloth merchants in the town’s
flourishing Welsh wool trade. The land for the Hall was
purchased from the mayor in 1560, when it was described
as a rabbit warren. Beyond their land were enclosed fields on
rising land leading to Birmingham Heath, and the important
sandpits at Hockley. Practically everything you could see from
St. Philip’s belonged to the Colmores.
“Ann Colmore had an astute business mind...”
The family lived in their fine manor house until about
1620, but then moved out, leasing the property to tenants.
78 Aesculapius, Summer 2012
Formerly, tiresome legal restrictions had prevented the estate
being divided up, but Ann Colmore was a very determined
lady, and obtained a private Act of Parliament allowing her
to grant leases for development. It is important to appreciate
that in the eighteenth century, women of Ann Colmore’s
social class were expected to be decorative, to entertain their
husband’s business friends, to do a little needlework and play
an instrument, while getting on with the important business
of producing an heir.
“She was definitely a ‘one off’.”
Ann Colmore was certainly not that sort; she had an astute
business mind that she intended to use to the full! She was
definitely a ‘one off’.
“...more roads became the busy network we
know to-day.”
The area was crossed by three important roads. The road
from Wednesbury and Wolverhampton was turnpiked
in 1727, followed by a similar measure to the road from
Dudley in 1760. Summer Row was added later, providing
a more convenient route into the town. These roads were
heavily used by carriages, and traders’ carts transporting
coal and other raw materials from Staffordshire into
Birmingham. The completion of the Birmingham and
Fazeley Canal in 1769, and ‘Miss Caroline Colmore’s
branch’, was of immense significance, stimulating the
construction of even more roads, which became the busy
network we know to-day.
By 1760, residential building had started at the newly leased
plots in the Great Charles Street area. More land was needed
when the Newhall Branch Canal was completed in 1772,
and by 1780, nearly all the Great Charles Street, and Lionel
Street areas had been built up. Development continued up
the hill into what is now the Jewellery Quarter, which at that
time was a desirable residential area for affluent merchants,
industrialists and those who could afford the rents for
‘upmarket’ Georgian houses. James Street, Caroline Street,
and Mary Street were all named for Colmore children. St.
Paul’s church, commissioned by Ann Colmore, and designed
by Roger Ekyns in the likeness of London’s St. Martin in the
Fields, is now the centre of a modern, and lively residential
development. In former times the church-yard was called
‘titty-bottle park’, because that was where middle-class babies
were taken for fresh air, sunshine, and an afternoon out!
Matthew Boulton invested locally in several properties, and in
Regent Place one was leased to William Murdoch, the firm’s
engineer/manager and ‘trouble shooter’ for their steam-driven
water-pumps in the Cornish tin mines.
Anchor’ Inn, the anchor becoming our ‘town mark’ for silver,
which explains this strange choice for a town so far from the
sea! The accompanying Sheffield silversmiths took the crown.
But as industry moved in, the middle-classes moved out, to the
more salubrious districts of ‘leafy Edgbaston’ and Moseley.
“...Birmingham did not have the restrictions
of the guild system...”
Most of these elegant homes were without a garden, and this
lack was the stimulus for the ‘Guinea Gardens’ in Edgbaston,
close to what was to become in 1832 Loudon’s Botanic
Gardens. There, on a pleasant Summer afternoon, (PSA)
the Georgian gentry could relax, and do a little gentlemanly
gardening. The name comes from the annual rent charged,
and enthusiast gardeners still use the gardens to-day.
“...small artisan businesses moved in.”
Although built as a predominantly residential area, in time
small artisan businesses moved in. ‘Toy-makers’ – the makers
of small silver items such as buttons, buckles, cap badges,
comb decorations, snuff boxes and chatelaines etc., also
included workers in precious metals and gems. Precious
metal working had been in Birmingham since the15th C. but
hall-marking meant expensive cartage to Chester or London,
with the risk of damage or pilfering. However, as a result of a
petition to Parliament by Boulton and others, the town had
its own Assay Office in 1773, and those journeys were no
longer necessary. While waiting to hear Parliament’s decision,
the Birmingham gentlemen lodged at the nearby ‘Crown and
The Jewellery Quarter Clock
Aesculapius, Summer 2012 79
Th e J e w e l l e r y Q ua r t e r
Most of the raw materials for small industry were practically
‘on the spot’. The sand for making the pattern moulds
for metal casting was present in enormous amounts at
Hockley and Sandpits, and coal came from Staffordshire.
Spectacle-frame makers, gun-lock makers, buckle-makers,
pen-nib makers, clock-face makers and book-binders
all found the area suitable for their work. The absence
of a ‘charter’ meant that Birmingham did not have the
restrictions of the guild system and apprenticeship
elsewhere, and as ‘open house,’ all sorts of craftsmen, and
free-thinkers were encouraged to move in. Agricultural
workers, anxious to improve their lot, came to the area
in droves; and the once beautiful Georgian houses were
converted into tenements, and workshops of all kinds, with
jewellers working at their ‘pegs’ in properties having the
good north light essential for their finest work. Expensive
solid silver-ware now made way for Sheffield plate, a
thin layer of silver fused to both sides of copper sheet.
Sheffield plate looked just like solid silver, and was more
affordable, but killed off almost overnight, when the
Elkingtons started their electroplating business in Newhall
Street. Silver-plated items looked just like the real thing,
but at a fraction of the cost.
The intellectual life of the town was vibrant – the Lunar
Society was flourishing, and there was a strong musical
tradition, with fund raising events held to build the Town
Hall and the General Hospital.
“...Birmingham was becoming ‘the town
of a thousand trades’.”
The developing canal system was built by ‘navvies’ mostly
Irish ‘navigation men’, which meant that the silverware of
Boulton and Watt, the silver plate of the Elkingtons, and
small goods from toy-makers were transported quickly, safely
and without damage to London and all parts of the country.
Birmingham was becoming ‘the town of a thousand trades’.
Coins, medals and regalia are still made in the area, but
Ralph Heaton’s Birmingham Mint built in1850 to stamp out
coins, was intended to replace the unpopular tokens.
It closed some years ago.
“...a police force was mandatory.”
80 Aesculapius, Summer 2012
Working with high-value materials meant that a police force
was mandatory. An elderly ‘jobbing jeweller’ told me that in
Victorian and Edwardian times new constables ‘learning the
ropes’ at Kenyon Street station, accompanied an experienced
Officer on his beat round the courts and workshops. He
knew the precise positions of the padlocks left when the
owners ‘shut up shop’, and it was the new constable’s job
to memorise them all!
Ann Colmore had been ‘canny’ enough to insist on different
durations of lettings for the properties she rented out. So it
is said that when leases were up, the properties were burned
to recover precious metal dust and filings which had fallen
between the floor boards; and this generated sufficient
money to pay for a new building! It follows from this that
properties in the Quarter are of varying dates, and reflect
changes in architectural taste; very different from Bath for
example, where most of the buildings are from one period.
However, many of the properties we see to-day are late
Victorian or Edwardian.
“...Murdoch found time to develop gas lighting.”
Apart from erecting and servicing Boulton & Watt’s
steam-driven water pumps in Cornwall, and designing valves
for them, Murdoch found time to develop gas lighting!
By 1836 Great Hampton Street had gas lights, and St. Paul’s
church had ‘gasoliers’, that is, gas lights on tall metal
stands. More practically, jewellers could dispense with oil
lamps and tallow candles, and use gas for their blow-torches
and lighting.
“...this highly skilled work has now
almost disappeared...”
‘The Jewellery Quarter’ is still active in 2012, but sadly
manufacture of the highest quality work is much less.
The backs of expensive mirrors, brushes, hip-flasks and
cigarette cases used to be decorated with beautiful engine
turning done by craftsmen, but this highly skilled work has
now almost disappeared, and recently there was only one
man still working. Seventy years ago one would see lads
carrying trays of, for example, silver tea-pot spouts or
handles being taken from small work-shops to silver-smiths
for assembly and soldering. Meeting their chums on the
way, the lads might put their trays on the pavement, to
indulge in a short game of ‘footer’ in the street! Even to-day
one can see men casually carrying brown-paper parcels
with gold, silver or platinum articles for hall marking at the
Assay Office. Precious stones wrapped in a small screw of
newspaper, and kept safe in a coat pocket are taken to ring
makers, or gem-setters. The Assay Office is the busiest in
Europe, marking up to 120,000 articles each day using laser
technology. The last forty years or so has seen a new lease
of life in the area, now opened up to retail trade; unheard of
until after WW2. On Saturdays young men and their fiancées
may be seen looking for engagement rings, or ‘lucky charms’
and gold chains.
“It’s a fascinating area to explore...”
It’s a fascinating area to explore, and in Dickensian properties
one can watch ‘jobbing jewellers’ working away at their
pegs, using modern tools, but also the old ones, such as
the one-handed Archimedian drill. The area is now to be
‘managed’ as an urban village. Old 19th C. warehouses are
being converted into expensive apartments for ‘city living’,
and new flats built, eg., around St. Paul’s Square. With the
exception of a single insensitive monstrosity, they are mostly
in keeping with the surrounding architecture. The ‘Big Peg’
of 1971 failed to attract jobbing jewellers – rents were too
high, but more importantly, the building did not have the
north light essential for fine work – did anyone consult the
jewellers? The studio offices are now used by ‘designers’ and
‘creative businesses’.
This area, ‘like Topsy, just grew’, and it should be left alone,
to carry on doing just that. To-day’s planners schooled in
‘management culture’, and anxious to ‘make their mark’
should be discouraged from tinkering too much with this
special place.
We need your help!
Less than 50% of eligible members have signed up to the Gift Aid Scheme so far.
Signing up costs nothing and indeed higher rate tax payers can claim a
small rebate.
!
If you are a UK taxpayer your subscription is paid from your taxed income. Please help the charity to reclaim
the gross equivalent, e.g. subscription of £20 gift aided is worth £25 to The Sands Cox Society.
Gift Aid Declaration
I wish The Sands Cox Society to treat the following as Gift Aid Donations:All donations that I make from the date of this declaration until further notice
Name ______________________________________________________ Address ___________________________________
__________________________________________________________________________ Postcode _____________________
Signed _____________________________________________________________________ Date ________________________
Please cut-out the form or if you prefer photocopy and return to: Dr John Jackson, 29 Station Road, Blackwell, Bromsgrove,
Worcestershire, Great Britain, B60 1QB or email: [email protected]
Charity No. 512347
Aesculapius, Summer 2012 81
Biography
Sir Harry
Guy Dain
MD,
LLD, FRCS
(1870-1966)
Liz Croton (M 2000)
D
r Harry Guy Dain was born in Birmingham and
educated at King Edward’s schools in Five Ways
and Aston. He studied at Mason’s College which
later became the University of Birmingham and gained
his MRCS, LRCP in 1893 and his MB London in 1894.
He set up in practice in Selly Oak and remained there for
the remainder of his working life.
Dr Dain was a key player in medico-political affairs for over
50 years. He was elected a member of the BMA in 1921
and later went on to become its Chairman from 1943-1949.
He was also a Direct Representative on the General Medical
Council from 1934. In 1957 he received the Claire Wand
Award for outstanding services to general practice.
He was described as a “smart dapper little man with blue
eyes, a kindly face and a brisk manner”. He was “terse and
lucid where others were flatulent and foggy”.1 It was these
qualities and his prestige that persuaded many general
practitioners to enter the new National Health Service in
1948. Interestingly, he initially appeared to be opposed
to the entry of the profession into the NHS but other
influences prevailed and he eventually had to agree with
the BMA Council.
In an interview with the London Sunday Express following
his appointment as BMA chair the 73 year old joked, “I
82 Aesculapius, Summer 2012
think they hesitated about approaching me to the job last
September because they didn’t think I’d last the year out,
but they are finding there is plenty of life in me yet.”2 A
further newspaper article from 1960 (origin unknown)
celebrates his “retirement” from the NHS at the age of 90
but quotes him as saying “I’m not retiring. I think retire
is an ugly word and I shall continue to serve the profession
in an advisory capacity.”
Dr Dain’s house and surgery survives as private residences
“Bournbrook House” on the corner of Bristol Rd and Alton
Road in Selly Oak. It was used as a surgery until 2009 when
Bournbrook Varsity Medical Practice moved into adjacent
larger premises. As a tribute to its original founder, the
consulting rooms on the third floor of the new premises have
been named the “Dain Consulting Suite” and the residences
in the adjacent converted technical college have been
renamed Dain Court.
Reference
1. Sir Guy Dain, FRCS, Hon MD, Hon LLD (1870-1966).
Ann R Coll Surg Engl 1966 June; 38(6):391-392
2. At 73, family doctor gets the biggest job of his life. The
Sunday Express London February 20 1944.
R e t u r n V i s i t t o Pa p u a N e w G u i n e a
Papua New Guinea
Revisited
John Speake (D 1964)
John Speake was a Dental officer with the Papua New
Guinea (PNG) Department of Public Health (See
Aesculapius 1995). This return visit was under the
auspices of the service club Lyons – editor
A
s the plane approaches Jackson’s Airport I reflect
that it is 22 years since we first landed here and
16 since we boarded a ship in Fairfax Harbour to
“go pinis.” As on that first occasion, it is the wet season
and the countryside looks fresh and green. I have been
mentally bracing myself for the rush of hot humid air as
I disembark but find it less formidable than expected.
Immigration and customs formalities are no worse than at
any other international airport and some air-conditioning
makes the queuing and waiting around more tolerable.
I am met by the Lions Project Coordinator, a large pommie
senior police officer who I has been recruited for his
expertise in public relations. Much is familiar, some things
subtly changed and others completely different. There
seem to be many more trees, many more people and many
more vehicles. There also seems to be much more sense of
purpose. We arrive at my host’s residence which is in a block
of townhouses in the area of Koki Market. The complex is
surrounded by walls topped with razor wire. On the gate are
three uniformed guards sporting lengths of iron piping. The
gate is closed behind us. My host tells me that he moved here
after the free standing villa he had originally been allocated
was burgled four times in a week. That night we go out to
dinner at a local club. I am struck by the absence of traffic
on the roads after dark and how my host keeps his 8 year old
son literally at his heel. At the club there is a watchman with
the now familiar length of iron pipe to escort us to and from
our car. The building is heavily barred.
“The gear is contained in nine cardboard boxes.”
The dental equipment and supplies I am to take with me are
in the care of Richard, the last remaining expatriate dental
practitioner in Port Moresby. Next morning I am taken over to
his practice. As he drops me off Ron casually mentions that
it is the responsibility of Richard to provide transport to the
airport and suggests I “remind” him. The gear is contained
in nine cardboard boxes. After an initial attempt to check the
contents in the humid , airless storeroom I decide to wing it
and start taping them up. There is also a locked metal patrol
box but no key. A hacksaw is finally produced. The contents
include dog eared soup packets, rusting cutlery, crockery a
mosquito net and a Coleman lantern. Later Richard’s driver
Joe takes me to the Ministry of Health now situated in
Hohola. As we walk down the corridors I could swear it is the
same impassive clerical faces watching as watched visitors to
Konedobu 20 years ago. The Chief Dental Officer who I have
come to see has taken a visiting WHO consultant to Wewak
but it’s good to meet some of my former orderlies who have
become Central Office Staff.
“....our old house is well maintained but now
surrounded by 2 meter chain link fencing...”
My flight the next day is not due till the afternoon so I take
the opportunity to visit our old house in Boroko. It is well
maintained but now surrounded by 2 meter chain link
fencing topped with razor wire. As I stand by the gate dogs
dash up and start barking. I decide to go to the new Dental
Clinic. At the new clinic I have an emotional reunion with
my old orderly Tavari.
After lunch I return to Richard’s surgery. Joe the driver
has four calls to make before returning to collect me, the
cardboard boxes , the patrol box and a 40 kilo compressor.
It starts to rain. I drag it all outside under cover. Time passes
and we wait and wait. “There’s nothing more useless than the
Papuan male” mutters my colleague. The flight is scheduled
for 3.30pm. At 3 o’clock Richard asks whether I think we
can get it all into his family car. Just as we are struggling to
cram in the compressor Joe turns up surprised at all the
kerfuffle. But he gets the message quickly enough and with
Aesculapius, Summer 2012 83
R e t u r n V i s i t t o Pa p u a N e w G u i n e a
the aid of his assistants we transfer everything into the back
of the pickup. The rain teems. A tarpaulin is found and we
set off up the Murray highway. The traffic is solid. With great
anticipation Joe cuts around the inside of a truck stalled
in the outer lane. We surge through 10cm deep puddles,
bounce over axel bending ruts and press on. We arrive at the
airport at 3.23pm. Joe urges me to abandon the equipment
and try to catch the flight. But there’s not much point going
without it. By 3.25pm we have found a parking space and
transferred all the baggage to the check in. The ground
hostess’s initial reaction is one of alarm until she realizes
that the flight is closed. She refers me to a guichet which is
besieged by highlanders. I stand directly in line but others
come in from the side, I stand to the side and they come in
from behind. Clearly “time bilong ol masta “ is over. Finally
I get to explain my problem to another ground hostess who
politely tells me that I have been off loaded. This requires the
attention of a customer service officer who wants to know if
I have been told why I have been offloaded. I mumble about
lateness of a lot of luggage. I don’t seem to be cutting much
ice. But the difficulty is transient and we look at tomorrow.
Unfortunately tomorrow’s flight is full. However, I can be
re-routed via Goroka and pick up the flight in Madang.
Dispiritedly I reload the damp luggage with Joe and his
assistant’s help and return to our starting point. My hostess
when I phone is very understanding.
“...baggage weighs 340 kilos...”
The next day I spend the morning trying to get through
to Wewak on the phone. Joe is fully briefed, probably
threatened and very much on the ball. The rain has eased
and we reach the airport by 2 o’clock. I am disconcerted to
find that the baggage weighs 340 kilos and offer to take it
back but suddenly it’s OK provided I go to another guichet
where another hostess disappears with my authorization.
Announcements during the course of the afternoon culminate
in news that the flight has been cancelled. In the subsequent
re-arrangement I gain through being transferred back to the
original route. On the other hand I must report back at 3am.
Thankfully I do not have to retrieve all the equipment and
so, grabbing my personal suitcase and desperately hoping the
cardboard boxes will not be left out in the rain I telephone
my hosts yet again. They remain welcoming and I insist
on taking them out to dinner at the Travelodge. Again the
absence of pedestrians on the streets and security precautions
around the hotel are noticeable.
My host drives me out to the airport. By 05.30hrs we are
airborne and on our way to Lae. It is my misfortune to be
sitting next to a junior member of the PNG Defense Force
who is clearly the worse for drink, but boisterous rather
than aggressive. Lae’s
International Airport is now
situated 45 km inland. We
land in the false dawn and
I disembark to stretch my
legs. The toilets are not up
to international standards.
Madang is as attractive
as ever with its rocky
headlands and inlets. After
a brief stop we are airborne
again and after a glimpse of
Kar Kar Island we fly above
the cloud until we descend
into Wewak.
There is no one to meet me
and everyone disappears,
but as I sit disconsolately
on my pile of luggage I am
Tekin was muddy.
84 Aesculapius, Summer 2012
rescued by a friendly local who offers to take me into town.
Abandoning the luggage which I am beginning to hate we
go first to the hospital where I hope to get transport. Alas
it is Saturday and the Hospital Secretary is out shopping.
Next stop the Windjammer Motel, much expanded since
my last visit and now presenting its exterior in the shape
of a crocodile. When I express surprise that the security
precautions seem as stringent as in Port Moresby my
newfound friend tells me that the “rascal gangs” in what I
had thought of as sleepy Wewak are just as bad.
“I finally establish contact with the Chief
Dental Officer...”
I finally establish contact with the Chief Dental Officer, Bias
Gwale a new graduate at the time I left PNG. He charmingly
explains his absence at the airport on his obligations to his
old military friends the night before. Given my shambolic
journey thus far I say it is scarcely his fault. We sit down to
breakfast with the WHO consultant. After hearing how much
the Windjammer now costs, I am relieved to hear that I have
been booked into the Baptist Mission Hostel at K10 a night.
Bias kindly offers me the use of his room and I sit watching
the test match live from New Zealand reflecting on the
fact that phone calls between Moresby and Wewak remain
problematic as ever. After the rigors of the early morning
departure I nod off. I am woken by Bias returning to take me
to lunch with his army friends at the local Moem Barracks.
Later, Bias reintroduces me to Moses the orderly with whom
I last worked 20 years ago in Lae. Moses shows me where he
lives and and tells me that last Christmas, as he was returning
home with his holiday pay, some rascals stepped out from
behind the kunai grass and relieved him of his wallet.
“...all 340 kilos of baggage remain at
the airport...”
I spend the night at the Baptist Children’s Hostel which is
comfortable enough. Its great disadvantage is that, like just
about everywhere in Wewak, it is miles from anywhere. It
is supposed to be bed only but in all the excitement I did
not buy any food. The family takes pity on me and provides
breakfast and when I insist on being charged it comes to
Moses gives post operative care.
$2.50. I also seek their advice on transport – all 340 kilos of
baggage remain at the airport and I need to shed a significant
amount before tomorrow. They offer to hire me one the
mission vehicles. I accept gratefully and set off to find Moses
and transfer it to the hospital where we set about sorting out
what we really need.
That evening I accept an invitation to accompany the
hostel supervisor and his family and charges to the Baptist
Mission service at their local chapel. The majority of the
congregation are expatriates. Afterwards I am introduced
to the pilot Llewellyn who has been playing the guitar
in the musical accompaniment. He tells me that the
Tekin airstrip has two windsocks which often point in
opposite directions.
The next morning the plan is that we should be at the airport
and board the plane by 7.30am. But as so often happens in
Aesculapius, Summer 2012 85
R e t u r n V i s i t t o Pa p u a N e w G u i n e a
this part of the world, things do not go according to plan.
Moses has already left his house when we arrive and we
fail to detect him as we drive to the hospital to pick up the
gear. Then it takes rather longer than anticipated to load
up. Finally it all comes together and we arrive at the airport
and our baggage is placed aboard the single engined Cessna
Station Master. Yesterday’s efforts have paid off and since
none of us is particularly large, it is decided that extra
freight can be carried. However Llewellyn points out that
Tekin is at 5500 feet and so whilst a relatively heavy
weight can be taken in, he can only take off again with
half the payload.
“...the people were only “discovered” in 1978...”
We climb steeply to clear the hills around Wewak. Below
are the serpentine Sepik River and the Chambri Lakes. It is
difficult to distinguish between water and weed. We continue
to climb gradually to 9000 feet, according to the instruments,
and on towards the mountain ranges that form the spine of
mainland New Guinea. The pilot wears headphones and a
microphone and talks to somebody “out there” periodically
and as we get further into the mountains. He tells us that
they were expecting us to go to Oxapmin first but he is going
to take us to Tekin. At one point he points to an airstrip and
tells us that the people were only “discovered” in 1978, four
years after we left. Further on he points out the Strickland
Gorge and soon we are making our approach. We spear down
at an angle of 45 degrees, touch and run uphill at angle of
30 degrees.
“The only incident is an attack by local dogs
on the mission goat.”
Tekin, despite an increase in flights, remains peaceful if
muddy. The only incident is an attack by local dogs on the
mission goat.
Keeping graduates in touch
with each other
The SANDS COX SOCIETY
needs your subscription
Apply to John Jackson:
[email protected]
and AESCULAPIUS
needs your news
Contact the editor:
[email protected]
www.sands-cox.org.uk
86 Aesculapius, Summer 2012
Reunions
50 year
Reunion –
Year of 1961
Much work went into chasing
contacts and “ lost souls” to develop
interest for a Fifty year Reunion.
The year has been meeting on a
five yearly basis so most contacts
were still viable, but inevitably a
few colleagues had disappeared, or
moved to inaccessible locations. The
year is now spread around the globe,
from Australia, via Singapore and
Geneva to Vancouver and Alberta.
We elected for a straightforward Dinner
– only event on Saturday 17 September
2011, and gathered at the Alveston
Manor Hotel in Stratford upon Avon,
since Stratford holds many happy
memories of previous Reunions.
We learned with sadness of the death
of three more of our year since the
Reunion in 1996 and the current
ill-health of four more. Apologies
were received from a dozen or so
of our colleagues who had other
arrangements, or couldn’t make the
long trek from overseas.
Betty Davies (Morgan)
There were no formal speeches, but a
vote of thanks was extended to Charles
Swan who had organised the event.
John Moore
Those who had been resident overnight
enjoyed a very pleasant “mini-reunion”
over breakfast, and an agreement was
reached that we should meet again in
four years in view of our age.
Sat Sood
Anyone interested in learning details
of the next event should contact
Charles Swan at 01782 616897 or
[email protected]
Charles Swan
John Masters
Bernard Juby
Nigel Gostick
Colin Leonard
Margaret James-Moore (Macaviney)
Sheila James (Quinn)
Keith Perry
Ken Watwood
Dorothy Nicholas (Jacques) and
Janti Shah were due to dine but were
prevented by illness at the last minute.
45 year
Reunion
List of participating graduates
Including thirty graduates, fifty-three sat
down to dinner. A few hadn’t braved a
reunion for over a decade, and joined
us with some trepidation. This proved
to be misplaced, and the start of Dinner
was delayed because of the difficulty in
breaking up the jolly conversation and
steering people into the dining room.
Gill Armstrong
Tables of eight worked well, with
some effort going in to placing friends
together for dinner.
Louise Henly (Lewis)
After dinner, groups mingled and
circulated, picking up the threads of
previous years. This activity continued
long into the evening, and only
began to wane when those who were
non‑resident had to break away. There
were some surprises which came
out of the many conversations, not
least that the Lien’s daughter and the
Swan’s daughter actually work together,
unbeknown to them and their parents!
Wing Ming Lien
Diana Evans (Price)
Brian Hopkinson
Barry Cooper
Tony Banks
Barry Hulme
Dick Hall
David Hewitt
Ann Smith (Hougham)
Charles Swan
Ian McK. Thompson
Bob Washington
Mike Weeks
Adiokosa Adebunmi
Roger Dent
John Davies
John Gunn
A nostalgic reunion was held by two
aging sports enthusiasts when Prof.
Dave Thomas and Dr Bryan Goodrich
met up in Wolverhampton in April
of this year. It was nearly 45 years
since they last met and it was their
common interest in golf that led to
the reunion.
Bryan and David were both
undergraduates in Birmingham from
1963-68 and subsequently lost contact.
Back in their undergraduate days,
they played soccer for The University
and Medical Dental Faculty teams.
Bryan had been County goalkeeper
for Durham Youth side which won the
national final vs. Essex in 1963 and
prior to coming to University he played
along side players such as the legendary
Man City player Colin Bell. Top clubs
like Arsenal, Luton Town and Wolves
all showed interest signing Bryan up,
but he wisely chose to study medicine
Aesculapius, Summer 2012 87
Reunions
instead. One interesting fact to emerge
was that David did his first fillings
on Bryan at The Birmingham Dental
Hospital in 1964, [You have to be
brave to be a goalkeeper!] and I am
pleased to report that they are still there
to this day!
Bryan had a very successful career
combining Anaesthesia with General
Practice and is a Senior Fellow of The
R.C.A. and is retired. After a life in NHS
general dental practice, Dave became
a Visiting and Honorary Professor
at the Schools of Health Sciences at
Staffordshire and Wolverhampton
Universities but is now happily retired
and living in Tettenhall.
Bryan lives in Poole, is married to Meg
and plays golf at Parkstone where he was
Captain in 1997. Dave was widowed
11 years ago and belongs to Little Aston
club in Birmingham where he still plays
off an “Iffy” six handicap. He also does a
lot of after dinner speaking with all fees
going to charity. Everybody hates going
to the dentist so his amusing anecdotal
stories about being a dentist in Dudley,
seniors golf and life as a professor make
him in demand for Old Boys, Rotary
WI, Golf Club dinners etc. He is also
a past Staffordshire Captain and past
President of The Staffordshire Union of
Golf Clubs. He has also been President
of the Central Counties Branch of the
British Dental Association. The chance
meeting between old friends arose when
David was speaking in Exeter; he met
John Smith the President of Dorset Golf
Union and also a Parkstone golfer who
gave him Bryans contact details. The
outcome was a most enjoyable reunion
and golfing day between two old friends.
Old men like to talk and they chatted
late into the night, both recalling
incidents, family history and other
dramas that the other had long since
forgotten. They both enjoyed the
meet-up so much that this long lost
friendship will be renewed when
Dave and partner Sue will be
travelling down to Poole in September.
If any other members of that era are
interested in catching up then Dave on
[email protected]
and Bryan at bryanmeggoodrich@
tiscali.co.uk who would love to hear
from them.
45 year
reunion of
1966 year..
The 45 year reunion dinner of the
1966 year group was held on October
15th 2011. The function was very
efficiently organised by Dave Hosking
who had booked the Priest House
Hotel at Castle Donington for the
gathering.
34 members of the year were able to get
to the reunion with about 12 spouses,
in addition to two couples where both
husbands and wives were graduates
from the year.
A difference from earlier reunions was
the encouragement to assemble on
the previous day (Friday 14th). Many
of the year took this suggestion up
and a most enjoyable pre-reunion get
together resulted. Most of the group
stayed at the Priest House Hotel and
a number joined a walk on Saturday
morning from Ticknall Village to
Ingleby for a pub lunch. The five mile
stroll through very pretty countryside
was much enjoyed by those who
joined in. Arthritic knees and hips
and poor eyesight did not dampen the
enjoyment and we were led by Dave
Horton who lived nearby and had done
the walk before.
Even though there were some detours
we arrived at the pub more or less
on time and were able to sit outside
in glorious sunshine. The whole
event was much appreciated and we
managed to get back to Castle
Donington in good time for the evening
gathering.
The main event worked extremely
well and the successful recognition
88 Aesculapius, Summer 2012
45 year reunion of 1966 year – the walk
Left: The Ticknall walk.
Below: Lunch at Ingleby.
45 year reunion of 1966 year – the reunion dinner
A few of the revelers.
Aesculapius, Summer 2012 89
Reunions
of old friends after a lapse of many years
(in some cases several decades) was
reassuring – in respect of the fact that
physical decay seemed to be limited
and memory was largely intact!
The attendees ranged in age from
around 68 to 80 but most were well
and active. Almost all were fully retired
though a few continued with some
(part time?) work.
Those present included: John Bate,
John Beynon and Wai-Pin (née Chan),
Charles (Humphrey) Browne, Hugh
Edmondson, Ralph Edwards,
Ian Forrest-Hay, Margaret Barker
(née Hall), Jean Harding (née
Wilkinson), Rob Harding, Di White
(née Hawkes), Ralph Hibbert, Dave
Horton, Dave Hosking, Martin
Hoskisson, Stephan Jain, Steve
Jones and Paddy (née Whytock),
Harry Leung, Eddie Majekodunmi,
Mike McKiernan, Jim Moore, Ann
Chande (née O’Donovan), Gordon
Read, Penny Holcroft (née Rice),
Guy Richardson, Mike Rose, Paula
Salmons (née Harris), Anne Rae
(née Skidmore), Mike Spokes, John
Walpole, Rob Wilkes, Jim Wilkinson
and Pam Sim (née Woodward). Grateful thanks are due to David
Hosking and to his wife Margaret for
their hard work in organising a most
successful reunion. We look forward
to the 50 year get-together with
anticipation!
Jim (Jimmy) Wilkinson
45 year reunion of 1966 year – the reunion dinner
Merged picture of the assembled year group:
Front row: Penny Holcroft (née Rice), Wai-Pin Beynon (née Chan), Paula Salmons (née Harris), Jean Harding (née Wilkinson), Jim Wilkinson,
Pam Sim (née Woodward), Dave Hosking.
2nd row: John Beynon, Ron Greenham, Jim Moore, Hugh Edmondson, Paddy Jones (née Whytock), Harry Leung, Mike Rose, Di White,
Jeff Williams, Sam Asiedu-Offei.
3rd row: Guy Richardson, Ralph Edwards, Margaret Barker (née Hall), Martin Hoskisson, Ann Skidmore, Stephan Jain, Ralph Hibbert,
Ann Chande (née O’Donovan), Rob Harding, Eddie Majekodunmi.
Back row: Rob Wilkes, Steve Jones, Mike Mckiernan, Humphrey Browne, Gordon Read, John Walpole, Ian Forrest-Hay, Dave Horton.
Note: Also present but hidden behind Jeff Williams – Mike Spokes and behind Ralph Edwards – Mike Gough.
Had hoped to come, but unable to at last minute: Ishola Abudu, Mike McEvoy, Andy Higginson, Ann Basketts (née Whitman).
90 Aesculapius, Summer 2012
45 year reunion of 1966 year – as we were
As we were – Graduation photograph 1966.
Front row: Anne Whitman, Margaret Hall, Penny Rice, Pam Woodward, Paula Salmons, Barbara Shann, Gill Davies, Paddy Whytock,
Penny Dykes, Jenny Davy.
2nd row: Jan Hall, Sandra Lloyd, Liz Wurr, Val Myatt, Anne Skidmore, Ann Downing, Angela Curran.
3rd row: Ishola Abudu, Neville Hodson-Walker, Harry Leung, Firouz Khamsi, P.A. Casey, Mike Spokes, Dudley Hubbard, Mike Rose,
Mohammed Kassim, Steve Jones.
4th row: Jim Moore, Ragnar Amlie, Humphrey Browne, Ron Greenham, Jane Evans, Paul Bayliss, John Bate, Ralph Edwards, Turab Chakera,
Ian Forrest-Hay, Gordon Read.
5th row: Mike McKiernan, Jeff Williams, Jim Wilkinson, Peter Gini, Eddie Majekodunmi, Dick Weston, Dave Horton, Andy Higginson,
Ralph Hibbert, Nigel Spencer, Julian Watts-Russell.
6th row: Dave Hosking, Dave West, Hugh Edmondson, Guy Richardson, John Kiernan, Phil Hamilton, Rob Harding, Stephan Jain,
Martin Hoskisson, Ben Hill, Geoff Holmes, Mike Radford, Andrew Mackenzie.
Back row: Rob Wilkes, John Beynon, Dick Blackburn, John Walpole, Bruce Hawkins, Mike McEvoy, PhilJudd, Malcolm Andrews, Ben Codling,
Mike Gough, Mike Cook, Mike Sambrook.
Absent from photograph: Wai-Pin Beynon, Jean Cumming, Dianne Hawkes, Phil Hughes, Roy Jarrett, Richard Mayou, Ann O’Donovan,
Ann Thurley, Tony Ward.
Aesculapius, Summer 2012 91
Reunions
45 year reunion of 1966 year – the reunion dinner
A few more of the revelers.
Planning a Reunion?
If you are planning a reunion of your year and wish to hold part of it in the Medical School,
you are asked in the first instance to contact the Alumni Relations Manager who would be pleased to
discuss with you how the Medical School might be able to help to make your visit memorable.
We can offer, for example, some hospitality, arrange for guided tours of the new facilities in the
School and for The Dean or another senior officer to talk to your group about current
developments and plans.
Michelle Morgan, College Alumni Relations Manager (Medical and Dental Sciences),
Room WG44, Medical School, University of Birmingham,
Edgbaston, Birmingham, B15 2TT
Telephone: 0121 414 3488 (Monday, Wednesday and Thursday)
0121 414 2513 (Tuesday and Friday)
Email: [email protected]
92 Aesculapius, Summer 2012
the sands cox society
Officers 2011-2012
President
Professor Hugh Edmondson
Vice-President
Professor Robert Stockley
Chairman (acting)
Professor Martin Kendall
Treasurer
John Jackson
General Editor
Keith Harding
Dental EditorVacant
Committee Members
Executive Secretary
Trustees
Sandy Buchan, Professor Lynn Jones,
Professor Damien Walmsley, Michelle Morgan
Sharon Charles
Professor Martin Kendall, Keith Harding,
Professor Damien Walmsley, John Jackson
All doctors and dentists who have studied as undergraduates at the University of Birmingham, wherever they qualified,
are entitled to join the Birmingham Medical and Dental Graduates Society. The Society is named the Sands Cox Society to
commemorate Sands Cox who effectively founded the Birmingham Medical School when he started the first organised classes
in human anatomy in this city in 1825.
Members of staff of the Medical and Dental Schools, and others who have substantial links with Birmingham medicine or
dentistry, may become members by invitation either on their own initiative or that of the Society’s Executive Committee.
The Society was founded in 1981 with the primary aim of keeping Birmingham medical and dental graduates in touch with
each other and with the Schools, by encouraging communication across the barriers that develop through geographical
separation, specialisation and ageing, principally through the publication of an annual journal, Aesculapius.
Aesculapius is published in the summer and comprises 70 to 100 pages of articles, letters, reports on reunions and obituaries,
all with illustrations where possible. Members and other former Birmingham undergraduates are encouraged to submit
material for publication. Critical and creative writing is welcome.
The Society also has a charitable role. Annually, there are four Sands Cox Society travel bursaries of £500 each, to support
electives for Medical Students plus one Dental, The John Rippin Elective Bursary of £800. Recipients are expected to contribute
to Aesculapius and to present to the Society. There is a further Dental prize, The Sands Cox John Rippin Memorial Prize for best
Elective Report of £200.
The Annual General Meeting of the Society is held in Birmingham in the autumn. The format of the meeting is evolving but
currently includes guest lecturers and student presentations as well as a business meeting. The latter reviews the activities of
the Society and its finances, and elects the officers.
The current annual subscription is £20 but as an introduction to the Society Aesculapius is sent free to students in the
final two years of the medical and dental courses. An application form to join the Society is included in the journal.
Additional forms are available from Dr John Jackson, Treasurer, Sands Cox Society, 29 Station Road, Blackwell, Bromsgrove, B60 1QB.
email: [email protected] web: www.sandscox.org.uk
The Society is a Registered Charity, No. 512347