[The following is excerpted from my memoirs, written in about 1991]
In 1961 the Social Medicine Research Unit (SMRU) occupied
the second floor of a set of office and laboratory buildings behind the London
Hospital Medical College on Whitechapel Road in the East End of London. I could
get there from our home in Newington Green on buses or the Underground, or on foot, via
Aldgate and Hatton Garden - a 35-40 minute walk through part of the top end of the
City, and along Whitechapel. I walked most often because we were very
poor. I barely had enough for us to live on after the rent was paid. This was
when Wendy demonstrated her truly sterling qualities, and I realized that she
was a women of unparalleled excellence.I wasn't surprised: we were children of the Great Depression, conditioned to thrifty ways of living.
The SMRU was doing several things. The most
famous were Jerry Morris's studies of London busmen, on which many papers had
been published, showing the relationship between physical activity at work and
reduced risk of coronary heart disease. David Pattison physically examined the
busmen, Jean Marr took detailed dietary histories, Austin Heady did the
number-crunching. Stuart Morrison was looking at factors associated with raised
blood pressure. He left the SMRU for a post at the department of social
medicine in the University of Edinburgh, where he re-entered my life again
later.
When I started working at the SMRU I told Jerry Morris that I wasn't very interested in his busmen, but wanted to
learn how to use epidemiology in studies of the working of health services, the
other main preoccupation of the Unit, and the part of its work that was mainly
in the capable hands of John Lee, a tall, fat man with a loud hearty laugh. I
attached myself to him, and through him I met Miles Weatherall
and Dick Joyce of the department of pharmacology; they had done some
elegant randomized trials of teaching methods, demonstrating the superiority of
small group problem-solving exercises over lectures or assigned readings. I was
fascinated by this display of scientific rigor in evaluating teaching methods. They were keen to study determinants of prescribing habits of GPs and specialist physicians.
I soaked up ideas and techniques like a sponge.
I got involved in helping Jerry revise his superb little
book, Uses of Epidemiology - my name appears in the
Acknowledgements because I spent many hours collecting and analyzing data from
all sorts of available and less-available sources, learning more in a few months
than in all my previous life put together. While gathering data for a table on
"Completing the clinical picture" I had the idea for a little paper
that might relate this to what goes on in the "average" general
practice; thus was born the idea for "The Iceberg" - a paper that is
still quoted 50 years later, the paper that established my scientific
reputation. There was much more, not only all sorts of odds and ends
of data-gathering, but an opportunity to capitalize on my background in general
practice by interviewing a random sample of general practitioners in
Stoke-on-Trent, Wigan and Middlesborough, three industrial county boroughs in
the north of England, characterized by striking differences in the rate at
which GPs prescribed sedatives, mood-modifying drugs, analgesics, etc for their patients. It was arranged that I would interview
about 100 GPs, and so I spent a while learning how to design questionnaires and
interview schedules, and with John Lee as my principal investigator and allied
with Dick Joyce and Miles Weatherall, I began commuting between London and
these three large towns, which I soon came to know as well as I had once known
the western suburbs of Adelaide. The work I did then led to a couple more
publications, but a lot of it remained unpublished until it appeared as the centre-piece of my MD thesis a few years later, along with my other epidemiological
studies of general practice.
There were many other ways in which that year
at the SMRU was a richly rewarding experience. I attended Michael Balint’s
weekly psychotherapy seminar series at the Tavistock Clinic, where I learned a
great deal about neurosis, anxiety, obsessive disorders and other emotional
aberrations that are compatible with functioning (more or less) in daily life.
I was introduced to the Keppel Club, an elite discussion group of public
health specialists in London and elsewhere in the UK, that met once a month at
the London School of Hygiene. I joined the Royal Society of Medicine, and
attended meetings of the Section of Epidemiology and Preventive Medicine. I met
Richard Titmuss, Peter Townsend, Ann Cartwright, Margot Jefferys, Donald and Roy Acheson, Tom McKeown and many others. I met visitors from the USA, Canada, Scandinavia
who dropped into the Social Medicine Research Unit. No Australians came through while I was at the SMRU; I was the first and only one.I was in the vanguard of the little band of GP-epidemiologists who
were starting to examine rigorously what went on in general practice. When I
presented my theoretical model of the "average general practice"
which then consisted only of a few tables with hardly any narrative linking
them together, a large crowd turned out to hear me. This was at the Keppel Club,
so there were people from as far
away as Birmingham and Manchester. The group from Manchester included Bob
Logan, who "borrowed" my raw data and actually published parts of it
without attribution; but fortunately all those who needed to know, knew that it
was my work, not his, and I got the credit.
Among the people I had introductions to in
London was Robbie Fox, Theodore, later Sir Theodore Fox, editor of the Lancet;
I owe that introduction to Ron Winton, editor of the Medical Journal of Australia, and am forever in his debt for putting
me in touch with the greatest living medical journal editor of that generation.
Robbie Fox took me to lunch at the Atheneum, an unforgettable experience in
itself; he was keenly interested in the work I was doing with Jerry Morris,
especially the model of the "average general practice." I showed this
work to him before leaving London, and sent back to him the revised paper that
also had the benefit of all Jerry Morris's amendments. I submitted it as
"Completing the clinical picture in general practice" and he wrote to
accept it with just one change, a change in title. That is how it came to be
called "The Iceberg."
There is so much more to say about that wonderful year, especially about our daily family lives. I'll save that for a future post.
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