Some academic activities in Edinburgh 1965-1969.

 Our family, including half-grown Labrador Boomer, in the garden below the bay window of our living-room, Christmas Day 1965







Posts excerpted from my memoirs or loosely based on these memoirs, appear on my blog in no particular order. They are most certainly not in chronological sequence. This one consists of some aspects of my academic activities during the years I spent as senior lecturer in social medicine at the University of Edinburgh. It’s the first of several on this theme.

Braidburn Park and the Pentland Hills, viewed from our living room window late on a summer evening in 1967

The Department of Social Medicine as it was then called was in the Usher Institute of Public Health across the Meadows from the rest of the medical school which was mostly clustered by the Edinburgh Royal Infirmary. The Usher Institute was a de facto school of public health with a large, diverse staff who had offices in the gracious old building on Warrender Park Road, and many connections with extramural specialist public health professionals in strategic locations including the Scottish Home and Health Department, where Sir John Brotherston, the previous incumbent of the Usher Chair, was Chief Medical Officer for Scotland. There was a close and fruitful relationship also with the City of Edinburgh public health department which provided local public health services. I got on very well with the City of Edinburgh’s medical officer of health, Seamus Gallagher. Later Seamus became a good friend when he joined the staff of the World Health Organization. I saw a lot of him and worked closely with him in Geneva in the 1980s and 1990s.  There were strong ties to the Research Intelligence Unit where some bright colleagues I had met at the Social Medicine Research Unit were now located. In both research interests and in my teaching role, I also developed close connections with several staff members in the department of psychiatry and in the MRC Psychiatric Epidemiology Research Unit, especially Morris Carstairs and Henry Walton. Henry Walton’s wife, Sula Wolff, had been a fellow resident with me at the Wittington Hospital in London in 1952-53.

Stuart Morrison had appointed me as a top-scale senior lecturer, though Fred Martin, a sociologist with the rank of reader nominally outranked me. Other senior lecturers included Donald Cameron, a communist and a rancorous old man whom none of us liked much; Ray Mills, who divided his time between Edinburgh and the medical school at Baroda in India that was affiliated with the Edinburgh medical school; Alwyn Smith, who soon left for Glasgow, having lost to Stuart Morrison in the contest for the Chair; Jim Burgess, a former colonial medical officer and his wife Millicent were authorities on infant and child nutrition, Norman Dean was a former general practitioner, Hugh Kinnaird, a health administrator and Hugh Russell, an urbane New Zealander who came to us from UNRRA; all except Hugh Kinnaird were medically qualified; less eminent staff members included Fred Forster, a geographer, Stanley Sklaroff, a statistician, Gillian Stanley, a sociologist, Walter Lutz, statistician, Mary Fulton, cardiovascular disease epidemiologist, Barbara Duncan, a young physician-epidemiologist; and a few others who came and went. One who came in my time and stayed for many years was Una MacLean, by far the most intelligent and capable of us all, denied the Chair later for no other reason than that she is a woman. The “chemistry” was just right, and almost all of us got along very well professionally and socially. Often several of us strolled across the Meadows to have lunch at the staff club.                  

Professionally my time at the Usher was highly successful. Within a couple of years people were coming from far and wide to exchange ideas with me about the work I was doing and publishing. This was mainly on the timely topic of methods and results of assessing aspects of medical education and medical care, and led to many publications and presentations at national and international scientific meetings. Two other important developments in my carer were that I was invited to contribute to and edit the community medicine sections of the large, ambitious Edinburgh textbook, A Companion to Medical Studies; and I was appointed as the Faculty of Medicine’s representative on the publications committee of Edinburgh University Press, the committee responsible for deciding what books the Press would publish. Also at this time I began to write pieces for the Lancet, and act as a reviewer of manuscripts that had been submitted to the Lancet for publication.  
                                                                                                                                                                                                                 

Poet's Tribute to Cartegena - "I love Cartegena as I love my comfortable old shoes"

In 1967 I had my first experience of work in international health. I went to Colombia with Gunnar Lindgren of the Karolinska Institutet in Sweden, and Don Anderson from the University of British Columbia in Vancouver, making up a PAHO/IEA team that visited all the medical schools in the country, advising about teaching methods and curriculum content in epidemiology. We flew in together, spent a few days in the fascinating old high-altitude city, Bogota and then went our separate ways to other cities before reassembling as a group with local reinforcement in Cali for a week-long seminar on teaching epidemiology at the graduate level. I went to Medellin and Cartagena. Medellin  was then a small, beautiful and climatically perfect city of about half a million people, the orchid capital of the world, with no auguries of its bloody future, except perhaps the shanty-town of slums clinging to the hillside on the outskirts; this then housed about 100,000 dispossessed rural peasants who had been forced off the land by what was described as rural banditry and was really the beginning of the populist uprising that became a festering civil war between the US-backed right-wing government and the leftist, sometimes communist FARC which supports its war by the drug trade. By 2012 that civil war had been going on for 45 years. In 1967 Colombia was already a violent nation: before I went, I did some background reading about the country, discovering, among other things that there had been several thousand murders the previous year, giving Colombia the highest murder rate in the world. (The local equivalent of Time magazine that I looked at in the Colombian consulate in Edinburgh while getting my visa had a story and pictures from Medellin of a family that had been hacked to death by bandits; the graphic pictures of decapitated and mutilated corpses told their own story and it seemed best not to mention this to Wendy). In Medellin I saw a fine new children’s hospital with about 500 beds – but it was an empty shell, because there were no nurses and no funds to equip it. Tom Hall, working for the Rockefeller Foundation and helped by Joe Wray (with whom I had much contact years later) was gathering data for the definitive book on health manpower in Colombia, and teaching a young man called Alfonse Mejia who later also became eminent in international public health and with whom I had several fruitful interactions some years later at WHO HQ in Geneva. The medical school in Medellin was over 100 years old and was very good clinically, but the department of epidemiology was not well developed then. Cartagena on the Caribbean coast was my next stop. This was a gracious, lovely old walled city (one of three in the Americas. The others are Veracruz and Quebec City, so I’ve been to all three). Cartagena has produced some of Latin America’s greatest literary figures, most recently the Nobel laureate in literature, Gabriel Garcia Marquez. In the 19^th century one famous local poet wrote of loving his city like his favourite pair of comfortable old shoes; so when he died, the city erected a statue, not of him, but of an old pair of shoes about two meters long. Its toes are constantly polished by passers-by who lovingly stroke them as they walk through the square containing this sculpture.

Medellin, Orchid capital of the world in 1967, later a fiefdom of drug cartels

Mountains tower above top end of Bogata, which is 3000 meters above sea level

The best thing I can say about flying in Colombia is that I survived it. The aircraft were old and poorly maintained, and landing and taking off at the airports, especially the one in Medellin that was set in a deep valley among high mountains, was a terrifying experience. But I had some spectacular views of the Andes to compensate for these white-knuckle adventures.

My academic connections extended well beyond the Usher Institute. As mentioned already, I had excellent working relationships with several colleagues in the Department of Psychiatry with whom I was involved in several research projects, and with several other psychiatrists who were mostly, as I was, exploring aspects of psychiatric epidemiology. At the request of the medical superintendent Max Jones, famous for the concept of the therapeutic community, I took some experienced general practitioners who were graduate students in public health, to Dingleton Hospital near Melrose in the Scottish Borders, to conduct a detailed medical review of over 1000 long-stay psychiatric patients. We found many serious untreated medical and surgical, i.e. non-psychiatric conditions. Jimmy (Sir James) Frazer, a baronet and senior lecturer in surgery and I, and a couple of others, experimented with team teaching medical students about the epidemiology, detection, and treatment of breast and colon cancer. I felt that I was at a peak in my professional career, and I was loving every minute of it.

Archie Duncan, the executive dean of the medical school, was reforming the curriculum. He involved me in evaluating the curriculum changes which I did using before/after comparisons and several indicators of educational processes and outcomes. This scrutiny was perceived as threatening by some of Edinburgh’s eminent medical teachers so it made some enemies for Archie Duncan, and for me, and there was a backlash later. But before that happened this work was noticed by the group based in London that was gearing up to provide background studies for the Royal Commission on Medical Education: John Ellis at the London Hospital Medical College, George Smart in Newcastle, and John Anderson at King’s College Hospital Medical School among others. These contacts led to my selection as principal investigator for a series of studies of aspects of medical education and manpower planning that generated many important publications including a major contribution to the final report of that Royal Commission. Gordon MacLachlan, the executive director of the Nuffield Provincial Hospitals Trust, gave me funds for several other studies of medical manpower and of general practice. I met a lot of other eminent men and women of medicine and science in those years, and moved confidently among them. Those were frenetic and pressure packed years of important productive professional work that established me as a leader in my field.

By late 1967 I had enough original research accomplished and enough energy to cobble it all together into a thesis that I submitted to the University of Adelaide for the academic degree of MD, in January 1968.  Preparing my thesis for submission was the first serious academic high point of my life, though it seems odd to single it out when I have done so many other things both before and since then. The intellectual discipline required to assemble material from many sources and prepare a coherent scholarly work that flowed smoothly from beginning to end was the most intellectually rigorous and demanding thing I have ever done. Reading the thesis many years later, I remain positive about it, and I’m sorry that I didn’t more aggressively pursue the idea of modifying and publishing it as a book. I explored the idea superficially with a man who was then the senior editor with E & S Livingstone, the Edinburgh-based medical publishing house. If there had been time I would have followed through with him or tried Penguins, and a worth while book might have emerged; but by then I had other distractions. These distractions and the life-altering decisions that followed, are described in a later chapter of my memoirs.