General practice in the Barossa Valley

Angaston is a pretty little town at the top end of the Barossa Valley, 90-120 Km north-east of Adelaide. In 1951 there was one doctor and a small hospital with 20 beds. It was named for one of the few British families who settled in the Valley in early colonial times; most are of German origin. In 1951, the original wave of German speaking settlers who had arrived in the 1840s and 1850s were long dead and gone; they had been joined in the 1870s by a further wave of migrants from Germany, disaffected members of a dissident Lutheran sect, and political refugees, including my grandfather Leopold Judell who began his Australian life in a general store at Truro, at the other end of the Valley from Angaston. In the 1914-18 World War, teaching of German had been banned in the schools; yet the local people still spoke English with a recognizably different local accent and odd sentence construction: “Already since six days this pain have I had.”  The Barossa Valley was a close-knit community, and outsiders took a long time to be accepted. I went as an “Assistant with view” (to becoming a partner in the practice); but it was not to be: I knew before I started that I would not be staying longer than the year I had contracted.

The other two principal towns in the Valley are Tanunda at the far end, where one of my friends and classmates was working as an assistant to the local GP, and Nuriootpa in the middle, where another classmate was a long-term assistant to the local GP. The three practices were linked in a loose federation of sorts; this meant that I did some relieving work in the Nuriootpa practice, and my classmate there relieved me - but in reality this rarely happened because I stayed in Angaston most weekends whereas my classmate in Nuriootpa  spent weekends away whenever he could.

I enjoyed the work very much. I had several interesting, even challenging medical experiences. There was an epidemic of mumps soon after I arrived in the Barossa Valley, my introduction to epidemic surveillance - memorable among other things for having to cope with the predicament of a family new to the town and knowing nobody. They all got mumps at the same time, both parents rather badly, and their brood of children too, all sick at the same time and utterly alone. I went in daily with meals and milk for them, to keep them alive as much as to see how they were doing. The Barossa Valley is a wine-growing district, notable now for excellent red wines. It was notable then among the alcoholics of South Australia and beyond as the place to be if one wanted to be as near as possible to the source of supply of cheap fortified wines like port and sherry. I saw more cases of acute alcohol poisoning and delirium tremens in six months in Angaston than in all my active clinical lifetime thereafter, including six months a few years later in the acute psychiatric receiving hospital in Adelaide. An unforgettable medical emergency occurred on Easter weekend when I was the only doctor in the Barossa Valley, the others all having decamped to the Oakbank picnic race meeting about 100 Km away. On the Saturday afternoon I was called to see a family of Latvian immigrants who had gone mushrooming. Unfortunately they threw away all the edible mushrooms and cooked and ate the puffballs and toadstools, which evidently resembled edible varieties of fungus that grew in their part of northern Europe. They were all very ill, the smaller children of the family especially so. They had some of the features of muscarine poisoning, and the children also had severe fluid and electrolyte loss from vomiting and diarrhea. I put intravenous drips into the smallest children, careful to avoid over-hydrating them, and had an anxious time trying to identify somebody in Adelaide who could advise me how to handle this situation. After several fruitless phone calls I made contact with an old friend, Bob Hecker, 2 years senior to me, who was embarking on a specialist career in internal medicine. We agreed that it would be best not to try to move them to Adelaide, at least two hours travelling time away even if I could persuade an “ambulance” (a station wagon containing a stretcher) to take them in their incontinent condition. The IV drips helped restore the children’s fluids, and with Bob advising me over the phone at intervals, I titrated suitable doses of antidotes of atropine and sedatives. Fortunately all survived, which no doubt demonstrated the recuperative powers of the healthy human body more than our medical skill. It was a satisfying medical experience from which I learnt a lot about management of emergencies and established some confidence in my ability among the nursing staff at the little hospital in Angaston. Soon after that the hospital matron asked me if I could give some lectures to the new nurses - my first experience of teaching, and a most enjoyable one that I would have liked to continue longer.

As well as the office in the doctor's home, I had to see patients in two branch offices, both some distance away - one was on the far side of the low range of hills that descended towards the River Murray valley, and in the little car that was provided for me, it was almost an hour's drive each way, most of it through sparsely settled grazing country, too little rainfall to support the fruit trees and vineyards in the basin of the Barossa Valley. Often as I drove to and fro I disturbed mobs of kangaroos, and I saw goannas, wallabies, wombats and other Australian wild life.  It was pleasant to get away on these weekly excursions, to make the house calls to the handful of housebound sick who required home visits, drink cups of tea with them, and exchange ideas. I suppose in these days of cell phones, fast cars, and rare or non-existent home visits to the sick, that relaxed way of life for country doctors is extinct.  Once at least however it would have been good to have modern communications. I had just finished and was on my way back to Angaston when an urgent call came in for me to see a small child who was convulsing.  I was pulled over by a policeman in a village half way back to Angaston, turned about and retraced my steps, forcing the little old car to far above its usual running speed of about 35 miles per hour. The convulsions were over by the time I got back to the farm where the sick child was in bed sleeping peacefully, but with a high fever and the tell-tale spots on the inside of his cheeks that made it easy to diagnose measles. The farm was so isolated that I brought the child back to the Angaston hospital where it was logistically much easier to care for him. Measles in those days was still potentially life threatening when it struck infants and tiny children. Fortunately that child recovered quickly.  

I got involved in the community life of Angaston to the extent of attending local council meetings and joined a club where I played badminton, where I met and mingled with others in my age group – all of them young married couples, so it was not a suitable setting to form a long-term relationship with a young woman, much as I wanted to do so.

At home with the elderly doctor whose house I was sharing, life was far from happy. My first inkling that matters were not as they should be was the episode of the blue vase. One day at lunch he flew into a rage at the appearance of this little vase containing a few flowers from the garden. One of his enemies had put this vase there, it was part of a sinister plot. Over the next few weeks similar episodes of strange conversation made me reluctantly accept the fact that I was working for a man with a paranoid psychosis, or perhaps dementia. Several times he came into my bedroom in the middle of the night, waking me to tell me about his enemies' latest evil plot that he had discovered or thwarted. His wife had given up and had left to live in Adelaide. He had a son several years my junior, whom I remembered vaguely at school; this son was then less than half way through medical school, destined eventually to join his father. Neither the absent wife nor the son were helpful; both urged me to stay in the house with him, to keep him company and do all I could to help him over this patch of nervous tension he was going through. It was easier said than done. I stood it as long as I dared, but after several occasions when he told me he had a loaded rifle by his bed, in case the enemies got into the house, I decided to leave after six months instead of staying for the originally agreed year.

A few weeks later, I embarked on a ship for London, where I would seek experience in hospitals of the British National Health Service, and where I would meet again my father whom I had last seen in 1939 when I was 12 years old.