In 1960 soon after I started the DPH course at the School of Public Health and Tropical Medicine at the University of Sydney, I wrote to Jerry Morris. I said that his article, "Uses of Epidemiology" in the British Medical Journal in 1955 had excited me; that I had gone on to read his book with the same title, that these readings had given me an entirely new outlook on health and medical practice; and that I would like to work under his supervision to learn epidemiology in the UK Medical Research Council's Social Medicine Research Unit. He wrote back saying he would be happy to accept me as a visiting scholar provided I could secure financial support. I obtained support from the Australian Postgraduate Medical Federation - a stipend for a single man with no dependents. Wendy and I and our two toddlers Rebecca and David traveled to England on a passenger-carrying freighter; and in the early summer of 1961 I went to meet Jerry Morris in his offices at the London Hospital Medical College on Whitechapel Road in the east end of London.
When I first met him in 1961, Jerry Morris was a wiry, restlessly vigorous middle-aged Scot with the thick Glasgow accent that he retained all his life despite his increasing eminence - like his close friend Douglas Black, later Sir Douglas Black, president of the Royal College of Physicians. Jerry, the rabbi's son, Douglas Black, son of the manse, started life in Gorbals, the worst of the Glasgow slums, and both were marked for life with its accent. I am fortunate indeed to be able to number both among my acquaintances. At my first meeting with Jerry, I said to him that I was more interested in his epidemiological studies of how health services worked than in the famous work on exercise and its role in reducing the risk of coronary heart disease. He seemed surprised and rather pleased when I blurted out this preference, tactlessly I instantly thought, because he was famous for the many published papers on sedentary bus drivers and actively mobile bus conductors, that showed the great differences in the incidence of coronary heart disease between the two classes of bus workers. Jerry put me to work on many small epidemiological exercises, one of which was to analyze death rates among doctors in various specialties in the National Health Service, where coronary heart disease seemed to spare the most physically 'active' specialists (orthopaedic surgeons) and hit rather hard at the more sedentary specialists in anaesthesia; but confounding factors made it impossible to state this with conviction. (There were other interesting features of that analysis of mortality rates among members of different specialties in the National Health Service, but this isn't the place to discuss that fascinating topic).
In conversation, Jerry Morris was constantly asking questions. The day I first met him, fresh off the ship from Australia, when he was director of the MRC Social Medicine Research Unit, he questioned me closely about my experiences as a general practitioner in Australia: what sort of patients had I seen, how many did I see each day, did I see them at home, in a clinic, in a hospital, what were the commonest diagnoses, how did i treat them, did I work alone or with help from a nurse? When I had been working at the Social Medicine Research Unit for a few months, he and his wife visited us at home one weekend; he asked all of us, including our two toddlers,, about our impressions of London, about the museums Wendy and the children visited, what had they all seen; and - perhaps recalling his early work on nutritional epidemiology - what had we all eaten for our supper the previous evening? He took us on a vigorous walk in Clissold Park with David in our ricketty old stroller and Rebecca struggling to keep up with the lightning-fast pace he set. When I began my fieldwork in three industrial cities in the north of England, he asked me for my impressions of these cities and the people I saw on local buses - did they look healthy, did they look happy? He was amused by a brief description I wrote of the sidewalks in Wigan spattered with purulent blobs of sputum, and the juicy coughs of bus riders - all of whom were smoking of course.
I owe a great deal to Jerry Morris's mentoring of me. He put me to work revising and updating some of the figures and tables in his book, Uses of Epidemiology, for a 2nd edition. Among the tables was one on "Completing the Clinical Picture" which displayed the differing impact on incidence or prevalence rates according to the disease stage at which observations were made. I saw that it would be useful to extrapolate the numbers to an "average" general practice. I wrote and submitted a paper to the Lancet setting out what was observed and what else was present as precursors, subclinical or undiagnosed disease. I submitted the paper to the editor, (Sir) Theodore ("Robbie") Fox, who accepted it without changing even a comma, but gave it a new title, "The Iceberg" and made my title, "Completing the clinical picture in general practice" into a subtitle. Robbie Fox was another of the eminent people I met during that wonderful year in London in 1961-62. The paper became famous, has been reprinted in several anthologies and has continued to be frequently cited 50 years after it was published. It will be reprinted yet again on its 50th anniversary in International Journal of Epidemiology with commentaries by several experts.
After we moved from Edinburgh to Ottawa I dropped in to see Jerry whenever time allowed during my rather frequent visits to London. Later he was especially interested in the work I did in Geneva with the WHO affiliate, the Council for International Organizations of the Medical Sciences on the ethical dimensions of epidemiology. He was keenly interested in my views on the danger that epidemiological research might lead to generalizations and "labelling" of high-risk individuals as lazy, fat, tobacco addicts, etc - "victim blaming" in other words. He was glad to know I was well aware of this and other dangers and was doing my best to ensure that the guidelines we were drafting at CIOMS explicitly identified such problems and the need to avoid stigmatizing people.
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| Jerry Morris in the late 1980s; see post of Feb 18 2012 for photo taken in 1961 |
I am forever in Jerry's debt for many reasons, perhaps most of all for encouraging me to develop and expand on his work on "completing the clinical picture" by calculating the dimensions of the hidden or submerged part of the "iceberg" of many varieties of disease.
More than any other epidemiologist I've ever known, Jerry always was acutely conscious of the social dimensions of health and sickness, always understood long before the term became fashionable that the social determinants of health were of paramount importance. For me, that was always the wavelength on which I was in closest accord with his thoughts and values.
That year under Jerry Morris's tutelage was financially precarious, but it was the happiest year of our married lives, to that point anyway, the most intellectually fulfilling, and academically a very productive year for me. It was a year in which I met all the leading men and women of British social medicine and epidemiology, as well as visitors from continental Europe, America and elsewhere, many as a direct result of introductions by Jerry Morris. Jerry's benign influence did much to shape the course of my career.
Jerry Morris lived to the grand old age of 98, walking from his home in Hampstead to his office at the London School of Hygiene and Tropical Medicine in Bloomsbury until near the end of his life, living testimony to his work on the protective effect of physical activity on preserving a healthy heart. Perhaps it's the specialty of epidemiology that fosters a long and happy life. Others I will mention in future posts have had long lives too, and so, come to that, have I.
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