LMITransactions&Report2012-13

Liverpool Medical Institution 

Transactions and Report 2012/13 

M e d i c a l L i b r a r y I M e m b e r s h i p I L e c t u r e P r o g r a m m e

LMI Transactions and Report 2012 - 2013 

Order of Contents 

Frontispiece, Mr Roger Franks, President 2 

List of SMC Members 3 

List of MEC Members 4 

The Liverpool Medical Institution Staff 5 

Editorial 6 

100th Birthday Celebration of Mr Clifford Brewer, FRCS, VD, PR 8 

A Short History of the Liverpool Medical Institution 9 

Inaugural Address of the President 

Held on Thursday 25th October 2012 17 

Henry Cohen Memorial Lecture 25 

Annual Healthcare Service 26 

Minutes of the Ordinary Meetings of the 174th Session 

including details of social events and admission of Life Members 27 

Retired Members’ Group 96 

Report of Council 97 

Report of the Honorary Librarian 99 

Obituary Notices 100 

The Life of Kitty Wilkinson 107 

Offices of Distinction, Awards/Honours 109 

International Nepal Fellowship Ear Camp 110 

Members Elected since last Transactions 112 

Auditor’s Report 113 

List of Presidents 115 

Charitable Donations 116 

Cover Illustrations 

Left: Gemma Walters, Fiona Claxton, Sally Olding, Poon Shi Sum, Margaret Tyau (photo taken 4.12.2012) 

Middle: Mr Roger Franks, Dame Lorna Muirhead, DBE and Mr Roger Phillips (photo taken 14.2.2013) 

Right: Professor Tom Solomon carrying the Olympic Torch past his supporters at the LMI (photo taken 1.6.2012)


Registered Charity No: 210112 

Transactions 

and Report 

The Institution book plate, reproduced on the front cover, was designed and engraved by Stephen 

Gooden, C.B.E., R.A. 

The basis of the design is the staff and serpent of Asklepios, bearing the date when the Library was 

opened to the profession in Liverpool and neighbourhood. 

On the shield is the emblem of Liverpool and it is supported by two fleams or lancets of a design 

once used for blood-letting. 

The Institution crest, reproduced above, can be seen in the library, the lecture theatre and as a 

mosaic in the main hall. It also shows the Staff and Serpent, with the opening words of the 

Aphorisms of Hippocrates: 

(Life is short, and Art long; the crisis fleeting; experience 

perilous and decision difficult). 

Trans. FRANCIS ADAMS 

114 Mount Pleasant, Liverpool L3 5SR 

Telephone: 0151-709 9125 Fax: 0151-707 2810 

Email: admin@lmi.org.uk Web Address: www.lmi.org.uk 

1


ROGER FRANKS 

President 2012-13 

2


Strategic Management Council (SMC) 2012-2013 

Chairman: 

A SWIFT 

President: 

R FRANKS 

President-Elect: 

L DE COSSART, CBE 

Treasurer: 

A ELLIS 

Secretary: 

A McCORMICK 

Librarian: 

S SHEARD 

D ANTONIA 

L DE COSSART 

A ELLIS 

S EVANS 

Members of SMC: 

R FARQUHARSON 

R FRANKS 

I GILMORE 

N GILMOUR 

W KENYON 

A McCORMICK 

A SWIFT 

Auditors: 

BAKER TILLY 

David Antonia 

Linda de Cossart 

Anthony Ellis 

Susan Evans 

Roy Farquharson 

Roger Franks 

Ian Gilmore 

Nigel Gilmour 

Bill Kenyon 

Austin McCormick Andrew Swift Sally Sheard 

3


Membership and Education Committee (MEC) 2012-2013 

President: 

R FRANKS 

President-Elect: 

L DE COSSART, CBE 

Vice Presidents: 

J CURTIS L PATEL 

Treasurer: 

A ELLIS 

Secretary: 

A McCORMICK 

Librarian: 

S SHEARD 

Members of MEC: 

J CURTIS 

P D O DAVIES 

L DE COSSART 

A ELLIS 

R FRANKS 

G GILL 

I GILMORE 

B JONES 

A McCORMICK 

L PATEL 

I RYLAND 

S SHEARD 

Additional Honorary Officers: 

Secretary of Ordinary Meetings: VACANT 

Editor of Transactions: B JONES 

(Assistant Editors: N R CLITHEROW, SAM PICKUP, SHARON HUNT AND LYNNE SMITH) 

John Curtis 

Peter Davies 

Linda de Cossart 

Anthony Ellis 

Roger Franks 

Geoff Gill 

Ian Gilmore 

Ivan Iniesta 

Bethan Jones 

Austin McCormick 

Latifa Patel 

Ida Ryland 

Sally Sheard 

4


The Staff of the Liverpool Medical Institution 

Jim Penwill (Finance Officer) Samantha Pickup (Manager) Adrienne Mayers (Librarian) 

& Sue Curbishley (Assistant Librarian) 

Audrey Roberts (Admin) 

Lynne Smith (Admin) 

Sharon Hunt (Admin) 

Joyce Williams (Bar) 

Tom Spearitt (Security) 

Other Team Members 

Dennis & Deborah Holden (Catering) 

Jackie & Bryan Williams & Caroline Lunt (Cleaning Team) 

Mark Ross (AV Technician) 

Jeremy Blades (AV Technician) Anna Reid (RCGP Office) Sarah Adams (RCGP Office) Jo Hewitt (RCP Office) 

5


Editorial 

‘The NHS of the future: ‘NHS Extra’?’ 

Where is the NHS going? The LMI programme 

commenced with a series of speakers focusing on the 

future of the NHS. There are significant changes 

occurring, transforming the NHS as we know it. The 

Tredegar born Aneurin Bevan set out three main 

principles for providing care, for free, to all British 

people when establishing the NHS in 1948: 

1. It should meet the needs of everyone. 

2. It should be free at the point of delivery. 

3. It is based on clinical need and not the ability to be 

able to pay for the service. 

Will these principles be lost, one by one? Seeing his 

memorial statue standing proud in the middle of 

Cardiff city centre, it made me think - is the NHS, in its 

current state, as strong and proud? 

As I read an article in the Guardian entitled “The NHS 

is not Tesco”, I couldn’t help but relate the deals of 

large, successful supermarkets against this concept 

within the NHS. Let us begin with ‘BOGOF’ - Buy One 

Get One Free - an acronym that we are more than 

familiar with. What about ‘Buy One Hip Get One Hip 

Free’?! Changing mind-sets into running a ‘business’ 

could lead to Trusts using such deals to attract General 

Practitioners to refer their patients to them. We 

should be aiming for improving and providing 

excellent care and services, making ourselves more 

competitive to attract referrals to secondary and 

tertiary care. But is this not the same as Asda having a 

better deal then Tesco at any one time? 

for this at present? Indeed, Dr Mark Porter, Chairman 

of the BMA Council felt that this was not possible - 

“the calls we sometimes hear for a Tesco NHS, full 

service, 24/7, are just ridiculous when the health 

service can barely afford its current model”. 

As clinicians, we strive to provide the best possible 

level of care. There are reasons for Tesco to be open 

around the clock and on the weekends, including it 

being profitable. Providing such a service within the 

NHS if very different. We know that providing 

comparable care out-of-hours could have an impact 

on improved quality of care and outcomes, however, 

due to the previously mentioned reasons, this is simply 

not possible. 

And so therefore I conclude that an ‘NHS Extra’ would 

not be the solution. I shall finish by again quoting Dr 

Mark Porter at a recent BMA meeting - "like many of 

you I work nights and weekends as well, at a time 

when much of the private sector is fast asleep and 

ministers are tucked up soundly in their beds”. 

I would like to extend my gratitude to all the staff and 

members who have contributed to this 2012/2013 

edition of the Liverpool Medical Institution 

‘Transactions and Report’. 

Moving on to the concept of the ‘points card’, for 

instance, the more times a patient visits the hospital, 

the more points they receive; or the more patients a 

GP refers the more rewards they gain. This could result 

in a negative effect and potentially be devastating, 

resulting in patients being over referred and as a 

consequence, over investigated and being more 

comparable to a Private system such as in North 

America. 

But should we be learning from such large and 

prosperous companies such as Tesco to improve the 

service that we provide? Will a 24/7 access to health 

care improve the NHS as we know it? Recent figures 

show that providing this level of provision will save 

4,400 lives per year. But do we have the infrastructure 

Bethan Fôn Jones 

Editor 

6

7 

LMI Transactions and Report 2012 - 2013


100th Birthday Celebration of Mr Clifford Brewer, FRCS, VD, PR 

On 29th April 2013, Dr Bill Taylor represented the LMI at the 100th birthday celebration of Mr Clifford Brewer 

held in Wickham, Hampshire. Mr Brewer is the oldest surviving Fellow of the Royal College of Surgeons and was 

a distinguished consultant surgeon at the Liverpool Royal Infirmary from 1958 to 1978. As a student in Liverpool 

he won every prize available, including the University Gold Medal in Gynaecology which now serves as the 

Presidential Emblem of the Liverpool Medical Students’ Society. During the Second World War he served in the 

Middle East and in Normandy and was awarded the Volunteer Decoration and, for operating on the Polish 

Leader, General Sikorski, the Order of Polonia Restituta. He delighted in being able to put the initials VD, PR after 

his name. The photographs show Clifford Brewer, his cake with a fisherman motif, the card from the Queen and 

a bottle of champagne from the LMI. 

Dr W Taylor 

8


A Short History of the Liverpool Medical Institution 

By Sam Pickup 

At the top of a hill in Liverpool, on the corner of Hope 

Street and Mount Pleasant, the site of the birthplace 

of William Roscoe, there stands an imposing 

neoclassical building. It is today, and has been since 

its opening in 1837, the Liverpool Medical Institution, 

and is home to the society of the same name, founded 

in 1839. 

Throughout its 175 years, the Liverpool Medical 

Institution has known some fascinating medical firsts 

and many illustrious members have passed through its 

doors. It could be argued that with their words and 

deeds they have shaped the city we know today and 

even the world beyond, and yet the Institution 

remains something of a hidden gem, hardly known to 

the public of Liverpool. In the words of the Liverpool 

Daily Post in 1963, ‘few know that the elegant 

Georgian building has been the scene of great 

revolutions in medicine and the meeting ground of 

the eminent surgeons and physicians since the early 

nineteenth century.’ 1 This brief history, with notes on 

some of the Institution’s eminent members will, no 

doubt, leave many a stone unturned and cannot hope 

to do proper justice to such an august institution and 

all the illustrious persons associated with it in so short 

a space. I will, however, attempt to provide an 

introduction for those unfamiliar with this remarkable 

organisation. 

The Liverpool Medical Institution houses one of the 

oldest medical libraries in the country, 2 and has a 

symbiotic relationship with the medical community in 

Liverpool; it existence is dependent on their support 

and their participation in its activities, and through 

activities and engagement it exists to support and 

enlighten the profession. This purpose should be even 

more relevant today where the importance of 

continued professional development and the 

dissemination of knowledge are widely 

acknowledged. For nearly two centuries, the 

magnificent building has been a focus of medical life 

and a meeting place for the medical community of 

Merseyside, its prime role being that of a medical 

library. 

The library is home to a unique collection of historical 

medical books, journals and memorabilia. At present 

there are approximately 30,000 books in the LMI 

Library catalogue. The collection includes some very 

early, rare books, many beautifully illustrated. The 

earliest book in the LMI’s archives dates from around 

1532 - early titles include the Opus de re Medica by 

Paulus Aegineta, dating from Paris in 1532, restored 

on 17th century calf, Opera - Claudius Galenus (Venice, 

1625), Andreas Vesalius’ Opera Omnia Anatomica et 

Chirurgica (1725) and several by Paolo Mascagni 

including Anatomia Universa (1823). 

There are eighteenth and nineteenth century texts by 

Thomas Addison, Edward Jenner and Isaac Newton, a 

fascinating collection of medical instruments including 

early bacteriological microscopes, a mid 20th Century 

ophthalmoscope (used in the 1950s and 60s by a 

missionary in Nigeria and donated to the LMI by Dr 

Patricia Owens), trephining instruments, cupping 

glasses, an infant gas mask from WWII (donated by 

9


Alder Hey Children’s Hospital in 2009), many portraits, 

and archives of members including personal papers 

and letters. The collections even hold a letter penned 

by Florence Nightingale c. 1869. There are two skulls 

- a cast of the skull of Robert the Bruce and the skull 

of a Tartar, which was found by a military mission that 

captured a fort at the mouth of the Pei-ho River, 

China, in the 1860s. Both skulls were donated by Mr 

John Shepherd as part of the Shepherd de Boer 

collection c. 1976. 

But how did this collection, this society and this 

building come to exist? 

Liverpool Medical Library. On the 7th of October 

1779, a meeting of ‘the Gentlemen of the Faculty 

attending the public Infirmary and Dispensary’ 4 was 

held during which it was resolved that: ‘A Medical 

Library be instituted by subscription under the name 

of the Liverpool Medical Library…’ 4 

The Library offered membership to all practitioners in 

the town and was initially lodged in the Infirmary. To 

make this resource available for the greater good was 

a commendable decision at a time when the 

profession was, as Shepherd notes, ‘notoriously 

individualistic, often jealous of each other and often 

reluctant to share their knowledge and skills.’ 4 

The first President of the Library was Dr Matthew 

Dobson (1732-1785). 4 Dobson qualified in Edinburgh 

and had been a member of the Royal Medical Society 

there. He moved to Liverpool not long after, and is 

notable for numerous achievements, being the first 

Liverpool writer whose medical studies were lauded 

in London commentaries, and in 1778 the first 

Liverpool doctor to be elected a Fellow of the Royal 

Society. 5 

Above: The Union Coffee House 

In 1749, the original Liverpool Infirmary opened in 

Shaw’s Brow, on the site now occupied by St George’s 

Hall. 3 The origins of the Institution can be traced back 

to the decision of three Liverpool surgeons (Lyon, Park 

and Alanson) to purchase books collectively for 

common use, a practice which grew gradually and 

informally along the medical staff of the Liverpool 

Infirmary and Dispensary. 4 This custom eventually led 

to the emergence of two organisations, the Liverpool 

Medical Library (1779) and later the Liverpool Medical 

Society (1833). 

The Union Coffee House in Mount Pleasant (pictured 

above) was the scene of the official formation of the 

Dobson was highly regarded for setting a high 

standard in clinical and scientific work, but perhaps his 

greatest achievement was to describe the link 

between sugar and diabetes, and to isolate sugar from 

the urine of diabetic patients, thereby establishing the 

first diagnostic test for the disease. 5 However, as with 

many pioneers, some of his experiments may seem a 

little eccentric. During his time at the Old Infirmary 

he conducted experiments on the treatment of fevers 

in a small chamber known as the ‘sweating room’, 

convincing his assistants to act as subjects. On one 

memorable occasion, Henry Park, ‘remained in the hot 

chamber long enough for three eggs to be cooked, 

emerged unscathed, consumed the eggs and walked 

to Everton Village in a hard frost without any ill 

effect’. 5 

Like many professionals of his time, Dobson was 

actively involved in various cultural activities, and 

aided the foundation of an academy of Painting and 

Sculpture with a surgical colleague, Matthew Turner. 5 

A trend for the foundation of social, professional, 

cultural and philanthropic societies appears to have 

been prevalent round about the time of the 

foundation of the Liverpool Medical Library. To name 

a random few, Athenaeum Library, 1797, The 

Athenaeum Club, opened in 1799, the Literary and 

Philosophical Society in 1812 and the Manchester 

10


Medical Society in 1834. Notwithstanding the wellknown 

rivalry between the two cities, the Liverpool 

Institution shares a reciprocal relationship with the 

Manchester Medical Society to this day, alternately 

hosting a joint meeting in a tradition dating back to 

1920. 6 A similar Joint Meeting is also arranged 

annually in conjunction with the Athenaeum Club. 

Many members of society devoted their time outside 

of work to cultural and philanthropic pursuits. An 

example of the practice of gathering subscriptions 

among professionals for common or philanthropic 

purposes can be seen in the voluntary hospital 

movement which produced thirty-five provincial 

public hospitals between 1736 and 1779 and which led 

to the emergence of the two Liverpool Charities, the 

Infirmary on Shaw’s Brow and the Dispensary in 

Church Street. 7 

With the development and formalisation of 

professional standards during this period, the origins 

of medical libraries of this type around the country can 

be traced not only to this fashion for founding 

societies of shared interest, but also to a common 

need for an easily accessible shared resource and a 

forum for discussion of current issues and the 

presentation of new ideas. 8 

The increasing requirement for a more formal training 

amongst doctors had meant that a growing number 

of Liverpool doctors were obtaining degrees in the 

more advanced medical schools such as Edinburgh. 8 It 

is possible that combined with other factors, the 

success of the Royal Medical Society founded in 

Edinburgh in 1737 may have had an influence on the 

desire in Liverpool practitioners to emulate and 

participate in a similar society in Liverpool. 9 Perhaps 

these trends provided a catalyst for the emergence of 

the Liverpool Medical Society in 1833. Up until 1822, 

the function of the Medical Library had been solely to 

house and make commonly available the collection of 

medical books. A turning point came on March 19th, 

1822, after which the rooms were opened on Saturday 

evenings for the reading of papers and discussion on 

medical subjects. 10 

On January 10th, 1833, the Liverpool Medical Society 

was founded by a group of approximately forty 

doctors who used a room at the Old Infirmary, where 

the Liverpool Medical Library was first located, as a 

meeting room. 11 From then on the Society met 

fortnightly in the Library, although the two 

organisations remained separate. 

Some societies were enjoyed as much for their social as 

their scientific aspect. Indeed, in some cases this even 

eclipsed their ostensible academic or scientific 

purpose. To quote one of the more ostentatious 

examples, the Harveian Society of Edinburgh was 

founded in 1782 to celebrate the achievements of 

Harvey and annually ‘commemorate the discovery of 

the circulation of the blood by the circulation of the 

glass’. 12 

By contrast, the aims of the Liverpool Medical Society 

were declared in its regulations to be the ‘promotion 

of medical and surgical knowledge, including every 

branch of science connected therewith’, and according 

to the judgement of one of its later members, Thomas 

Bickerton, was suitably true to these aims in the 

success of its professional work, liberality and public 

spirit. 13 It entertained discussion on hot topics of the 

day such as medical reform, medical education and 

public health, 13 and on occasion lobbied both the local 

Corporation and the government via the House of 

Commons, for example petitioning the House of 

Commons for medical input on the Poor Law Bill to 

make it ‘more useful to the poor and more 

honourable to the profession.’ 14 

The swift growth of Liverpool in the early 1800s, and 

particularly after 1827, is reflected in the necessity for 

the Library to undertake many removals before 

settling in its final home at the top of Mount Pleasant. 

In one turbulent period this necessitated four 

removals within the space of ten years. 15 From its 

initial home in the Old Infirmary, the Library moved to 

the Dispensary in Church Street, circa 1782, only to 

move back to the Infirmary in 1807. Subscriptions had 

been collected from members 16 to fund the erection 

of a suitable room over the archway forming the 

patients’ entrance to the Infirmary for specific purpose 

of housing the Library. 17 

In 1826, however, the Library received notice from the 

Borough Surveyor to quit the current venue as it was 

‘the wish of the Corporation to pull down the Library 

Room’ to clear the site prior to the construction of St 

George’s Hall. 17 The minutes of a special meeting of 

the Library held on December 7th, 1826, record the 

composition of a communication to the Mayor and 

Corporation of Liverpool informing them of the 

origins and purpose of the Library and requesting that 

the Corporation erect ‘in lieu of the present building, 

a suitable building on any convenient and nearly 

central piece of land which may not be wanted for any 

purpose more important.’ 18 

11


The request was granted, and two capacious, gas-lit 

rooms adjoining the weighing house in Lime Street 

were constructed for that purpose, into which the 

Library moved in 1827. 19 This proved rather shortsighted 

as in April 1833 another notice to vacate was 

received, requiring the Lime Street site for a new 

railway station for the Liverpool and Manchester 

Railway, which had previously opened in 1830 with a 

passenger terminus at Edge Hill, but was due to be 

extended into the town. 19 Thereafter, the Library was 

housed on various sites including Wood Street and 

Suffolk Street until it was moved into the present day 

building. 20 

Rutter has been described as ‘a Quaker, a bachelor, 

and a man of simple and sober appearance.’ He was 

instrumental, along with William Roscoe, Dr James 

Currie and others in the founding of the Athenaeum 

Club in 1799: ‘he thus bequeathed to Liverpool two of 

its cultural institutions, and laid the foundations of 

two outstanding libraries.’ 23 He was also a member of 

the first Council of the Provincial Medical and Surgical 

Association founded in 1832, which later became the 

British Medical Association. 23 Today, Dr Rutter’s 

portrait hangs in pride of place in the Institution’s 

Lecture Theatre. 

Rutter instigated and accomplished the negotiations 

which obtained the land for a new building, formerly 

a bowling green and the site of an inn, on the corner 

of Hope Street and Mount Pleasant. The lease was 

signed by the Corporation in July 1835. 24 The Library 

and Society joined forces to campaign to raise funds 

for new premises, and a Building Committee, 

involving Rutter, James Dawson, Frederick 

Worthington, James Carson and Thomas Jeffreys was 

constituted. Subscriptions towards the erection of a 

building from members of the medical profession 

contributed £1,592. 19s, and lay public £575. 9s. 10d, in 

addition to which the Corporation subscribed £1,000. 25 

It took foresight and imagination to turn this series of 

crises into an opportunity. Dr John Rutter (1762-1838, 

pictured above) was a senior, eminent and well 

respected Liverpool physician and an active member 

and during this period he was elected president of 

both the Medical Library and recently formed Medical 

Society. 21 Rutter is credited with conceiving and first 

articulating the idea to consolidate the resources and 

activities of the physicians and surgeons of Liverpool 

in a single institution befitting the profession. On 

April 23rd, 1833, he wrote to the President of the 

Library, William Squires, as follows: 

‘…it seems to me that more accommodation is really 

wanted. And several gentlemen are of the opinion, 

and I quite agreed with then in this opinion, that it 

would be most desirable to procure a building which 

would suffice for every purpose for which it could be 

required by the profession at large: that is, in the first 

place for a Library, and secondly for all Meetings of 

the profession, for Medical Lectures, or the Meeting 

of Medical Societies, with a Committee room annexed 

to it, and with a convenience house for the 

Librarian’ 22 

The architect Clark Rampling (1793-1875), was 

commissioned to design a building in the neoclassical 

style to house the Liverpool Medical Library. The 

building, which came to be known as the Liverpool 

Medical Institution, cost £4,000 and was opened in 

1837. 26 The wedge-shaped building has many unique 

architectural features, including a beautiful D-shaped 

lecture theatre (pictured above) and a curved first 

floor Gallery with three glass roof domes. The 

building is now Grade II* Listed by English Heritage, 

with features of special interest on both the interior 

and exterior. Rutter, at the age of seventy-five, 

presided over the opening ceremony. 27 He died in the 

following year, and a memorial tablet was erected to 

12


his memory in St Peter’s Church. Very little remains of 

St Peter’s today except the name of a street in central 

Liverpool, and a brass X on the floor outside Topshop, 

which marks the original site. The memorial, however, 

was re-erected in the Main Hall of the Medical 

Institution in 1921 and has remained there ever 

since. 27 

Unfortunately, the completion of this magnificent 

building left the Building Committee trustees in 

considerable debt. The burden was alleviated by 

means of a bazaar and public appeal held by the ladies 

associated with the Library, following a suggestion by 

Mrs James Dawson, the wife of the Treasurer. The 

bazaar, held on October 10th, 1838, was an immense 

success and raised £1050, discharging the debt. 28 

The stated aims of the Institution were broad and 

ambitious, aiming to unite the medical fraternity of 

Liverpool and encourage them to work together for 

the benefit of the patients of Liverpool, rising above 

personal allegiances, to provide a forum for discussion 

of public health and welfare issues, a venue for 

lectures, meetings, study and mutual instruction, and 

a home for the Liverpool Medical Library. 28 

The Medical Society remained a distinct Society, 

holding its meetings in the Royal Institution in 

Colquitt Street, until it merged with the Library in 

1839. The new organisation took the name of the 

building and has been known ever since as the 

Liverpool Medical Institution. 

Concurrently the 1830s saw the antecedent of a 

Liverpool Medical Faculty. Before 1834, 

apprenticeship to the Infirmary or a private 

practitioner and attendance at one of two Liverpool 

schools of anatomy was the route into medicine. 

Lectures were given at the Royal Institution, and in 

1834 the Liverpool Royal Institution of Medicine was 

founded. 29 The school remained based here until the 

winter of 1844, after which it moved to a building 

behind the Infirmary, and came to be known as the 

Liverpool Infirmary Medical School. 30 

The Institution has witnessed many distinguished 

members of the profession pass through its doors, 

with many taking a role as Members or Officers of the 

Institution. Liverpool in general has an association 

with many medical firsts, and just a few are outlined 

in this piece. In fairness, however, it must be added 

that this was by no means always the case, and one of 

the Institution’s more recent chroniclers, Mr Shepherd, 

notes that within the discussions at meetings and 

papers presented ‘not infrequently there were pleas 

for the revival of discarded methods’ which in the 

1870s included blood-letting, wet-cupping and even 

tobacco enemas. 31 

Perhaps one of the more well-known members of the 

Institution is Dr William Henry Duncan (1805-1863). By 

1811, Liverpool was the second most populous British 

city after London, but despite the rapid rise in its 

number of inhabitants, the required improvements in 

terms of sewers and public hygiene were woefully 

lacking. 32 The 1801 Census tells us that ‘a large 

proportion of the population are living in cellars and 

typhus fever and other diseases carry off many each 

year in the lower, crowded parts of the town’. Duncan 

was President of the Medical Society in 1837, during 

the foundation of the Medical Institution. 33 

During his time as physician to the Liverpool Infirmary, 

Duncan campaigned robustly to raise awareness of the 

link between poor sanitation and diseases such as 

cholera, and for the improvement of living conditions 

in the poorer and more crowded parts of the city, 

making many inspections of the dwellings of his 

patients. In 1840, the year of the passage of the 

Liverpool Building Act, Duncan delivered to the Poor 

Law Commission a Report on the Sanitary State of the 

Labouring Classes in Liverpool. He expressed concerns 

at the cramped conditions, sanitary deficiencies of 

existing housing and the conditions of those 

unfortunates forced by poverty to live in cellars. 

Between 1843 and 1844 he delivered three lectures to 

the Liverpool Literary and Philosophical Society, the 

last of which described in harrowing detail the 

conditions of families living in stifling cellars 10ft by 

6ft, with no water, sanitation or ventilation. 34 Duncan 

also campaigned to stem the rate of immigrants 

fleeing the Irish potato famine, as many refugees from 

this country in their destitution occupied the 

hazardous dwellings he was attempting to eradicate. 35 

Duncan’s appointment as Medical Officer of Health on 

January 1st 1847 under the 1846 Act for the 

Improvement of the Sewerage and Drainage of the 

Borough of Liverpool was the first of its kind in both 

Liverpool and the world. 36 

A memorial tablet to Duncan was transferred from St 

Jude’s Church to the Institution and can still be viewed 

in the LMI today. It describes his contribution to 

Liverpool’s welfare: 

13


“In memory of William Henry Duncan, M.D., Medical 

Officer of Health for the Borough of Liverpool… Dr 

Duncan was appointed under the Sanitary Act of 1846, 

which was obtained chiefly through his exertions, and 

by his judicious measures, under the blessing of God, 

he succeeded in reducing the rate of mortality in 

Liverpool nearly one third.” 37 

The Institution houses several such memorials. Not all 

represent people. Above the entrance to the 

Orthopaedic Library of the Liverpool Medical 

Institution is a curious plaque reading ‘H.O.T. Surgery 

1866’. The plaque originally marked the location of 

the workshop of Mr Hugh Owen Thomas (1834-1891) 

in Nelson Street. Thomas, descended from four 

generations of Welsh bone-setters, had orthopaedics 

in his bones, as well as the advantage of a formal 

medical training, and was to pioneer a technique for 

splitting which would later become known as the 

‘Thomas splint’. Unsung in his day, Thomas treated 

the workers and inhabitants of Liverpool’s dockland 

areas with ‘astute diagnosis, skilful manipulation and 

ingenious splints’ at a time when the treatment of 

bone and joint problems could often offer nothing 

more than amputation or deformity. 38 

Later, his nephew Sir Robert Jones (1857-1933) would 

use the ‘Thomas splint’ in field hospitals during World 

War One, saving ‘countless lives and limbs’. 39 Between 

1887 and 1893 the Manchester Ship Canal Company 

had consulted Jones in the operation of a series of first 

aid points and hospitals along the construction of the 

canal. This experience of managing medical teams 

and resources to delivery emergency care would 

become essential during his service in the Great War. 

Jones was involved in the foundation of several 

orthopaedic and children’s hospitals between 1900 

and 1909, whilst performing surgery at the Royal 

Southern Hospital and maintaining Hugh Owen 

Thomas’ practice after his death. He was an active 

member of the Medical Institution and in 1912 he 

became President. 40 As Major-General and Director of 

Military Orthopaedics, he succeeded in reducing 

mortality of compound leg fractures from 80 per cent 

in 1916 to less than 8 per cent in 1918. 41 

Whilst not all are recorded, the names of fourteen 

Liverpool doctors who were killed on active service 

during the 1914-18 war are remembered on the 

Institution Memorial. 59 Of the members of the 

Institution, more than a third served in the Forces. 42 

Under the Presidency of Hope in 1914, members 

pledged their assistance to colleagues serving, and 

contributed to the education of soldiers in the 

Western Command on venereal disease. 43 Professor 

Edward Hope (1856-1951) was Medical Officer of 

Health for Liverpool from 1894-1924. During his 30 

years tenure of office he established child welfare 

clinics, tuberculosis and venereal disease clinics and 

worked to eradicate slum conditions within the city. 44 

A regular attendee at the Institution, he frequently 

brought such public health issues to the attention of 

the members, often resulting in influential petitions 

to local or national authorities. 45 

Among the most moving contributions to the war 

effort is the record of Noel Chavasse (1884-1917). 

Chavasse studied at Oxford and represented Great 

Britain in the 1908 Olympic Games. He qualified in 

Liverpool serving as a house surgeon under Robert 

Jones at the Royal Southern Hospital. At the onset of 

war he was called to serve in France as a Regimental 

Medical Officer, during which time he was awarded 

the Military Cross in 1915 and the Victoria Cross in 

1916. Despite being seriously wounded himself, on 

July 31st 1917 Chavasse continued to brave a sustained 

enemy action to rescue injured comrades from the 

field and attend to their wounds. After sustaining a 

second wound, he died in hospital on August 4th, and 

was posthumously awarded a bar to the VC, a 

decoration only received by three individuals to date. 

In the inter-war period, the membership flourished 

but the years of economic depression brought no 

further innovations, saving a renovation of the 

building in the 1930s. 46 The Institution weathered the 

blitz years of the Second World War with a reduced 

programme of meetings and the removal of more 

valuable items to Ruthin Castle in North Wales. 

Miraculously the Institution building survived the 

bombings, if not entirely unscathed. Some damage to 

the windows, doors and roof caused by a nearby 

bomb is recorded in May 1941. Keith Monsarrat 

(1872-1968), who had been Dean of the Faculty of 

Medicine of the University of Liverpool 1908-14, 

organised the Emergency Medical Services in the 

Liverpool region from an office in the Medical 

Institution during World War Two. The year 1957 was 

notable for the inauguration of the first female 

President, Dr Margaret Thomas. 47 

On August 8th 1964, in the thirteenth year of the 

reign of Elizabeth II, the Institution was incorporated 

by Royal Charter. The Charter is still in force, and 

14


reiterates the Objects of the Institution: ‘…..the 

cultivation of Medicine, Surgery and the collateral 

branches of Science, exclusively, together with the 

maintenance of a library’. 

By the end of the 1950s, it had become clear that the 

Institution faced problems accommodating increasing 

amounts of library stock, members and specialist 

societies. The problem was solved with the purchase 

of land occupied by several houses on Mount Pleasant. 

These were demolished to make way for an extension 

complete with basement archive. On October 28th, 

1966, the new extension was opened by HRH The 

Princess Margaret. Lord Cohen of Birkenhead gave an 

oration commenting on the work of the Institution 

that, ‘here the opportunity has been offered to 

hundreds, nay thousands of doctors, to translate into 

practice Plato’s dictum that education is a lifelong 

business’. 48 

More recent developments in medicine involve such 

members of the Institution as Professor Sir Cyril Clarke 

(1907-2000) and Dr Ronald Finn (1930-2004) who were 

responsible for developing a method for preventing 

rhesus haemolytic disease in newborn babies - one of 

the major advances in preventative medicine of the 

latter half of the Twentieth Century. Professor Cecil 

Gray (1913-2008) developed the ‘Mersey Method’ 

which established modern methods of anaesthesia. 49 

In 2007 a room in the Institution was dedicated to his 

memory. 

Current members of the Institution include Professor 

Averil Mansfield CBE and Professor Sir David 

Weatherall. The latter is a physician and researcher in 

molecular genetics, haematology and clinical medicine. 

He founded the Institute of Molecular Medicine in 

1989 and was the recipient of the 2003 William Allan 

Award of the American Society of Human Genetics. He 

returned to the Institution in November 2011 to lecture 

on the history and future prospects of molecular 

medicine. His portrait, completed in 2011, hangs in the 

Oak Study of the Institution. 

Professor Mansfield was the UK’s first female Professor 

of Surgery at St Mary’s/Imperial College in 1993. A 

graduate of Liverpool University, specialising in 

vascular and stroke prevention surgery, she succeeded 

Mr Felix Eastcott, who had carried out the first carotid 

artery reconstruction in the world. 

After a further major refurbishment with the aid of 

Heritage Lottery funding, on November 11th 1998 the 

Institution was re-opened by The Princess Royal. Today, 

the Institution is a Registered Charity, and continues to 

serve the purposes for which it was founded, adapting 

itself to meet the various challenges of the times. It 

exists to foster an environment for furthering medical 

educational and knowledge - undergraduate, post 

graduate and across all specialities. 

It is also a grand venue for scientific and social 

meetings and in recent years has expanded to become 

a Meetings Industry Association accredited conference 

centre, playing host to events and conferences for 

postgraduate education in the medical and allied 

professions, local, national and international. More 

recently, the Institution has opened for several public 

Heritage Open Days and tours of the building. 

Our challenge is to ensure that the LMI stays relevant 

to medicine in modern times whilst preserving its 

priceless heritage, and to provide a place for medical 

communities to meet, network and discuss professional 

issues, to facilitate the growth of medicine in 

Merseyside and beyond. 

Miss Sam Pickup, Manager, 


Acknowledgement 

This article owes much to the spoken and written 

words of Mair Pierce-Moulton and Adrienne Mayers, 

LMI Librarians, and the works of countless chroniclers 

over the years. 

Bibliography: 

Books: 

Bickerton, T.H., ‘A Medical History of Liverpool from 

the Earliest Days to the Year 1920: From the Data 

Collected by the Late Thomas H Bickerton, Ch.M, 

Liverpool, FRCS, England’, John Murray, London, 1936. 

Elwood, W.J. (Ed) ‘Some Manchester Doctors: A 

Biographical Collection to Mark the 150th Anniversary 

of the Manchester Medical Society 1834 - 1984’, 

Manchester University Press, Manchester, 1984. 

Seager, T., ‘The Founding of the Liverpool Medical 

Institution’, Liverpool, 1978. 

Shepherd, J.A., ‘A History of the Liverpool Medical 

Institution’, Bemrose Press, Chester, 1979. 

15


Articles: 

Sanderson, G., ‘A Note on the Liverpool Medical 

Institution’, Medical History. 1972 October: Vol. 16(4): 

pp.383-386. 

Halliday, S., ‘Duncan of Liverpool: Britain’s First 

Medical Officer’, Journal of Medical Biography, 2003 

August: Vol. 11:pp. 142-149. 

Pierce-Moulton, M., ‘Some Notable Members of the 

Liverpool Medical Institution’, LMI Transactions & 

Report, 2007-2008: pp. 78-79. 

Notes 

1 

‘Extension of City Premises: £35,000 needed for 

Medical Institution, Liverpool Daily Post, Monday 

Jan 14, 1963. 

2 

Seager, T., The Founding of the Liverpool Medical 

Institution, Liverpool, 1978, p.1. 

3 

Shepherd, J.A., A History of the Liverpool Medical 

Institution, Bemrose Press, Chester, 1979. p.8. 

4 

Op. Cit., p. 22. 

5 

Op. Cit., pp. 10-11 

6 

Elwood, W.J., (Ed) & Tuxford, A.F., (Ed) Some 

Manchester Doctors: A Biographical Collection to 

Mark the 150th Anniversary of the Manchester 

Medical Society 1834 - 1984, Manchester University 

Press, 1984, p. 46. 

7 

Bickerton, T.H., A Medical History of Liverpool from 

the Earliest Days to the Year 1920: From the Data 

Collected by the Late Thomas H Bickerton, Ch.M, 

Liverpool, FRCS, England, John Murray, London, 

1936, p.11 

8 

Shepherd, J.A., History of the Liverpool Medical 

Institution, p.14. 

9 

Op. Cit., pp. 14-15. 

10 

Bickerton, T.H., A Medical History of Liverpool, 

p.63; Shepherd, J.A., History of the Liverpool 

Medical Institution, p.25. 

11 



12 

Op. Cit., p.16. 

13 


p.63. 

14 

Op. Cit., p.64. 

15 


Institution’, Medical History. 1972 October: Vol. 

16(4), p. 384: Shepherd, J.A., History of the 

Liverpool Medical Institution, pp. 29-30. 

16 


Institution, pp. 23-24. 

17 


p.62. 

18 

Op. Cit., pp.62-63. 

19 



20 


p.63. 

21 


Institution’, p.384. 

22 


p.64; Shepherd, J.A., History of the Liverpool 

Medical Institution, p. 29. 

23 


Institution’, p.384. 

24 


p.64. 

25 

Op. Cit., p.69. 

26 

Op. Cit., p. 66. 

27 


Institution’, p. 383. 

28 

Bickerton, T.H., A Medical History of Liverpool, pp. 

68-69. 

29 

Op. Cit., pp. 77-84. 

30 

Op. Cit., pp. 88-89. 

31 



32 

Halliday, S., ‘Duncan of Liverpool: Britain’s First 

Medical Officer’ Journal of Medical Biography, 

2003 August: Vol. 11: pp. 142-3. 

33 



34 

Halliday, S., ‘Duncan of Liverpool’: p.144. 

35 

Op. Cit., p.145 

36 

Op. Cit., p. 144 

37 



38 

Op. Cit., pp. 159-61. 

39 

Op. Cit., p.232. 

40 

Op. Cit., pp. 231-232. 

41 


Liverpool Medical Institution’, LMI Transactions & 

Report, 2007-2008: p.78. 

42 


Institution, p. 223-224. 

43 

Op. Cit., pp. 197-198. 

44 

Op. Cit., pp. 232-233. 

45 

Op. Cit., p.167. 

46 

Op. Cit., p. 201. 

47 

Op. Cit., p. 245-247. 

48 


Institution’, p. 386. 

49 


Liverpool Medical Institution’, p.79. 

16


‘In Pursuit of the Inoperable’ 

The Inaugural Address of the 174th Session of the Liverpool Medical Institution 

Thursday 25th October 2012 

By: The President - Mr Roger Franks 

The retiring President, Sir Ian Gilmore, opened the 

Inaugural Meeting of the 174th Session of the 

Liverpool Medical Institution. Sir Ian thanked the 

members present for their support in his year of office 

and proposed a most sincere vote of thanks to the 

Liverpool Medical Institution staff for their help, 

guidance and support throughout the year and 

proposed a formal vote of thanks to this effect. This 

was carried unanimously. 

occasions and to bomb disposal for its team approach 

when going well and individual responsibility when 

going less well and also for the potential for the 

significantly devastating effect (though not physically) 

when not successful as there were few half measures 

with the success. 

Sir Ian then introduced his successor, Mr Roger Franks, 

about to retire Cardiothoracic Surgeon at Alder Hey 

with some biographical notes. He then invested Mr 

Franks with the Presidential ‘gong’. 

Mr Franks thanked Sir Ian for his kind remarks of 

introduction and presented Sir Ian with the Past 

President’s badge in thanking Sir Ian for his 

stewardship over the last year. Mr Franks suggested 

that it be regarded as a lasting token of the 

organisation’s appreciation and thanks for his services 

in the last year. Mr Franks went on to congratulate Sir 

Ian on the quality and breadth of his programme. He 

commented that he was pleased finally to meet Sir 

Peter Rubin, Chairman of the GMC, to which 

organisation he had been referred on more than one 

occasion, though through the intervention of the 

filtering system and the MDU, never had the 

opportunity of meeting Sir Peter and it had been a 

pleasure to meet him under more relaxed 

circumstances. 

Mr Franks briefly outlined the programme for the 

coming year, in particular over the next two months, 

looking at the implications of the recent Health and 

Social Care Bill which dramatically changed the 

methods of service provision in the health service. This 

would be looked at from various different angles. 

Mr Franks added a few more biographical notes to Sir 

Ian’s introduction saying that he had been born in 

Kent and had worked as a cardiothoracic surgeon in 

New Zealand and in Liverpool at Alder Hey. He briefly 

likened the surgery of congenital heart disease to a 

combination of watch making, for its scale on 

The contents of the chest had been held in awe and 

revered by most civilisations, presumably from the 

knowledge of what happens when it is interfered 

with. The South Americans offered the heart still 

beating to the deities in very dramatic ceremonies. 

Prior to that the Greek and Roman civilisations knew 

that it stopped if interfered with but some earlier 

observations were more sophisticated than that and 

there was a realisation that its function was not 

necessarily impaired straight away but would be 

sooner or later. Epamonidas was a Greek statesman, 

general and strategist and he was felled by a spear at 

Mantinea and (to read from a contemporary account) 

“was brought yet living to the camp and when the 

physicians that were sent for told him that he would 

certainly die as soon as the dart was withdrawn from 

17


his body he was not at all daunted, but first calling for 

his armour bearer he asked whether his shield was 

safe. The armour bearer said that it was and showed 

it to him. He then enquired which side had won the 

day. The youth made the answer that the Beotians 

were the victors, ‘why then’ he said ‘now is the time to 

die’ and forthwith ordered the dart to be drawn out 

and so upon drawing out the head of the dart, he 

quietly breathed his last”. It was not entirely true that 

his side had won the day, this is one of the few 

recorded battles that ended as a draw. 

powers of cosmic energy. Whilst probably a charlatan, 

he did lay down the rules of hypnosis and in 1810 

Squire Ward amputated a leg under hypnosis. James 

Esdaile did over one hundred operations in India 

under hypnosis but he could not get it to work at all 

when he retired to his native Scotland. 

A breakthrough came with the discovery of nitrous 

oxide and chloroform by Humphry Davy in 1830, thus 

making a great deal more surgery realistic and 

possible. In 1846 Morton and Wells in Boston gave the 

first true anaesthetic for surgery as recorded in this 

well known picture. 

On the whole however, people stayed clear of the 

chest whilst being quite happy to open the head to let 

out evil humours for whatever reason. That said 

history does contain references to quite simple 

observations that not all succumbed. Hippocrates 

knew that an empyema could be drained with 

survival. One Jason Phalareus was told he had an 

inoperable tumour of the chest. He resolved to die 

gloriously in battle, not ingloriously in bed, so he 

found a convenient battle, rushed onto the point of 

the sword and, it is recorded, thick pus mingled with 

blood poured forth and he felt much better and made 

a full recovery from his inoperable tumour, in fact 

empyema necessitatis. The inoperable thus overcome 

by a mixture of pride and patriotism though this is not 

necessarily a reliable strategy. 

2000 years elapsed before more serious attempts were 

made. In 1649, John Riolan, a naturalist and 

contemporary of William Harvey, advocated tapping 

a pericardial effusion by trephining the sternum. He 

didn’t do it. In 1798 someone tried and missed and 

aspirated the pleura. In 1819 the first successful 

pericardium was performed. 

I suppose to be fair, anaesthetics left a bit to be 

desired. Hashish, mandrake, opium, and alcohol had 

all been tried and found wanting. Hypnosis had a 

vogue when Mesmer said he had harnessed the 

To make much progress within the chest, control of 

the ventilation is required. Success with empyema and 

effusions relied entirely on adhesions preventing 

pulmonary collapse. Artificial ventilation was first 

recorded by the prophet Elijah who breathed into the 

mouth of the widow’s child by way of resuscitation. 

Vesalius postulated positive pressure ventilation in the 

16th Century and used it for animal work. Paracelsus 

18


talked about it using fire bellows and Duval used it for 

animal work via a tracheostomy. In 1893 Eisenmenger 

invented a cuffed endotracheal tube and George Fell 

invented a bellows ventilator and a chap called 

O’Dwyer brought these two together in 1896 into a 

form which now begins to look recognisable. 

It was apparent though that two sides were beginning 

to develop but unfortunately with the likes of Billroth 

against progress it was not surprising that this was 

slow. 

Until this time the major challenge had been injuries, 

stabbings, but not everyone was in favour of making 

an attempt at surgical repair. The famous Billroth in 

1893 (he of gastrectomy fame) dismissed attempts of 

surgery of the heart as “little short of madness” and 

suggested that those who attempted it should “lose 

the respect of their colleagues”. In 1895, two years 

later, an Italian called deVecchio incised and sutured 

successfully the heart of an animal. In the same year 

Axel Capelin sutured the heart of a stabbed 24 year 

old. He died of sepsis later. Again in Italy, Guido Farina 

tried but his patient died of pneumonia many days 

later but his heart was found to be healed perfectly at 

post mortem. 

Success finally attended Ludwig Rehn, professor of 

surgery in Frankfurt in 1896, three years after Billroth 

told them not to do it. Ludwig Rehn later became 

famous for his work on cancer in aniline dye workers 

but despite this success resistance did not abate. 

Stephen Paget, son of famous James Paget, said he 

thought that surgery of the heart had gone as far as 

it could. Clearly a chap who mistook the blue painted 

inside of the lid of the box for a blue sky. 

Let us travel forward a number of years. 

The persistent arterial duct (PDA) is the second most 

common cardiac condition. In 1907 Munro in Boston 

suggested that it would be beneficial to close a PDA 

and described how to do it via a sternotomy. He had 

anaesthesia (1846), he had artificial ventilation (1896), 

he had blood transfusion (1900). He didn’t do it. In 

1927 the same possibility was raised in Stanford but 

the local luminaries suggested that the mortality risk 

was too high so the patient died without operation. 

In 1932 the possibility was raised again in a young 

woman with severe right heart failure and the 

possibility of closing the duct was to be dismissed 

again locally as nonsense. In 1935 McIntosh, Professor 

of Paediatrics in New York said attempts would be 

disastrous. It was not clear what he thought would 

happen to the patient otherwise. Unknown to him, 

Humphreys and Moore, doing some work on oxygen 

saturation in dogs, found that one dog had a 

persistent arterial duct. Unwilling to waste their dog 

and their experiment, they tied the duct and got on 

entirely uneventfully. In 1937, Streider and Graybiel, 

who had heard Munro 30 years previously, did it. 

Their patient died sometime later of a non cardiac 

cause. In 1938, Gross in Boston ligated the duct of a 

seven year old. Endocarditis he thought might make it 

inoperable and indeed it still makes it difficult and 

relatively dangerous. In 1939 Oswald Tubbs under 

somewhat similar circumstances ligated the duct after 

pre treatment with sulphonamides. Both Gross and 

Tubbs were successful. The inoperable is thus 

overcome, closure of the persistent arterial duct is now 

a simple straight forward operation taking 25 

minutes. 

19


about how to do it but not unsurprisingly could not 

find anyone to help him. It was not until 1914 that 

Alexis Carrell and Theodor Tuffier managed it by 

invaginating the outer wall of the left atrium and 

stretching up the tight mitral orifice. 

Let us look at the mitral valve. Rheumatic Fever, 

common in time gone by, may result in a grossly 

thickened, stenotic mitral valve. In 1890, Arbuthnot 

Lane, an abdominal surgeon at Guy’s Hospital, author 

of papers on constipation, middle ear saturation and 

an advocate of screws and plates for fractures, 

suggested the possibility of dilatation of the stenotic 

valve. In 1893, you will remember, Paget had said 

enough was enough. In 1897 a chap called Samway, a 

physician, gave rather more encouragement 

suggesting that “with the progress of cardiac surgery 

the severest cases of mitral stenosis will be relieved”. 

However the great Sir James Mackenzie was nearer to 

Billroth in his opinions of cardiac surgery. Whilst 

achieving very important work on heart rhythm, pulse 

and inventing a polygraph and founding a golf club, 

Mackenzie felt “it would be a pity if surgeons ever 

found a way of operating on this untouchable organ”. 

Alexis Carrell was an interesting chap. His mother was 

an embroidress and when he was called upon to repair 

the assassinated French president’s torn portal vein he 

went to an embroiderer for advice on how it might be 

repaired. He has also suggested a controlled trial after 

seeing healing at Lourdes, he was an enthusiastic 

eugenicist with strong views on the treatment of the 

insane and criminals, and finally migrated to the 

United States to breed cattle. He did do a lot of early 

cell culture work at the Rockefeller Institute and 

succeeded in preserving blood vessels. 

In 1923 Cutler and Levine attacked the stenotic mitral 

valve with a long thin tenotomy knife passed through 

the atrial wall. They were successful with their first 

few patients but latterly, presumably became more 

enthusiastic, and caused a lot of regurgitation and 

gave up. At last Paget and Mackenzie’s inoperable 

mitral valve was now becoming a little more operable 

and in 1925 Sir Henry Souttar, from the Middlesex 

Hospital, pushed his finger through the stenotic mitral 

valve and dilated it up through a purse-string in the 

atrium. Sir Henry Souttar died in 1961 with the 

justifiable claim that he was the only cardiac surgeon 

never to have had an operative death, that being his 

sole cardiac operation. Oswald Tubbs made the whole 

operation a great deal easier by the invention of his 

mitral valve dilator which still finds occasional use 

today. 

Despite all this however in 1902, Lauder Brunton, a 

physician at St Bartholomew’s Hospital, did some 

experimental work and made helpful suggestions 

Let us consider congenital heart disease. As we move 

through the 1940s and 50s the establishment was 

becoming a little less discouraging and even on 

occasions positively encouraging. 

20


Tetralogy of Fallot was first described by Etienne Fallot 

in 1880 in which era, like most congenital heart 

disease, you died of it. 

In 1942 Helen Taussig had observed that those with 

Tetralogy of Fallot and a persistent arterial duct did 

rather better and so Alfred Blalock constructed an 

artificial duct, borrowing the subclavian artery and 

turning it down into the pulmonary artery with good 

effect and others, Waterston and Potts invented 

similar alternatives. But these are only represented 

palliation. By 1947 Brock and Holmes Sellors had 

much the same idea and invented a punch to chip out 

the tight right ventricular outflow of the Fallot’s 

Tetralogy. This works well causing Brock to announce 

that he had cured congenital heart disease. 

Something of an overstatement but what a long way 

from Billroth. 

consequence surgical techniques but without a market 

volume none of this could have happened. 

But not everything could be overcome with money 

and in particular anatomists, morphologists, 

physiologists have made colossal contributions to the 

understanding of congenital heart disease with 

improvements in surgery and post operative care. 

Despite the current trend in the opposite direction 

there is a continuing need for post mortem studies for 

better understanding of anatomy, micro-anatomy and 

thus physiology, and thus much improved pre 

operative preparation and post operative care. 

The hypo-plastic left heart remained a terminal 

condition until recently. Then with the careful study 

of the anatomy Norwood came up with his operation 

and initially only he could get it to work and the only 

alternative was transplantation, but gradually with 

better pre-operative preparation and case selection 

and post operative care and through communication 

and practice and perseverance, the previously 

inoperable condition now has a reasonable chance of 

success. Interestingly when Norwood himself moved 

from one centre to another it took him some time to 

re-establish his previous levels of success but the 

initially inoperable has become operable in this 

instance by many interlinking factors. 

All that we have discussed thus far is closed heart 

surgery and no real progress was made until the heart 

could be stopped and this required the need for an 

alternative. Initially, alternative circulation was 

provided by the cross circulation with someone else. 

A difficult and dangerous procedure for two people. 

Early heart lung machines were cumbersome and 

probably equally dangerous but with the commercial 

realisation that money was to be made, huge 

developments occurred in the design and 

manufacture of heart lung machines and much the 

same with artificial valve substitutes. Research into 

metals and all that in parallel with improved surgical 

instruments and suture materials and as a 

Good results come from experience. Experience comes 

from bad results and the treatment of a hypo plastic 

left heart certainly bears out this aphorism. 

Transposition of the great arteries went through 

similar difficulties. In the 1950s and 60s it was certain 

death. Various people had tried various extra cardiac 

procedures, largely palliative, and then in the 1970s 

Bill Mustard in Toronto came up with a very creative 

way of diverting the blood within the heart to achieve 

a more satisfactory circulation. Senning from Sweden 

came up with a similar procedure. A condition which 

previously carried a very high mortality in the 

neonatal period with only occasional patients 

21


surviving for palliation could now be treated with a 2- 

3% mortality. Mustard and Senning’s operations were 

not ideal because they left the right ventricle 

providing the systemic circulation but it was usually 

able to do that for twenty or so years. Failure after 

that usually meant transplantation but in the early 

1980s Jatene came up with the arterial switch 

operation, transferring the main aorta and pulmonary 

artery as they leave the heart. This anatomical 

correction was simply not possible before; suture 

materials were not up to it, but with industrial 

quantities of coronary artery disease and the semi 

microsurgical techniques involved, dividing and reanastomosing 

neonatal coronary arteries and aortas 

became possible. Money comes into it again in 

practice, and experience from other areas. But 

another problem reared its head. If you could carry 

out a Mustard or Senning procedure at 3% mortality, 

how do you persuade yourself and others to convert 

to switch operation which inevitably initially carries a 

20% mortality though its long term outlook is much 

improved? The anatomical correction, the switch 

operation, can now be achieved at a less than 5% 

mortality. 

the lungs and that state can prevail successfully for a 

number of years, but remains palliative. 

Francis Fontan from Bordeaux noted that these 

patients tended to have hypertrophied right atrium 

and he joined that hypertrophied right atrium directly 

to the lungs in the expectation that it would be 

capable of pumping blood to the lungs as would a 

right ventricle. This works. He established ten 

commandments, he underlined conditions by which 

the operation will function best, and it became a 

successful procedure. A semi artificial ventricle for the 

lungs had been created where one previously did not 

exist. Rather unsurprisingly with the widening of the 

operative criteria it worked less well and then, in the 

1980s, Marc deLaval from Great Ormond Street took a 

closer look and he discovered by angiography that the 

muscular right atrium does pump but most of the 

blood goes backward when it does and that a majority 

of the forward motion of the blood is provided when 

the intra-thoracic pressure is negative, ie, on 

inspiration. He suggested significant modifications to 

the operation with much improved outcome for many 

more patients than previously had been possible. 

Science and research, properly focussed on the 

problem, achieving that success. 

Let us transfer our thoughts to the heart which has 

only a single ventricle. These folk are committed to a 

life of that which is known as common mixing. That 

works well in a frog but frogs are not capable of 

sustained exercise and most children want to do that. 

Precautions must be taken initially that there is 

sufficient but not too much blood or pressure reaching 

Over the years we have seen some making very 

determined efforts to push progress along while 

others not exactly opposing it, not rarely helping. 

Improvements in ultrasound had enabled anatomy to 

be fairly accurately established at about 20 weeks of 

pregnancy and this in turn opens the possibility that 

22


where anatomy is not compatible with life, and some 

things are still incompatible, thought can be given to 

termination or more commonly, better preparation 

for whatever it is at the time of birth. Better 

preparation by good early resuscitation dramatically 

improves the outcomes of surgical repair. 

There have been other difficulties in overcoming the 

inoperable. In 1950 all congenital or acquired cardiac 

defects were inoperable in New Zealand, there was no 

service. Douglas Robb was sent to the United States to 

bring back cardiac surgery to New Zealand. In his 

diaries he wrote that he was ‘flabbergasted by the 

ritual, the aura and what were made to seem like 

insuperable difficulties surrounding this type of work’ 

and was on the verge of returning home. William of 

Ockham had made somewhat similar observations 800 

years previously. He suggested that entities should 

not be multiplied unnecessarily. Nature would in vain 

use more where less will do. Paraphrased, something 

simple is more likely to work than something 

complicated. Douglas Robb went on to another 

centre in Canada where he found things done “simply 

and with good results” and thus cardiac surgery in 

New Zealand got off the ground. The inoperable 

overcome by making it less complicated. 

oxygenators - pure economics. Persistence, courage, 

intuition or was it arrogance of those early mitral 

operations? and a lot of it against considerable 

opposition. 

Medicine has not been alone in overcoming these 

difficulties over the years. Orde Wingate, a long term 

non conformer had said that he would recover a 

strategic point, guarded by more than a thousand 

Italian troops using his 500 irregular soldiers. Those in 

authority said it was ‘inoperable’ and felt that he 

should be relieved of his command for making such 

an outrageous suggestion and sent a message to that 

effect. He turned off his radio and got on with it and 

turned up a week later with the remains of the Italians 

as prisoners. We will need no reminder of how Nelson 

dealt with an instruction to withdraw at the Battle of 

Copenhagen in 1801 although interestingly those who 

sent him the signal did predict that he was likely to 

ignore it. 

So dealing with the inoperable over the years has 

presented many challenges and has owed something 

to many elements; science - Humphrey Davey, logic - 

Marc de Laval, serindipity, skill - Alexis Carrol the 

embroiderer, money - all those valves and sutures and 

Over the years it has been left significantly to 

individuals on many occasions to set a ball rolling, a 

hare running or just do it, to overcome things but 

many actually required a considerable team to provide 

the necessary support. Lord Darzi told us last year of 

the rewards for innovation in the brave new health 

service. I suspect he had management of patients in 

mind, not treatment of the individual patient and he 

may or may not have approved of Russell Brock, he of 

tetralogy and mitral valve surgery. He was no team 

player but he was an innovator. He did not have 

health and safety or ethics committees, evidence 

based units or political masters to contend with, he 

just did it. Brock proclaimed that ‘by timorous 

meditation we arouse fear and postpone success’ - a 

phrase he might well have borrowed from Isaac Watts 

hymn, ‘There is a land of pure delight’: 

23


‘But timorous mortals start and shrink 

To cross this narrow sea; 

And linger shivering on the brink, 

And fear to launch away. 

Oh! could we make our doubts remove, 

Those gloomy doubts that rise, 

And see the Canaan that we love 

With unbeclouded eyes!’ 

Russel Brock 

24


40th Henry Cohen History of Medicine Lecture 

Delivered on Thursday 29th November 2012 

By Professor Rosalie David, OBE, FRSA, Director KNH Centre for Biomedical 

Egyptology, Faculty of Life Sciences, The University of Manchester 

‘Ancient Egyptian Medicine and Paleopathology: Scientific studies on disease, 

lifestyle and treatment’ 

Left to right: Professor Vikram Jha, Professor Rosalie David and Mr Roger Franks 

We were unfortunately unable to obtain any minutes for this meeting. Professor David’ Power Point Presentation 

is however available either directly from the LMI or on the LMI website member area. 

Professor David was introduced and welcomed to the LMI by the President, Mr Roger Franks. Her presentation 

introduced the audience to Egyptian medicine, including the Egyptian Gods, and the Temples, considered as the 

centres of healing. The art of mummification was discussed and both the Manchester Egyptian Mummy Project 

and the KNH Centre for Biomedical Egyptology work was summarised. 

Dr Bethan Jones 

25


Annual Healthcare Service 

Sunday 28th April 2013 

The 2013 Annual Health Care Service was held at the Liverpool Metropolitan Cathedral on Sunday, April 28th and 

the theme this year was Mental Health. The readings were from Ecclesiasticus chapter 38 and James chapter 5 

and were read by LMI president Mr Roger Franks and retired anaesthetist Dr Raymond Ahearn. Prayers were read 

by senior pupils from St Hilda’s Church of England High School. 

Bishop Vincent Malone gave a brief homily based on the readings. The Ecclesiasticus reading bids the reader 

(verse 1) to “treat the doctor with the honour that is his due, in consideration of his services” but reminds us that 

all healing comes from God who has (verse 4) “brought forth medicinal herbs from the ground”. Certainly we 

can give thanks for the treatments now available for psychiatric disorders and the reduced stigma associated with 

them. However this was brought challengingly into context when Dr Mo Wilkinson, consultant psychiatrist spoke 

movingly about her experience in Malawi, where she was the only psychiatrist in the country. Here she found 

mentally ill patients bound in ropes and mission hospitals with no facilities for the management of mental illness 

– the images were reminiscent of stories from the Gospels themselves. Into this bleak picture she was able to bring 

some hopeful stories – for example, of one seriously ill patient restored through appropriate medication and now 

working in the mental health service himself. 

Dr Wilkinson’s address dovetailed with that of Michael Crilly, Head of Spiritual and Pastoral Care at Merseycare. 

The reading from James reminds us of the value of prayer in the context of illness. Michael Crilly spoke of the 

importance of offering support (including prayer) to patients, relatives, carers, and staff, especially around 

spirituality, faith and religious and pastoral concerns. The service brought a challenge to all in health care, not 

just those specifically involved in mental health and was set in the context of beautiful choral singing. 

Dr Alan Fryer 

26


Minutes of the Ordinary Meetings of the 174th Session 

and details of Social Events 

Minutes of the First Ordinary Meeting 

Held on Thursday 1st November 2012 

‘Where is the NHS Going?’ Series Part 1 

‘The End of the NHS’ 

Professor Allyson Pollock, Professor of Public Health, Research and Policy, 

Centres of Primary Care and Public Health, Queen Mary University of London 

Mr Roger Franks and Professor Allyson Pollock 

Professor Pollock was introduced by Dr Andrea Franks. 

After medical training in Dundee, Professor Pollock 

trained in public health in London where she became 

head of the Health Policy Unit at University College 

London before moving to Edinburgh University where 

she set up and directed the Centre for International 

Public Health Policy. She returned to London in 2011. 

In the 1990s she and colleagues researched the Private 

Finance Initiative. She was asked to give evidence on 

this to the Parliamentary Health Select Committee but 

when she showed that PFI would be financially 

disastrous (which they did not want to hear) there 

were disgraceful attempts to discredit her work and 

threats to her funding. 

Professor Pollock has always been a fierce critic of NHS 

privatisation and her 2004 book ‘NHS Plc’ prophesised 

all too accurately the steps which would be taken to 

destroy this vital public service. 

She has published numerous articles in the BMJ and 

elsewhere, has lectured widely in the UK and overseas 

and has appeared a number of times on radio and on 

television. 

Professor Pollock began by asking the large audience 

how many realised the NHS in England would end on 

March 31st 2013. About half raised their hands. 

In the last two or three years it has often been said 

that the NHS is unaffordable without “reform”. 

Professor Pollock put this in perspective by pointing 

27


out that the UK expenditure on healthcare, as a 

percentage of GDP, is still less than the European 

average in spite of significant and much needed 

increases under the last Labour government. At nearly 

10% of GDP it is lower than the 12% spent by France 

and Germany. US healthcare, at 18% of GDP, is the 

most expensive in the world, even though over sixty 

million people are without any health insurance. 

Under-insurance and medical debt are extremely 

widespread and health bills are the commonest cause 

of bankruptcy even though most of those affected are 

insured. 

Why is US healthcare so expensive? Many of the 

corporations providing health care are “for profits”, 

with very well paid senior management. The interests 

of shareholders are prioritised and in many cases this 

has led to very serious fraud including one instance in 

which 43% of a series of angioplasties were found to 

have been performed unnecessarily. The 

administrative costs of dealing with numerous 

providers are also extremely high. 

The NHS was set up in 1948 on the basis of universality 

and equity, service planning and the assessment of 

population need. Services were integrated, with no 

market mechanism, and were allocated as fairly as 

possible. The whole population was covered. By 

contrast, US healthcare is organised as a market. 

Organisations see it as important to identify and to 

predict the risk of caring for expensive patients and 

demand a premium for taking them on. Inevitably, 

some groups of patients are not covered or have care 

denied. Worldwide experience has repeatedly shown 

that a competitive healthcare market increases costs 

because of higher administrative charges, fraud and 

company profit. It also results in overtreatment, overinvestigation 

(e.g. unnecessary scans and blood tests) 

and inappropriate treatment, loss of innovation and 

increase in inequalities. Private providers cherry-pick 

by selecting patients with few co-morbidities, who 

require simple procedures, while avoiding other more 

expensive patients who need more complex care. 

Providers increase profits by coding the patient in the 

most lucrative way possible (for instance exaggerating 

the severity of a condition) and they also restrict 

entitlement to care. Additional charges may be 

introduced and patients encouraged to take out topup 

insurance. 

Figures from 2010 show that in the UK only 15% of 

healthcare costs were spent privately, considerably less 

than other European countries such as Spain, Italy, 

France and Germany. Most UK healthcare is publically 

funded at present. In the US, just over half of 

healthcare spending is public with very high levels of 

private spending. Professor Pollock pointed out that 

in spite of the enormous costs of US health care, 

women in the USA have a higher risk of dying of 

pregnancy-related complications than those in forty 

other countries. The likelihood of a woman dying 

during childbirth in the USA is five times greater than 

in Greece, four times greater than in Germany and 

three times greater than in Spain, with particular 

problems for African-American women. 

The Health and Social Care Act is going to bring 

massive and fundamental changes to UK healthcare. 

From April 1st this year the Secretary of State will no 

longer have a duty to provide comprehensive care and 

will no longer have to ensure services are free at the 

point of delivery or prohibit charges for patients. 

Widespread commercial competition is to be 

introduced and GP consortiums will not be obliged to 

provide a comprehensive service. The consortium will 

behave as an insurer and is likely to favour low risk 

patients and avoid those with greater need for 

healthcare while imposing increasing co-payments, 

restriction of treatments and time limits on care. 

The new structures arising after the Health and Social 

Care Act are much more complicated than before and 

effectively end the National Health Service in England. 

Professor Pollock outlined the stages of privatisation 

that had achieved this. The first stage had been the 

introduction of managerial structures in 1979, 

followed by the internal market and purchaseprovider 

split in 1991, a change that in Scotland was 

reversed by the Scottish Government. From 1992 

onwards, PFI funding was proposed and has been 

widely used, causing insuperable financial problems 

for many hospitals because of the greatly increased 

costs. Non clinical services were increasingly 

outsourced and privatised. From 2000 onwards, under 

the NHS plan, clinical services began to be privatised. 

Hospitals became foundation trusts which were 

obliged to act more or less as businesses while clinical 

work was given to numerous private sector 

organisations, independent sector treatment centres 

and community services. This process has culminated 

in the Health and Social Care Act which will end the 

NHS in England on April 1st 2013. The Secretary of 

State will no longer be required to provide free 

comprehensive healthcare for all and charges may be 

levied for NHS services. Commissioning groups will be 

28


required to put services out to tender to ‘any willing 

provider’ making it difficult or impossible to plan 

services in a locality, as has been the case in the past. 

In hospitals up to 49% of beds may be used for private 

treatments, a change which will result in a two tier 

service and will widen inequalities. Professor Pollock 

mentioned work by Wilkinson and Pickett in their 

book, ‘The Spirit Level’, which showed the worsening 

of numerous health and social problems resulting 

from increasing income inequality between the richest 

and the poorest in the society, whether that society 

was rich or poor. 

Professor Pollock ended by summing up why publicprivate 

partnership, provision of essential public 

services by a marketised private sector, does not work. 

Risk selection is fundamental as private sector 

providers may deny care to patients with expensive or 

complex conditions. Such patients may be unable to 

access care or be burdened by substantial user charges. 

When profit is the prime motive for running a service, 

over-treatment, inappropriate treatment and fraud 

are inevitable. All this significantly increases overall 

costs, as does the increased burden of bureaucracy in 

a much more complex service. 

This talk was followed by considerable discussion. A 

number of members of the audience asked Professor 

Pollock what they were to do. She advocated joining 

groups, which have been attempting to influence the 

Act and its implementation, such as Keep our NHS 

Public, NHS Support Federation or the NHS 

Consultants Association. Overall however, the outlook 

for the English health service remains deeply worrying 

as the NHS is being pushed inexorably towards a USstyle 

market system. 

Dr Andrea Franks 

29


Minutes of the Second Ordinary Meeting 

Held on Thursday 8th November 2012 


‘Reformation or Rehabilitation?’ 

Dr James Kingsland, National Commissioning Lead 

The President welcomed the audience and introduced 

the speaker. Dr Kingsland is a GP from a practice in 

Wallasey and is the National Lead for Commissioning. 

His own practice has received several awards for 

innovation. He has served as an advisor to Lord Darzi, 

GP advisor to the Department of Health, member of 

the National Leadership Network, the NICE 

Commissioning Steering Group, the Care Quality 

Commission Stakeholders’ Committee and Dr Foster’s 

Ethics Committee. He has been Chairman and 

President of the National Association of Primary Care 

and is currently a non-executive Director of 

Clatterbridge Hospital, Primary Care Advisor to the 

Wirral Teaching Hospital Group, Undergraduate Tutor 

to the Liverpool Medical School and University College 

Hospital, London. He is a former Vice-Chairman of the 

Wirral Health Authority, Non-Executive Director of the 

Family Health Services Authority and of the Wirral 

Local Medical Committee. He is also the resident 

doctor for BBC Radio Merseyside. He was appointed 

an OBE in last year’s New Year’s Honours List. 

Dr Kingsland commenced by saying that he also had a 

wife and children somewhere in his spare time. His 

father, Charles Kingsland, was a gynaecologist at the 

Liverpool Women’s Hospital. He is a Liverpool 

graduate (1984) and has always aspired to give a 

lecture at the LMI. The changes which will occur will 

be the largest and most wide-ranging changes to the 

NHS since its inception in 1948. The lecture would 

attempt to give an overview of these changes. 

However, firstly it was necessary to consider why 

change was needed. The existing NHS structure has 

been put under pressure by the demographics of the 

ageing population, the increasing cost of new 

technology and drugs, by the demise of the extended 

family and by the increasing demands of patients. At 

the time the Blair government came to power, the 

need was seen to be better access and shorter waiting 

times. This was brought about by increasing the 

percentage of Gross Domestic Product spent on the 

NHS from 6.5% to the European average of about 

8.7%. At that time the cost of the NHS was £32 billion. 

It took the Blair government six years to introduce its 

reforms. The present government took 60 days to 

announce their proposals. 

The NHS now costs £102 billion annually. Everybody 

agrees that we should put more money into the NHS. 

Nobody wants to pay more tax. With an annual 

increase of about 1% per year and inflation of NHS 

costs of 4.5% per year, we need to save 3.5% per year 

just to stand still. The reforms aim to improve patient 

services, improve access and improve outcomes. Our 

social care system is means tested. Some are now 

looking at how the NHS which is “free to all at the 

point of access” could follow that pattern. If we don’t 

increase productivity we will be having a very 

different debate in 2015 about the viability of the NHS 

in its current form. 

Over the last ten years we have seen no real 

improvements in health inequalities and survival rates. 

If you lived in Birkenhead ten years after Primary Care 

Trusts (the current funding mechanism) were created, 

you were going to die earlier than you did ten years 

before. There was a sense that this enormous 

investment of public funds had to have some better 

outcomes for patients. Clinicians who currently refer 

patients will drive this. Referral to a hospital is a 

commissioning act. But commissioning is not the sole 

province of GPs so the commissioning organisations 

are now called Clinical Commissioning Groups or CCGs. 

They are self-selecting and will be the statutory bodies 

holding the public purse. There will be 211 CCGs in 

England. Our efforts to improve productivity, reduce 

waste, improve efficiency and stop duplication of 

service have been at practice level. CCGs are intended 

to be very different to the PCTs which they replace. 

Just to manage the demographic changes we will 

need to release £20 billion from the current spend, not 

to save, but to use it to finance the increased health 

costs of our ageing population. 

CCGs will have to reform care pathways, have new 

dialogues, and integrate clinical and social needs 

between primary and secondary care. Community 

30


facilities will have to be capable of dealing with earlier 

discharge of patients from hospitals, and be able to 

provide adequate care and services with the aim of 

trying to avoid readmissions. GPs will have to take 

over some of the more mundane hospital work from 

the hospitals, looking after the chronically ill with 

their own multidisciplinary teams and have patients 

seen by consultant only for the occasional difficult 

problem, high tech investigations or operations. 

UCH has looked extensively at its out patients and has 

managed to increase its out patient discharge rate 

from 8% to 15%. They previously had 800,000 out 

patient appointments per year. The reduction has 

been achieved by shifting the review appointments to 

general practice. Some countries in the European 

Union don’t have hospitals with outpatients. 

However, the greatest potential resource in the NHS 

is from its estates. 

Too many people are going to Europe to look at 

insurance-based systems, methods of means testing 

social care. General practices are changing the way 

they work and offering a wider range of services. That 

is the way forward. The old systems of completely 

separated primary and secondary care are inefficient 

and outdated. We need to recognise that this is not 

an adversarial relationship. We need to rebuild joint 

working. 

At this point Dr Kingsland took questions. 

Q: Are you arguing that if these reforms don’t work 

we will end up with something similar to the US 

model? 

A: I hope not but some European systems, eg. those 

of Holland and Sweden include an element of 

payment for some patients. The NHS constitution is 

quite clear that there should be no payment at the 

point of contact, but think tanks are looking at, eg, 

partial means testing. The NHS budget takes almost 

9% of our GDP. We can see what happens in countries 

like Greece where the cost of services has outstripped 

the country’s ability to pay. Unless we are all prepared 

to pay more tax, we either need to become much 

more efficient or change the way that services are 

provided. 

Q: Is a three year training period for GPs sufficient to 

take on all these new activities including differential 

diagnosis? 

A: I am not suggesting that GPs take on all the more 

complex work, just that with a different mind-set, 

hospital admissions can often be avoided and the 

patient treated at home or with earlier hospital 

discharge at a lower cost. 

Q: That was a good answer but you haven’t really 

answered my question. 

A: Treating this patient (a type II diabetic with cellulitis 

of the leg) at home or with early discharge from 

hospital would have saved about £5,000. 

Q: You still haven’t answered my question. You as an 

experienced doctor may have been able to do this but 

would a new GP with three years training at SHO level 

be able to? 

A: This example is not a complex case and if a type II 

diabetic with an acute infection episode cannot be 

dealt with in general practice then I fear for general 

practice. 

Q: What I want to know is does the new scheme of 

doing things include the means of teaching a trainee 

GP to handle these cases with the same expertise that 

you have after twenty years of practice? 

A: The example of a type II diabetic with cellulitis is a 

situation that I would expect a final year medical 

student to be able to handle. If better handling of this 

example would save £5,000, extrapolated across the 

8,300 practices in England, then one such episode per 

week would save £2.16 billion per year. 

Q: Reforms are already in place in the NHS to bring 

about the changes in general practice you advocate. 

Why do we need another complete reorganisation at 

great expense when this could have been done 

through the existing channels? 

A: The government felt that putting clinicians into a 

PCT environment would not change the mindset. 

Q: It is interesting that 25% of CCGs do not include 

GPs. 

A: The figure is more than 25% of CCGs do not have a 

clinician on them, but there are only about two CCGs 

in which the GPs have declined any involvement. 

Q: Yesterday in The Lauries Community Centre in 

Birkenhead there was a gathering of about 250 

31


patients and relatives in an appalling state of panic 

because of the cuts imposed. These are the most 

vulnerable people. I am seeing dramatic changes for 

the worse. 

A: I don’t think the current reforms have led to this 

situation. It has been developing over a long period. 

General practitioners have been able to say “I’m not 

interested in mental health” in a way that they could 

not say over any other branch of medicine. Seventy 

percent of all contacts in primary care have a 

significant mental health aspect. It is not acceptable 

for a GP to say “I don’t do that”. 

Q: It starts in January? 

A: It starts on April Fool’s Day next year. 

Q: What evidence is there that the problems you 

describe can be solved by providing health care 

through the market, and when I say evidence, I’m 

talking about properly conducted studies or reviewed 

articles? 

A: You probably know that the international evidence 

in favour of commissioning is weak. I don’t think we 

have ever had strong evidence for these changes. It’s 

more about opinion and policies and saying “is there 

a better way of doing it?” This reform was based on 

a dialogue over a long period of time between the 

former Secretary of State and the clinical community. 

That lead to his belief that this was how it should be 

done. That is entirely the way that the Health Service 

has been managed - through politics, not through 

evidence. The internal market structure of 1990 was 

a New Zealand model and Margaret Thatcher was 

persuaded that that was the best way to efficiently 

manage the tax payers’ money. The example of 

America could give evidence to the contrary where 

they spend twice the percentage of GDP that we do. 

Q: I wonder if you’ve read the Health Select 

Committee report of just before the last election that 

came to the conclusion that “after 20 years of costly 

failure the internal market should be abolished”? 

A: The BMA has for a long time been trying to get rid 

of the internal market. Whether that would be a 

more efficient system or not is difficult to say. 

Q: The questioner did not accept that “The NHS is safe 

with us.” He thought that health should not be a 

market but a right. The fact that funding is protected 

only for the life of the government is not reassuring. 

A: I wouldn’t disagree with most of what you say, but 

let me make it quite clear again - I’m not the voice 

piece of the government. 

Audience: You are, you are. 

Q: I have travelled extensively and looked at the 

health services in many countries. The Saudi Arabian 

health service is wonderful, but they have the money 

to fund it. Otherwise the best example I have seen is 

the Canadian system of Provincial Insurance in which 

you pay if you can afford it and don’t pay if you can’t. 

I suppose we have to move forwards to something like 

that. 

A: I suppose you are talking about a social care system 

which is based on your means and a health system 

which is free to all. The NHS Constitution is being 

refreshed at the moment but currently none of our 

political parties will even debate a system which is not 

free at the point of contact. 

Q: The NHS has always had to deal with increasing 

demand but I really doubt that there is going to be a 

250% increase in the over 65s in the next ten years. I 

can’t see that allowing firms like Virgin - new entrants 

to the healthcare market - to make money out of the 

NHS will in any way make it more efficient. I’d rather 

the increasing need be dealt with in a health service 

which can evolve and adapt and which is determined 

by the will of the people. 

A: This is something started by the last administration. 

If there is a gap in the service you can bring in new 

entrants eg. Virgin - this amounts now to less than 5% 

of the service. 

The President thanked Dr Kingsland for an interesting, 

informative and enjoyable evening and the meeting 

closed. 

Dr W Taylor 

32


Minutes of the Third Ordinary Meeting 

Held on Thursday 15th November 2012 


‘How to Build a Hospital in a Park’ 

Mrs Louise Shepherd, Chief Executive, Royal Liverpool Children’s Hospital 

Mr R Franks and Mrs L Shepherd 

The President introduced Louise Shepherd, previous 

Chief Executive of the Countess of Chester Hospital, 

Deputy Chief Executive of the Womens’ Hospital, and 

now Chief Executive of Alder Hey Hospital for the past 

four and a half years. In this capacity she is charged 

with rebuilding this Edwardian building at a time of a 

changing NHS environment, repeated reorganisations, 

the advent of PFI and an ongoing credit 

crunch. Mrs Shepherd set out to clarify the convoluted 

pathway that enabled the construction of something 

special that would last into the next century. 

The issue of children’s health dates back two centuries, 

to the early era of Dr Duncan’s Public Health. Indeed, 

Florence Nightingale placed herself at the forefront 

of the design of Alder Hey. Yet much was amiss, 

including great limitations on parental visiting and 

depressing views of bricks and cars through the 

windows; witness today’s liberated freedoms where 

parents are encouraged to support ward staff, even 

sleeping by their child. 

To bring things into the 21st century, much needs to 

change to fit working practices. As it stands, Alder 

Hey will never meet the Disability Discrimination Act 

standards, and there are many structural 

shortcomings, including the lifts, accommodation and 

topography with its quarter of a mile walk from 

Accident and Emergency to the Intensive Therapy Unit 

and Operating theatres, with Radiology lying midway. 

Within Merseyside’s service redesign, covering the 

Royal as well as Alder Hey, the latter was to remain as 

a standalone children’s hospital, to be reconstructed 

within Springwood Park, nearby the current site. A 

strategic case covered buildings design and staffing 

for this new, modern, standalone children’s hospital, 

that would take three and a half years to build, using 

private sector funding and completing in 2007. Yet 

the world was rapidly changing around the design 

team, and Foundation Trust status was rejected in 

2007, bringing the scheme to an abrupt halt. 

33


In 2008, Mrs Shepherd was appointed with the aim of 

creating a Foundation Trust and then moving the 

scheme forwards again. This meant addressing the 

key negative issues: an unaffordable capital cost of 

£350m, against Alder Hey’s £150m turnover and a 

need to meet unitary payments of £35m per annum. 

The turnaround would create a robust Foundation 

Trust that could be considered a serious contender by 

Monitor and the Department of Health, with a 

rational approach and an affordable scheme. This was 

all the more necessary given the background at 

Whiston, moving forward without Monitor’s support 

and becoming unaffordable. 

Alder Hey appointed a project director. The financial 

flexibility and alternative borrowing sources were 

explored and a cash reserve for the ‘deposit’ was 

created. The ideas and views of the children 

themselves were incorporated into the design and the 

floor area was reviewed (the greatest determinant of 

capital cost at £4000/sq m). A computed realistic 

estimate of future activity was made and the scheme 

was separated into three phases (inpatient facility, 

outpatients and education/research). In 2009 the 

scheme cost £260m, of which PFI was £187m, close to 

the ideal of matching income (£170m). 

The views of children were paramount and fed into 

the core principles of functionality, workflow, logical 

and direct routes, and specific needs. Of these, 

uppermost was that the iconic design of this 

‘healthcare’ building would itself aid recovery through 

being sustainable, integrated into the fresh air and 

daylight of the natural parklands around the new site. 

Foundation Trust was endorsed in 2009, followed by a 

public consultation, which received an unprecedented 

7500 responses from the public. Of these more than 

900 were from children, with an emphasis on nature, 

play, health and accessibility to green spaces. Next 

was the selection of a preferred bidder in 2012 with 

building commencing in March 2013 and opening in 

summer 2015. The public park would then be 

reinstated around the new building. 

Balfour Beatty enthusiastically revised their building 

approach in line with the best, child and staff-centric 

design principles and an eye on keen pricing by the 

contract team. One example of their painstaking 

approach is the construction of innovative single 

rooms using sliding glass panels. At the same time, a 

recession, with competition for a dearth of building 

activity, plus falling profit margins, allowed the 

negotiation of a reduction in the floor area costs to 

£3000/sq m. The scheme’s cost had now reduced to 

£227m, with a PFI cost of £157.9m, which had 

suddenly become affordable. 

That £227m had become surmountable due to: £72m 

from the Trust’s cash reserves; access to low 

Government lending rates within the Foundation 

Trust scheme; deriving the PFI from the European 

Investment Bank (£51.5m) plus capital markets 

(another £51.5m); using charitable donations 

(£11.5m); a lower ‘mortgage’ (£12m); revenue at 

£14m; additional unitary (£12m) and FTFF interest 

(£2m); a surplus of £14m. 

After 10 years gestation, work is to start in March 

2013, completing in 2015, after which the PFI 

providers have responsibility for building 

management over the next 30 years, followed by a 

hand back of an ‘as new’ facility. Mrs Shepherd then 

showed us video reconstructions of this ‘hospital in the 

park’, with much grass and trees, a logo designed for 

and by children, and a large atrium into the 21st 

century complex. 

Questions covered the smooth corners of the interior, 

the locked in contract of the PFI consortium to 

maintain a good state of repair, window cleaning 

within contract, and whether PFI was a bad deal for 

the taxpayer. On this point, Alder Hey had negotiated 

with the Treasury to allow payment to commence at 

startup. This ‘pay as you go’ approach saved £21m 

from the public purse. Unlike Peterborough, the 

financial plan had been made to fit within the earning 

capability of the Trust. Perhaps, then, PFI might work 

where budgets have been derived with due care, such 

as invoking the game-changing, ‘pay as you go’ 

argument. Indeed, at present, there is no other game 

in town. Charitable funding is no longer an option, 

though Alder Hey is better placed than most other 

Trusts. PFI is the current means of funding capital 

where there is no longer any NHS capital money. 

Was money pulled out of child-care to feed into PFI? 

The current cost to rebuild Alder Hey was £3-400m. 

The scheme described in this talk seemed affordable in 

comparison. PFI is a different way, but has funded the 

Forth Road bridge and now seems viable for Alder 

Hey. Repayments are fixed at current rates, which are 

beneficial in the current climate. 

How would the PFI company be made to meet their 

obligations? They have 100% stake in the buildings 

34


and in 30 years must hand these back in the same state 

as when they had been completed. This is a new era of 

PFI, but requires great care in drawing up and 

managing the legally binding contract. 

The surplus that Alder Hey had generated was 

discussed. It derived from the unique specialisms 

within paediatrics, which had removed competition 

from surrounding DGHs. This resilience would also 

avoid the financial downside of such competition 

occurring through the commissioning process in the 

future. 

The eco-footprint of the new hospital was questioned. 

This had been an important part of the programme, 

driven by a research postgraduate at John Moores 

University. The buildings were indeed to fall well 

within building standards for CO2 emissions. 

What of staffing levels? A full complement of staff 

was to be fully funded, with increasing specialist staff 

in some areas such as pre-op assessments. Some staff 

reductions were inevitable from natural wastage, 

helping to meet their 4-5% share of Nicholson’s £20b 

‘efficiency savings’. 

The President thanked Mrs Shepherd, and 

complimented her on her leadership of the team that 

would take forward such a challenging revision to the 

Edwardian facilities on the current site. 

Dr D Gould 

35


Minutes of the Fourth Ordinary Meeting 

Held on Tuesday 4th December 2012 

The Eighth Annual History of Medicine Medical Students’ Prize Evening 

Left to right: Mr R Franks, Gemma Walters, Fiona Claxton, Sally Olding, Poon Shi Sum, 

Margaret Tyau and Dr S Sheard 

Fiona Claxton - Winner 

‘A great patchwork, a good deal of intentions, a great 

deal of inadequacies’ (Geoffrey Rivett) Why was our 

NHS born? 

It has long interested me why the NHS ever started in 

Britain. Is it a manifestation of something unique in 

British society and ideology? The presentation aims 

to look at the factors involved in the birth of Britain’s 

beloved NHS in an attempt to shed some light on this 

question. 

Ideas stressing the importance of worker health 

alongside Keynesian ideas about the government’s 

role/responsibilities in the economy were established. 

Alternatively, with two wars, the simple economic 

viability of an NHS may have been absent previous to 

1948. The system before the NHS was an 

uncoordinated patchwork of organisations, incapable 

even of dealing with bombing casualties. The 

Emergency Medical Service was temporarily set up in 

response; its irrefutable success arguably revealed a 

superior system. Also, for various reasons the financial 

viability of the voluntary hospitals had ended and the 

loss of this substantial bulk of Britain’s medical services 

was simply unacceptable, so the government was 

forced to step in. Or was it the weakening of the 

BMA’s fierce opposition to the idea of an NHS that 

facilitated its implementation? 

WWII in particular brought a glimpse of greater 

equality to homeland Britain. More importantly, men 

from all classes died protecting her, for a second time. 

How could a world war not impact on national 

psyche? Was it a fresh, and so clearly justified, 

demand for a fairer, more inclusive healthcare system 

that led to the formation of the NHS? Or maybe a fear 

of a re-emerging socialist and communist threat was 

driving government policies. 

Many suspect the current government of privatising 

and eroding the NHS by stealth. It would be 

interesting to know the extent to which popular 

demand versus the other factors created the NHS. This 

may, in turn, allow us to gauge the chances of such 

demand now saving it. A reminder of why it exists 

may even provide motivation and vindication for 

standing firm behind it in the coming storm. 

36


Sally Olding - Joint Second Place 

‘Nightmares In Wax: The Models And Moulages of 

Joseph Towne’ 

Even in the age of plastination and 3D computer 

modelling, the anatomical wax models of Joseph 

Towne have lost none of their uncanny realism and 

are still used as teaching aids today. Towne (1806- 

1897) worked for Guy’s Hospital for 53 years, creating 

many hundreds of models, moulages (wax casts) and 

illustrations. With Towne’s work as the focal point, 

this presentation considers the history and craft of 

wax modelling with respect to medicine. The unique 

qualities of wax as a medium and the process of 

creating wax models and moulages are outlined. 

Next, Towne’s work is compared with the earlier 

creations of Susini (1754-1814) and Calenzuoli (1796- 

1829), whose work for Florence’s La Specola museum 

reflects both contemporary aesthetics and attitudes 

towards the study of anatomy. The carefullyorchestrated 

displays of La Specola, with their 

normative portrayal of the human body and its 

systems, contrast vividly with Towne’s highly specific 

dermatological moulages, each cast from an individual 

patient. In Towne’s work, we see no attempt to 

disguise his points of reference - the sick and the dead 

- marking a shift in the use and meaning of such 

models following the 1832 Anatomy Act. 

Today, the moulages of Towne and his European 

counterparts can offer us a snapshot of the 

contemporary doctor’s caseload - representations of 

syphilis abound. As dermatology and venereology 

developed as distinct disciplines in the latter half of 

the 19th century, moulages were to play a key role in 

teaching, learning and communication between 

specialists internationally. The use of wax models and 

moulages continued until the 1950s, when other 

forms of image reproduction and modelling took 

precedence. The final part of this presentation 

considers the re-positioning of moulages as historical 

artefacts (with their own very particular conservation 

problems) and as works of art in their own right. 

Gemma Walters - Joint Second Place 

‘The Hysterical Woman’ Women and mental health 

from the 19th century to the present day 

This presentation combines two areas of particular 

interest to me; namely women’s health and Psychiatry. 

The topic of women and Psychiatry is vast and 

extremely fascinating. The aim of this presentation is 

to provide an overview of some of the common 

mental health problems associated with women 

historically, whilst comparing past and present 

treatments and perceptions of female mental health. 

It will explore the concept of the classic ‘female 

malady’ of hysteria, from its origins in ancient Greece, 

to its widespread use as a diagnosis in the 19th century 

and associated treatments. I will touch on some 

Psychoanalytical theories and how they influenced the 

treatment of hysteria. 

I will also explore how Victorian women who did not 

conform to the male constructed social ideal, often 

found themselves committed to mental asylums, in 

some cases for decades. I will then go on to examine 

how the perception of certain mental illness 

associated with women has changed from the 19th 

century to the present day. In particular I will look at 

case studies of women diagnosed with ‘insanity 

caused by childbirth’ and contrast this with how 

postnatal depression is perceived and treated today. 

Finally I will discuss whether or not gender differences 

still exist in mental health, posing questions such as is 

‘the modern woman’ more at risk of developing 

mental distress due to the ‘have it all’ mentality of the 

21st century? I am currently researching the Liverpool 

Lunatic Asylum, opened in 1792 and hope to be able 

to relate the ideas of my presentation to case studies 

and data from Liverpool, in order to make the 

presentation as interesting and relevant as possible for 

my colleagues. 

Margaret Tyau - Runner Up 

‘HeLa Cells’ 

Ubiquitous in laboratories worldwide, HeLa cells have 

contributed to countless medical breakthroughs over 

the past six decades. These cells originally came from 

the cancer cells of an African-American woman, 

Henrietta Lacks, in 1951. No consent was taken for 

the removal of her cells. This happened in spite of 

several prominent guidelines, such as the Nuremberg 

Code, highlighting the importance of informed 

consent. Why was it that, despite the existence of 

these guidelines in Henrietta’s day, informed consent 

was not widely employed in clinical research in 

America until the mid-1960s? This presentation will 

identify possible factors in 1950s America which 

influenced the behavior of the medical researcher’s 

treatment of Henrietta. 

Discussion will overview key factors which played a 

role in research and healthcare in the 1950s. These 

include lack of external regulation of research, 

37


conflicts of interest between the investigator and the 

patient, poor ethics teaching contributing to 

misconceptions about ethical research conduct, and 

unfamiliarity with existing guidelines of the day. 

Additionally, there was the belief that poor patients 

deserved to be used in experiments to pay back for 

free treatment. There is still much controversy in 

human tissue research. And this topic is still relevant 

to study today in the UK. Understanding America’s 

past helps us understand the necessity for the existing 

regulations and governance over human research and 

a systematic approach to medical ethics education 

today. 

Poon Shi Sum - Runner Up 

‘Traditional Chinese Medicine’ 

Growing up as a Chinese, my perception of traditional 

Chinese medicine is that it is slow, holistic, deeply 

rooted, and involves the interaction of mind-body 

with less side effects. The western dominance in the 

field of medicine is well recognised but what drew my 

attention to Chinese medicine is its longstanding 

history, unique sets of theoretical approach and its 

role in modern medicine. 

Traditional Chinese medicine has a 5000 years of 

legacy and is the current standard of practise in China. 

It is based on a unique set of Chinese philosophy and 

its premises revolve around 'the 5 elements'- Wood, 

Fire, Earth, Metal, and Water, 'Qi'- an essential life 

source, and also Yin and Yang- a complement to the 

aforementioned. The Yellow Emperor's Inner Canon, 

an ancient Chinese text comparable in importance to 

Hippocratic Corpus, has been a fundamental source of 

traditional Chinese medicine, with historical physicians 

including Zhang Jiegu, Li ShiZhen and most notably 

Hua Tuo. Western medicine had an influence on China 

in the 19th century, but it was not until the 1960s that 

traditional Chinese medicine was declared the 

national standard of practice in China by Mao ZeDong. 

To date, dispensaries aimed at broad spectrum of 

healing changed little and herbs are weighted out on 

a daily basis, a reflection of its efficacy despite the 

changing pattern of diseases. It is increasingly 

becoming more common in the West as acupuncture 

practice is approved in several countries, yet another 

testament of its significance in the medical field. 

Nevertheless, the complex aspects of the formula rule 

in prescription make it hard for westerners, who are 

used to 'one solution to one problem'. With evidencebased 

medicine practice such as double-blind, 

placebo-controlled studies for Chinese medicine still 

in its infancy, it is hard to attract researchers and 

public from world-wide to fully explore the potential 

of traditional Chinese medicine and hopefully the 

situation will ameliorate in the future. Through 

reviewing vast amount of literature, I hope to give an 

insight into history-rich Chinese medicine and its 

development in the modern society. 

38


Minutes of the Fifth Ordinary Meeting 

Held on Thursday 6th December 2012 


‘The Future of the NHS’ 

Mr Derek Campbell, Chairman, Liverpool PCT 

The President welcomed everybody who had come 

despite the appalling weather. Many people present 

knew the speaker. This lecture was the fourth in the 

series about the future of the NHS. 

Mr Campbell is the Chairman of the Liverpool PCT. He 

comes from Glasgow and read chemistry at Glasgow 

University. Later he studied accountancy and joined 

the Civil Service. For 14 years he had worked in London 

in various government departments including the 

Ministry of Defence where he dealt mainly with 

Property Management. He started to work for the 

NHS in Lewisham and it will be recalled that Guy's 

Hospital was part of the first wave of hospital trusts. 

He later moved north (from London, though south 

from his origin in Glasgow). He was a Finance Director 

in Cheshire and then joined the Liverpool Health 

Authority, which was then the centre of the PCTs. The 

President invited Mr Campbell to give his talk. 

Mr Campbell said that he does not usually stick to his 

script and he may be contentious. He would begin by 

stating that it is currently thought that the NHS is 

better than it ever has been. He said that as a twoyear-old 

he had scarlet fever and recalls his general 

practitioner saying that when he started to scream, he 

was getting better! At the age of three he had a 

tonsillectomy and his experience of a paediatric ward 

was that the parents were barred from seeing their 

children. At the age of 7, he had measles. He is certain 

that patient care is now much better and also the 

medical treatments available have improved 

tremendously. The spending has increased ever since 

1949 though it has stopped in the middle of the last 

decade. 

Using pie charts he showed various pieces of statistical 

information. There has not been a great deal of 

change in how the budget is spent over the last 10 

years; about 9% on general practice and about 50% 

on hospital service. The number of patients waiting 

more than four hours in Accident Departments since 

the early years of the last decade showed it was 10% in 

2003-4; this is now reducing. 

Targets are necessary to assess the delivery of care. One 

measure has been the percentage of patients seen and 

started treatment within 18 weeks, and this is now on 

target. The incidence of Clostridium difficile infections 

and of MRSA cases is dropping and there has been a 

marked improvement over the last 10 years. 

The new generation of managers and doctors have no 

experience of the old style of the NHS. The new ones 

did not know of the early struggles that had been 

made to improve the service and assess that it is easy 

now. Many of the newer employees have no 

experience of what it was like dealing with the hard 

times. Many now see hospital practice as “a conveyor 

belt" and if it is stopped, problems pile up. 

There is a projected funding gap. Even if there is no 

change in hospital treatment, the expected costs of ill 

health will increase. 

What are the present problems? The population is 

growing, life expectancy is increasing, the population 

is ageing, there are significant health inequalities and 

there are also problems of individuals’ health 

behaviour such as alcohol abuse, smoking and obesity. 

What is the public's perception of the NHS? There is a 

rising expectation that serious illnesses will be treated, 

the NHS is still highly valued, the public want it to be 

protected from the spending cuts (72% in one poll) 

and what matters to the patients is a high standard of 

care. 

With the prospect of severe government austerity, the 

NHS is entering treacherous waters according to a 

recent Kings Fund report. They base this on 

information from progress on targets, diverse 

performance improvements and various forms of 

outcome of treatment. The future will be 

concentrating on outcomes, devolution of services and 

transparency. These are being substituted for 

performance management and extremely challenging 

times lie ahead. 

39


There is a need to show that the CCTs have a clear 

target in outcomes, which can be measured, and what 

action has to be taken if they fail to meet these. 

Merseyside and Cheshire is a relatively small area with 

about 1.2 million patients. The government is taking 

a "hands off" approach. In the country there are 27 

area offices; one in Merseyside and 1 in Cheshire. 68 

staff are employed, 11 in the finance departments. It 

is not certain exactly what they are supposed to do. He 

expects that the area offices will disappear in the next 

two years and the teams will need to consider and 

manage various local area problems. He thinks it is 

likely to be four years as a maximum before this occurs. 

The administration is being devolved to GPs but many 

of the plans put forward by Mr Langley have been 

watered down by the NHS Management. A lot of 

experienced people have been lost to the service and 

there is the damage that will occur from the loss of this 

corporate memory and experience. These people 

knew how to handle various situations that arose. The 

policy seems to be that a lot is "thrown in the air". 

There will be about 3 to 4 years of turmoil until 

everything settles down. The staff have been treated 

appallingly, especially the senior members of staff, and 

there is a great deal of resentment. There is a loss of 

goodwill – it is virtually all destroyed. Even some of 

the people who have been employed and given new 

jobs, even with promotion, still feel discontented. 

With the loss of this experience, undoubtedly mistakes 

that had been made in the past will be repeated and 

not just in commissioning tasks. 

There have been problems with urgent care and in 

accident and emergency departments, which he had 

been tracking for 15 years. He referred to the bad 

winter of 1998-9, particularly in Liverpool. 

Chief executives need to look both inside and outside 

for the best treatment of the patients, such topics as 

social care are involved. There is much talk about 

leadership but there is not much about. There are no 

right answers. 

He then considered Foundation Trusts. He commented 

that it was not his job to run hospitals. Self-governing 

trusts had been set up and the concept was that money 

would follow patients. When he joined the NHS in 

1989 he worked at Guys Hospital in Lewisham where 

he was a finance manager. There was a great deal of 

paperwork and documentation and threats of legal 

action if the hospital was not paid for the work done. 

The Foundation Trusts are similar to the old trusts but 

it is still likely that they will need to be bailed out. The 

behaviour of the trusts is the worst that he has 

experienced. They are supposed to collaborate and 

work together but they do not seem to. They may 

seem more equal at the start but changes will develop 

and it will be dramatically different in 20 years. He 

foresees the possible total failure and collapse of the 

system. Action may be taken when things are 

becoming serious or they may wait until there is 

complete collapse. The trusts are under instructions to 

save 5% per year through efficiency savings but in fact 

all the fat has been cut out and done effectively in the 

last 2 to 3 years. There is no fat left. More and more 

hospitals are now jetting into financial difficulties. 

Semi-fixed and fixed costs have been reduced and 

savings can only be made by cutting the infrastructure. 

There are some difficult decisions which will have to 

be taken and political problems solved or all of the 

achievements of the past 10 years will be lost. It is 

necessary to find new ways of collaboration. Groups of 

chief executives have been meeting together and none 

want to be the first to fail. They need to find solutions 

and to work within them. Many trusts, however, are in 

a bad state and merely merging them won't solve the 

problems. He feels that Merseyside and Liverpool have 

done a good job. There have been good achievements 

in urgent care, vascular services and in major trauma 

work. They want to see the evidence and use it to find 

a way forward. It may be necessary for all to give up 

something but the worst would be if all of the trusts 

had to give up everything. 

He finished by wondering what can be done to make 

the NHS work and he focused the problems and 

solutions mainly on the clinicians. How do we make it 

work? 

“Remember what we are here for. 

Need to work for the common good. 

Clinicians need to lead the way, show maturity and be 

altruistic. 

Clinicians must put pressure on the local boards and 

management to break down barriers. 

Accept there are no completely right or correct 

solutions so go for the best fit and challenge clinical 

variation. 

Do the commissioners’ work for them. Think like a 

commissioner as we are in a hiatus now. 

Think the unthinkable: be radical. 

Do it from a position of relative strength now not a 

future time of chaos. 

40


Understand the short-term nature of politicians, ignore 

it and deal with the fundamentals. 

Stop looking for excuses and authority figures to 

blame, take the ownership and respond to it.” 

He then invited questions. 

One person asked about the connection of the people 

with the commissioners. There was supposed to be a 

regulated market but nobody knows what is going on 

or what they are up to. He felt that the commissioning 

had improved and was more professional, as it had to 

be. He also felt that the private sector was peripheral 

here on Merseyside. 

Dr Philpot summarised his experiences in psychiatry for 

the elderly, particularly with dementia care. In the 20 

years since he was first appointed, there are increasing 

numbers of staff available to treat the elderly with 

dementia and also the availability of care in the 

community. A lot had been spent on dementia 

patients. Originally there were many beds in 

numerous hospitals but these had been reduced to 

about 60 to 80 beds for more intensive treatment. 

With the new lines of treatment, fewer beds are 

needed, particularly “acute” ones, and more is done in 

the community involving carers in the patients’ homes. 

There was a query about Personal Health Budgets. You 

want healthier patients so the cost is less. Are the 

general practices becoming "geographical"? It is 

necessary to ensure that there were no gaps for people 

to fall through. The CCTs are responsible for the 

geographical areas so if there is no care available 

elsewhere, they have to take responsibility for the care 

of the patients. There are no catchment areas for 

practices. It is CCTs responsibility and not that of the 

general practitioners. There is a lot of cross-boundary 

flow now. There was speculation that the surgeries 

might "cherry pick" but the CCTs will have to ensure 

that this does not occur. However questioner had no 

confidence that this would actually occur. A lot of 

profit can be made from private care with insurance 

companies promoting private care from the fear of 

lack of healthcare. This is found not just here but also 

in the United States and Europe, and has led to an 

increase in these markets with doubts about the NHS 

appearing. However Mr Campbell felt that there 

would always be a publicly funded service. The PCTs 

had bought care from the trusts and GPs and the 

future CCTs will also do it. There is the possibility that 

marketing of private care may lead to profiteering but 

the CCTs have to ensure every case is treated. 

There was a further question concerned with PFI. This 

had taken a big slice out of the NHS budgets and had 

the risk of unravelling the service. He felt that the new 

style of PFI - PFI2 was more effective than the previous 

one with more controls and he defended it with the 

national interest rates but he was not keen to discuss 

the topic. There have been faults in the past though 

part of it lay with the purchasers who had, for 

example, built two hospitals instead of one, as at St 

Helens, and also there have been extensive 

investments in expensive equipment. 

There may be legal constraints to the CCTs in 

commissioning outside services but they do have more 

freedom. It is hoped that a lot of surgery may be done 

on a very short-term or even day case basis - as was 

proposed by a former GP czar (Dr Colin-Thome), but 

there is still a lot of hospital building going on. Using 

the triage system in accident departments there has 

been a 17% drop in non-elective admissions in 

Liverpool last year. 

Some hospitals may well merge. A lot of the NHS work 

may go to private sources and there was a query 

whether the CCTs can send patients to these smaller 

private providers. There was a question about more 

hospitals becoming smaller or whether major ones 

might join together. He felt there was a need to see 

the evidence for this and collaboration was essential. 

The private sector is still small in Merseyside. Some 

orthopaedic patients from Liverpool had been sent to 

Halton Hospital in the past but this was not needed 

now and the orthopaedic service was provided mainly 

in Liverpool, at Broadgreen Hospital etc for its 

residents. 

There will have to be a change in the system and talk 

about the number of large hospitals. The politicians 

and public will have to face this and decide. He does 

not know the answer. 

He was asked if it was part of the ideology now to run 

down the NHS and change to private insurance. 

Despite the diversion of some work into private 

insurance companies he believed that the government 

was not set on demolishing the NHS, (though not all 

the audience agreed). 

Dr N R Clitherow 

41


Admission of Life Members 

The following members were admitted to Life Membership of the Institution at the 

Celebration and Admission of Life Members on Thursday 13th December 2012. 

Two Public Orators presented these citations. 

In his introduction the President reminded members 

present that qualification for Life Membership was to 

have completed 45 years of continuous full 

membership. It would also appear, as a purely 

unscientific observation that membership of the LMI 

had a beneficial effect on longevity. For this year, no 

fewer than 12 members had qualified. The President 

also reminded the meeting that Life Membership 

relieved the member of any subscription but reminded 

the aspirants that they were perfectly free to continue 

to pay a normal membership subscription. 

CARLOS MICHAEL AZURDIA 

Carlos Michael Azurdia 

qualified in Liverpool in 

1963 and trained at the 

Liverpool Royal Infirmary in 

surgery under Prof. C.A. 

Wells and medicine under 

Prof. Sir Cyril Clarke. He 

gained a wide variety of 

experience as a Senior 

House Officer, first in A&E 

then orthopaedic surgery at 

LRI, then paediatric orthopaedic surgery at the Royal 

Liverpool Children’s Hospital in Myrtle Street under 

Professor Roaf, followed by general surgery at 

Warrington and lastly obstetrics and gynaecology at 

Mill Road Maternity Hospital with Prof. Sir Norman 

Jeffcoate and Mr Brian Hibbert, before turning his 

attention to General Practice. 

He worked as a GP in Bebington from 1969 to 2001, 

becoming a Senior Partner in 1990, and is still very 

busy doing innumerable GP locums all over the Wirral. 

He was the Divisional Surgeon for St John’s 

Ambulance Brigade from 1972 - 1992, and Medical 

Officer for British Rail from 1968 - 1997. 

His particular medical interests are Hypertension, 

Orthopaedics and Geriatric Medicine. He is also 

interested in Sports Medicine and was Medical Officer 

for Tranmere Rovers until 2004. His enthusiasm for 

sport can also be seen in his hobbies. He was a very 

keen player of rugby, squash and tennis in his younger 

days, and still plays golf and tennis regularly. He also 

enjoys gardening, crosswords and reading non-fiction 

books. 

He had medicine in his blood, coming from an 

established medical family. His paternal grandfather, 

a polymath, philosopher, poet and practising doctor, 

emigrated to Liverpool in 1910 with his large family, 

was appointed Consul General for Guatemala in 

Liverpool and continued to practise medicine in 

Liverpool, alongside teaching Spanish at Liverpool 

University. His father was a GP for 30 years, and his 

mother, a Liverpudlian born and bred, trained as a 

secretary, but instead devoted herself to her family as 

housewife and mother. Carlos grew up with his two 

brothers in Liverpool, attending La Sagesse School and 

St Edward’s College, followed by his medical studies. 

His wife Gill is a nurse and midwife, who qualified at 

the Liverpool Royal Infirmary and Radcliffe Infirmary, 

Oxford respectively. They were married in 1966 and 

together they have four children, Richard, Ruth, 

Debbie and Katie, and (currently!) seven 

grandchildren. Richard is now a Consultant 

Dermatologist at Broadgreen Hospital, Ruth an 

assistant Head Teacher at a school in Roehampton, 

Debs a full time mother of three daughters in Tring 

(still finding time to act as Treasurer for local auction 

rooms), and Katie, the youngest, a Senior Sales 

Executive at the advertising company Clear Channel in 

Manchester. 

He is and has been involved in numerous charitable 

activities; sitting on the Executive Committee of 

Clatterbridge Cancer Research Trust from 1975 - 1986, 

being President of the Bebington Branch of Arthritis 

Care from 1983 - 1990 and being Governor of 

Birkenhead High School since 2002. He was 

nominated President of the Birkenhead Medical 

Society from 2004-5, and now has the honour of being 

an LMI Life Member. 

42


ALEXANDER PAUL BRACEY 

Paul Bracey qualified as a 

doctor in Liverpool in 1966 and 

went on to work as GP Trainer 

and Senior Partner at Netherley 

Health Centre. His main 

medical interests are Women’s 

Health and Family Planning. 

After gaining the Diploma of 

the Royal College of 

Obstetricians and Gynaecologists he also became a 

Fellow of Faculty of Sexual and Reproductive 

Healthcare of the RCOG. He worked part time as a 

Senior Clinical Medical Officer for Child Welfare and 

as an instructing family planning doctor at the 

Liverpool Women’s Health Directorate. 

He was a Member of the Professional Executive 

Committee of South Liverpool and was involved in PCT 

commissioning for GP and hospital services, and is still 

active as an Accredited Expert witness for GP Clinical 

Negligence. 

Paul grew up in Liverpool and attended first Rudston 

Road Primary School and then Quarry Bank High 

School. He is a keen youth worker and was for many 

years was involved in the Jewish Lads and Girls 

Brigade. As well as organising the medical facilities at 

the annual national summer and winter camps, he was 

in charge of the Liverpool Unit for four years. This is 

an interest he shares with his daughter Natalie, who is 

also actively involved in youth work. 

Natalie recently graduated with BSc Hons in 

psychology from Leeds University and has just 

commenced PGCE Primary School teachers’ course at 

Liverpool Hope University. His other daughter, 

Georgia, has just commenced reading Hispanic Studies 

at the University of Liverpool. 

Hilary, his wife, as well as being a qualified nurse, is 

also an accomplished violinist who plays 1st violin in 

the Liverpool Phoenix Concert Orchestra and the 

Wirral Symphony Orchestra. 

KEVIN HARDINGE 

Prior to retirement, Kevin 

Hardinge was a Consultant 

Orthopaedic Surgeon at the 

Centre for Hip Surgery at 

Wrightington Hospital from 

1976 to 1999. He was at 

Manchester Royal Infirmary 

for the preceding 3 years 

and latterly is Honorary 

Lecturer in Orthopaedics at the Victoria University of 

Manchester. 

After studying at Douglas High School 1951 to 1957, 

he went on to qualify in medicine in 1962 from the 

University of Liverpool, and gain a Mastership of 

Orthopaedic Surgery in 1968 from the same 

institution. He did his orthopaedic training in 

Liverpool from 1965 to 1973 and was made Hunterian 

Professor of Royal College of Surgeons of England in 

1966. His particular focus was on total hip 

replacement in Juvenile Rheumatoid Arthritis and also 

Secondary Osteoarthritis due to congenital hip 

dysplasia, of which he saw 5000 cases, and total knee 

replacement in Rheumatoid and Osteoarthritis, of 

which he saw around 2500 cases. 

He is married with two daughters. His wife, Honor, 

has been a practice manager since 1963. Their elder 

daughter is a Consultant Respiratory Physician at 

Radcliffe Infirmary, Oxford, whilst their younger 

daughter is an Executive Producer for BBC TV, working 

on children’s programmes. He describes his current 

interest outside medicine is living ‘the good life’ - 

which he defines as a combination of travel, food, 

wine, jazz and motoring. 

ROBERT MORPETH JAMESON 

Robert Morpeth Jameson 

was a Consultant Urologist 

at the Royal Liverpool 

University Hospital and at 

the Spinal Injuries Unit in 

Southport Hospital. He had 

developed a particular 

interest in the neuropathic 

bladder. 

He was born in the North East and had a peripatetic 

childhood going to sixteen schools, his family being 

nautical during the War. On the basis of this 

43


unbelievable breadth of educational exposure he 

went to the Durham University Medical School (in its 

previous incarnation) and qualified in 1957. He 

underwent surgical and urological training in 

Newcastle and at the Institute of Urology in London 

and remembered the French hospital in Shaftsbury 

Avenue, by then part of the Institute of Urology, 

originally set up by French nuns to deal with the long 

term effects of Frenchmen marooned in England with 

the maladie Anglais. The French hospital is now a 

block of flats. In 1968 he was appointed as Urologist 

in Liverpool and Southport. In his work in Liverpool 

and on the strength of time spent particularly in the 

Middle East he became a considerable expert on cross 

cultural sensitivities, interpersonal skills, body 

language and communication, in particularly sensitive 

areas which we might call personal intimacy and all 

this in the face of disability, thus he crossed 

boundaries between GU Medicine, Surgical Urology 

and disability and this was a time when scout regard 

was being paid to it. 

He was an examiner for the Royal College of Surgeons 

and taught and examined in Nigeria, Ghana, Cairo, 

Khartoum, Baghdad and Libya. He married Fiona, 

later a GP in the Grassendale practice and who has 

accompanied him on many of the voluntary and 

missionary trips abroad. He was widowed three years 

ago. They had four children; a bio medical engineer 

working on European patents in Berlin who invented 

a portable ventilator, two Consultant Anaesthetists, 

one in Chester and one finance director. He is a lay 

reader in the Church of England and holds a Bishops 

licence to preach within the Liverpool diocese. 

Throughout his life he was an enthusiastic motorcyclist 

and was sad to sell his motorcycle about a month 

previously. 

GRAEME ALISTAIR McGREGOR (in absentia) 

Graeme Alistair McGregor 

spent his working life as a 

General Practitioner in 

Appleton Village near 

Widnes and retired in 1998. 

He had been brought up in 

Liverpool and went to the 

Holt High School and then 

on to study medicine at 

Liverpool University. In 

preparation for his general 

practice he worked at Clatterbridge in medicine and 

surgery, paediatrics and obstetrics, and obtained the 

Diploma in Obstetrics from the Royal College of 

Obstetricians and Gynaecologists and left with, in his 

own words, souvenir Dorothy, a Ward Sister, who 

became his wife. During his working life he has taken 

a keen interest in sports medicine and was the Medical 

Officer for Widnes Rugby Football Club and in 

occupational health being involved with ICI (now 

INEOS), Fisons, Seagrams and Greenall Whitley and Rio 

Tinto Zinc. He pointed out that his appointments in 

occupational health generally had a bad effect on 

businesses involved, most of which have closed under 

his jurisdiction. He is a member of the Rainhill Rotary 

Club and Blundell’s Hill Golf Club. He had married 

Dorothy in 1964, the year he entered general practice, 

and they had two sons and a daughter and now three 

grandchildren. 

He remembered with affection his greatest claim to 

fame was closing up the Southern Hospital as a 

medical student by catching Smallpox at a 

bacteriology class, having the entire medical school 

vaccinated and closing the Chinese laundry in Penny 

Lane and related Chinese restaurants where the 

laundry staff were moonlighting. He was one of the 

last Presidents in the New Ferry Fever Hospital, which 

was subsequently burned down though he hoped that 

the relationship was temporal and not causal. On 

appointment to his general practice in Appleton he 

took the wise precaution of joining the Liverpool 

Medical Institution at the instruction of his senior 

partner, Jack Cheetham, who had been the President 

at the time in 1967. 

ALAN PATTERSON 

Alan Patterson qualified in 

medicine after studying at 

the University of Liverpool 

from 1951 to 1956. 

Prior to retirement he was a 

senior ophthalmologist at 

St Paul’s Eye Unit in the 

Liverpool Royal Infirmary 

and Head of the 

Ophthalmology Unit at the Liverpool University 

Department of Medicine. He was a Fellow of the 

Royal Colleges of Surgeons (England) and a Fellow of 

the Royal College of Ophthalmologists, also obtaining 

a Diploma in Ophthalmology (DRCOphth). 

His medical areas of interest are in herpetic infections 

of the eye and the field of keratoplasty, or corneal 

44


transplantation. Outside of work, he has diverse 

interests including the occupations of golf, gardening 

and raising sheep. He has also raised three children 

with his wife Flo! They are named Andrew, Luise and 

Julie. 

GILES PANDELY SECHIARI 

Giles Sechiari was a 

Physician in Ormskirk with a 

particular interest in 

Diabetes. He related that 

the Sechiari family were 

bankers and had come to 

this country from Genoa in 

1803 to take a particular 

interest in slave trading but 

they largely missed the boat 

and slave trading was abolished in 1807. Dr Sechiari’s 

father had worked for Shell and he himself had been 

born of British parents in Mexico. His family had 

returned to Liverpool in 1930 when his father was 

concerned with the pipeline under the ocean (PLUTO) 

but when the War and the bombing of Liverpool 

began his mother sent him, his brother and his sister 

to live in South Africa. He has fond memories of eight 

other children travelling on the same ship together 

and of a sailor, named Wally, who entertained them 

on the mouth organ. He was at school and qualified 

in South Africa and is fluent in Afrikaans, which he 

later found useful working in Belgium, Holland and 

Germany. He returned to Liverpool in 1959 and 

continued training in general medicine in and around 

the city in Southport and in Ormskirk. He had married 

Pauline Park, an Anaesthetic Registrar in 1963 and 

they had lived in Ormskirk where he was subsequently 

appointed as Physician and was told that he was 

taking an interest in diabetes. He related that he had 

lived in three houses in Ormskirk because each 

previous one he had been informed reliably was 

unsuitable for what status he had by then achieved. 

Throughout the years he has been a loyal member of 

the Territorial Army and feels that he can no longer 

cope with the officers’ mess after midnight, although 

the drill and physical activity poses him no particular 

problems. His wife Pauline had died six years 

previously and he had re-married one month prior to 

this occasion to a ward sister from Southport whom 

he remembered of days of yore, but had re-met at a 

village fete near Southport. 

THOMAS WILFRED STEWART (in absentia) 

Tom Stewart was a 

Dermato Pathologist and 

Clinical Dermatologist in 

Liverpool and Southport. 

He was a Mancunian by 

birth and went to the 

Manchester Central High 

School for Boys and then to 

Manchester University 

Medical School. He trained in general medicine and as 

a dermatologist at Hope Hospital and subsequently at 

St John’s Hospital in London, in Sheffield and in Leeds. 

He was appointed as a Dermatologist at the Liverpool 

Royal and at Southport and Ormskirk, but throughout 

had taken and was an excellent opinion in dermato 

pathology (the specific histology associated with 

dermatology). He was known particularly for his great 

consideration of his junior staff and in particular 

making sure that they got to meetings and he himself 

was always a convivial host. He had married on his 

birthday as a houseman and has two daughters and 

two sons and three grandchildren. He is a keen 

photographer and enjoys travelling. 

FRANCIS JAMES WEIGHILL 

Francis Weighill was brought up in Hoylake. He went 

away to school to Wrekin College in Shropshire but 

came back to Liverpool to the Medical School. His 

early jobs were in and around Liverpool. He shared a 

casualty job, as it then was, with Dr Azurdia and 

completed orthopaedic training in Liverpool and 

Edinburgh. He had brief excursion into cardiac 

surgery whilst rotating through Broadgreen but saw 

the light and returned to orthopaedics. He worked 

with Charnley at Wrightington and at the Toronto 

Children’s Hospital and was then appointed to the 

Manchester Hospitals in 1976. Throughout his life he 

has sailed, more latterly he said by sitting in the stern 

and criticising the technique of others, in his 36’ 

Oceanis, which is still in family ownership. He plays 

the piano. He has not played his fiddle for many years 

having been the orchestra leader in his younger days. 

His wife Christine, who sadly died in 2007, was a 

physiotherapist at the Liverpool Royal. He is still does 

medico-legal reports, though is rapidly faltering at the 

thought of revalidation. 

Dr Eric Birchall, Dr Nick Clitherow and Dr Tony 

Nightingale also qualified for Life Membership but 

wished no specific oration. 

45


Minutes of the Sixth Ordinary Meeting 

Held on Thursday 10th January 2013 

Joint Meeting with Merseyside Medico-Legal Society 

‘Medicines, Devices, the Law and Regulation’ 

Professor Sir Alasdair Breckenridge and his Team 

Mr R Franks, Mr P Feldschreiber, Prof Sir A Breckenridge and Dr A Zsigmond 

We were unfortunately unable to obtain any minutes for this meeting. 

46


Minutes of the Seventh Ordinary Meeting 


Joint Meeting with the Liverpool Society of Anaesthetists 

‘The Medical Supervision of Motorsport’ 

Dr Paul Trafford, Consultant Anaesthetists, Arrowe Park Hospital 

and Medical Adviser to the FIA 

The meeting was introduced by the LMI President, Mr 

Roger Franks, who welcomed everyone and invited 

the LSA President, Dr Janice Fazackerley, to take over 

proceedings. Dr Fazackerley introduced the speaker, 

Dr Paul Trafford who began by introducing the 

organisation for whom he worked, the FIA, which is 

the governing body for world motor sport. In 

addition there is also the FIA Institute, an 

international not for profit organisation that develops 

and improves motor sports safety and sustainability 

and the FIA Foundation, an independent UK charity 

which supports the promotion of road safety 

internationally, the environment and sustainable 

mobility as well as funding motor sports safety 

research. He paid tribute to Professor Sid Watkins 

who had recently died in November 2012, a Liverpool 

University graduate who had made a major 

contribution to the medical safety of Formula One 

drivers over the last 30 years. 

Dr Trafford proceeded to show a video of one of the 

first major accidents in motor racing at the Le Mans 

24 hour race in 1955. This had resulted in 83 deaths, 

mainly among spectators with a further 122 with 

serious injuries. This tragedy highlighted the 

complete lack of medical response and facilities 

resulting in no help being available. He contrasted 

this with the race today where up to a quarter of a 

million spectators may be present with a medical 

service cover of over 60 doctors with a similar number 

of nurses and 25 ambulances being immediately 

available. 

The number of motor racing fatalities worldwide 

between 1990 and 2008 were noted, stating that 

there were 55 deaths in 2008 alone. He commented 

that deaths on racing circuits were reducing, whereas 

those associated with rallying were increasing. The 

latter did not include deaths of spectators. 

Dr Trafford then talked about biomechanics, which is 

the study of the mechanism of injury and tries to 

quantify human tolerance levels and therefore the 

prediction of injury. He showed the effects of 

different types of crashes on the body with injuries to 

the neck being common to all sorts of impacts. In 

Formula One, all crashes are individually investigated. 

He demonstrated this by looking at two, which 

happened in the same place at the Monaco Grand 

Prix. Both drivers survived principally due to the 

design of crash barriers and Dr Trafford revealed how 

these had been tested. Interestingly the best barriers 

seemed to be old tyres tied together except for headon 

collisions when cars tend to go through them. He 

then looked at other types of crash investigation and 

simulation, including the use of crash test dummies, 

cadaveric studies and digital models, the latter being 

one of the best but most expensive. The science of 

injury risk assessment has been developed because of 

the amount of data now available following accidents 

with their resultant type and severity of injury. It 

therefore becomes possible to establish which kinds 

of impact cause which types of injury. This provides 

engineers with sufficient data to design systems that 

can help to prevent these injuries in future. 

Dr Trafford spoke about head injuries. The severity of 

a head injury can be predicted by the Head Injury 

Criterion (HIC) score, which was derived from crash 

test dummy experiments. The use of crash helmets 

greatly reduces the incidence of head injury. Another 

piece of recently introduced equipment is the HANS 

Device which helps to stop the head whipping 

forward following an impact causing fractures to the 

base of the skull. 

Next Dr Trafford showed the dangers of rallying with 

videos of the consequences of two accidents. This 

demonstrated the relatively isolated nature of rally 

driving and the difficulty of getting medical personnel 

to the scene of the accident rapidly. As a 

consequence, rally drivers are now taught basic first 

aid, hopefully thus being able to provide immediate 

support to their co-driver in addition to those who 

47


might be injured in the car in front due to average 

one-minute intervals between competitors. Medics 

can often take, on average, up to 10 minutes to 

attend. 

The dangers of fire were discussed. He demonstrated 

this with a video from 1973 showing a racing car on 

fire with the only rescuer being a fellow driver. The 

lack of fire fighting equipment was obvious and as a 

result the driver died. This danger has not gone away, 

as a recent fire in the pit area during defueling after 

a Formula One race demonstrated. As the race had 

finished, many of the fire appliances had already left 

the circuit. One of the major problems is the 

poisonous nature of the smoke because of the 

burning plastic and carbon fibre. His final video was 

of a touring car race in Suzuka, Japan. An accident 

between two cars had caused a massive fire and the 

only personnel available were fire fighters who 

started to extinguish the fire. They eventually 

dragged the driver out of the car who appeared dead 

but then started to move. The fire fighters continued 

to fight the fire until a minibus arrived and the injured 

driver was thrown in and driven off. This recent video 

demonstrated the continuing poor medical facilities 

at motor racing even in first world countries. 

He concluded by looking to the future, which he said 

included education. This was absolutely vital because 

motor racing is now held in countries with no 

tradition of this sport and therefore no idea what to 

do when injuries occur on the track. Research in 

extricating drivers and training is also important 

particularly for paramedics who he thought were 

often better at dealing with injured drivers than 

doctors. He commented that in the US, the protocol 

for any injured racing driver was a full body CT scan. 

This is the equivalent of 700 chest x-rays with the 

potential of being repeated a number of times a year 

if drivers regularly crash. He commented that a far 

more clinically based approach was needed where 

drivers were medically assessed. If they were conscious 

and had no pain they should be allowed to get out of 

their cars themselves if able to do so, without the use 

of collars and other traditional safety equipment. 

Medics and paramedics are fearsome about putting 

intelligence before protocol because of the perceived 

threat of litigation. He thought that future safety 

developments such as new helmets, safety belts etc 

would further improve drivers’ survival after crashes. 

Dr Fazackerley thanked Dr Trafford for his talk and 

after a number of questions from the floor asked Dr 

Colin Hopkins to give the vote of thanks. 

Dr Ewen Forrest 

48


Minutes of the Eighth Ordinary Meeting 


‘Sustaining Excellence in Medical Education: 

My Vision for the Liverpool Medical School’ 

Professor Vikram Jha, Professor of Medical Education, 

Director of the Undergraduate School of Medicine, University of Liverpool 

Professor Vikram Jha and Mr Roger Franks 

Gynaecology in Northern Ireland and Dundee and 

became an Education Research Fellow of the Royal 

College Obstetricans and Gynaecologists in 2000. He 

achieved his Masters in Medical Education in Dundee. 

He was a Lecturer in Obstetrics and Gynaecology in 

the University of Leeds 2002-2006 and obtained a PhD 

(Leeds) in Medical Education in 2007. From 2007-2012 

he was Senior Lecturer and Honorary Consultant 

Obstetrician in Leeds. 

Fig 1. 

Professor Jha was welcomed by the President and 

started his talk by explaining his background and how 

he came to his present post. He grew up in Calcutta - 

the ‘City of Joy’ and India’s business centre. The city 

contains some fine old colonial buildings and the 

Calcutta Medical College (Fig 1) is the oldest medical 

school in India. He trained in Obstetrics and 

He was appointed to his present post in Liverpool to 

provide new leadership in the University at Faculty 

Board level against a background of poor 

performance of the Liverpool Medical School in the 

National Student Survey and league tables and 

disengagement of the NHS, the hospitals and the 

students with the current course. His agenda is to 

review the curriculum, to engage all of the 

organisations, groups and individuals involved, to 

improve the student experience, encourage staff 

49


development and to carry out education research. 

Change is driven by the medical school, the university, 

the requirements of the workplace and by changing 

views on medical education. Surprisingly, there was a 

satisfactory GMC visit in 2012 with clinical contact, 

preparedness, career advice, clinical skills and patient 

safety being highlighted as areas of good 

performance. However, the GMC visit assessed 

procedures rather than academic features. 

Fig 2. 

Fig 3. 

In the National Student Survey, Liverpool ranked 28 

out of 31 and in the Guardian Survey, which assessed 

satisfaction with teaching, feedback, student-staff 

ratios, space per student and entry tariff, Liverpool 

was 27th out of 31. Limitations highlighted since 2004 

had not been addressed. In Fig 2, the percentage of 

doctors by medical school who thought that they were 

well prepared for their job and Fig 3, the percentage 

who thought they were not well prepared, Liverpool 

is labelled as Medical School ‘9’. 

The University is undergoing the biggest cuts to higher 

education in our lifetime. Student recruitment was 

unpredictable with £9,000 fees, changes in student 

number controls and the reduction in the number of 

A and A* grades gained at A-level. Medicine on a 

whole is more exposed than ever. Students are 

consulting league tables before applying and 

demanding a better student experience. There is a 

change in the evidence base for medical education 

and regulation from the GMC and Local Education 

Training Boards is increasing. Liverpool has 

approximately 330 students in each year - the largest 

UK medical school. Pending innovations such as 

simulation need to be brought in and the question of 

international students, who bring large amounts of 

money into the University, needs to be addressed. The 

reputation of the Medical School is at stake and we 

are accountable to society as a whole as well as to 

individual stakeholders. The question of fitness for 

purpose arises. 

The response is to strive towards excellence in medical 

education, starting by examining what we do. 

Education needs to take account of changes in 

healthcare and has to be integrated with research and 

continued professional development. Teaching needs 

to be “professionalised” by promoting teaching and 

scholarship career pathways, by becoming a focus for 

the NHS and Research Institutes and by recognising 

demands on providers. The medical curriculum needs 

to develop and evolve in keeping with trends in 

medical education. Evolution of medical education in 

the past has been slow, through the 18th and 19th 

century apprenticeship models to the Flexner model 

(1910) of graduate entry, basic sciences then clinical 

science, then Problem Based Learning which requires 

elaborate prior knowledge and is self directed, to the 

integrated model (Harden, 1995) with early clinical 

contact and horizontal and vertical integration. More 

recently there has been the outcome-based curriculum 

defined around what sort of doctors we aim to 

produce, the spiral curriculum with repetitive 

organisation of content and structure, and evidencebased 

learning and longitudinally integrated 

clerkships. In general there has been change from 

teacher-centred learning to student-centred learning, 

from knowledge-giving to problem-based, from 

medical discipline-led to integrated, from hospitalorientated 

to community-orientated and from a 

standard programme to a systematic approach. 

Problem-based learning has its good points. It results 

in self directed life-long learner, in enhanced cognitive 

50


abilities such as communication and critical thinking, 

better integration and retention of knowledge, the 

ability to deal with problems and uncertainty, and to 

self-assessment and motivation. In the Liverpool 

context the pure PBL model has lost its support. Most 

of the data on which it was based came from small 

medical schools with graduate entry. It is now 

thought that peer teaching in small PBL groups does 

not necessarily work because of lack of structure and 

limited peer knowledge. Clinical problem solving is 

not for students and medicine should not be self 

taught. Facilitators are misused and the cases 

employed are contrived. The evidence on which the 

effectiveness of PBL is based is limited and PBL has 

been driven by enthusiasts. 

In Professor Jha’s view the conflict over teachercentred 

or student-centred learning should be 

resolved by a teacher-student dyad and the conflict 

between didactic or self-directed learning should be 

resolved as guided learning. The conflict between 

knowledge-giving or PBL should be resolved by a 

modern curriculum in which we see learning which is 

guided, case-based, tutorial-based, technologyenhanced, 

partly in the workplace, repetitive and 

systems-based all playing a part. We should be aiming 

not merely for competence for all but, at least for 

some, as excellence as a scholar, a practitioner and a 

professional. Professor Jha’s aim is to have the 

Liverpool Medical School recognised as one of the top 

schools nationally and internationally. This would 

require use of evidence, innovation and achievement 

of academic excellence. 

There followed a spirited discussion with the 

audience. An F1 trainee at Aintree who was a 

graduate of Queen’s University, Belfast asked about 

the timetable for change. Professor Jha said the 

curriculum review would go on for the next three 

months and it was hoped that a new course could be 

introduced in 2015, although some changes could be 

started in 2014. The more different the new course 

was from the current one, the more difficult 

introducing the new course would be. He wanted to 

get it right. An F2 trainee at the Royal who was a St 

George’s graduate said that she did not realise how 

wonderful her education had been until she came to 

Liverpool. There was mention of ‘surgical scousers’, 

which is endorsed by the Faculty, and the cap of 7.5% 

on international students who brought a great deal 

of money to the University. 

The President thanked Professor Jha for his fascinating 

talk and wished him well with his mission. 

Dr W Taylor 

51


Minutes of the Ninth Ordinary Meeting 

Held on Thursday 31st January 2013 

‘Life for A Doctor as an Independent MP’ 

Dr Richard Taylor, Retired Consultant Physician, Independent MP for Wyre Forest 

2001-2010 and Co-Leader of the National Health Action Party 

Mr Roger Franks and Dr Richard Taylor 

Dr Taylor gave a fascinating insight into the life of an 

independent MP, and his experience of representing 

both his constituents and the wider interests of the 

public as a medical man in Parliament. He did not 

present any slides because “you all know what the 

House of Commons looks like - very full at Prime 

Minister’s Questions and very empty with a few 

people asleep at other times.” Instead he stated self 

deprecatingly that it was his intention to talk “until 

he saw people beginning to drop off”. 

Being a Member of Parliament had been a most 

amazing second career and it had been an enormous 

privilege to represent the people he had known so 

well as a physician. The huge advantage of being an 

Independent was that you were free to vote for what 

you thought was right and in the best interests of your 

constituents, without the interference of whips. Being 

an MP was a full time job, involving going to London 

on a Monday, coming home late on a Thursday, and 

spending time with constituents on Friday. So, the 

role was divided into two parts, the work in London, 

and the work at home. 

At home, an MP’s job was a round of formal openings, 

concerts, charity events, scout parades, visits to 

schools, factories, offices, businesses, and lastly 

surgeries. However there was a huge difference 

between medical surgeries and MP surgeries - you are 

allowed to take the history, but you are forbidden to 

carry out the examination! 

Dr Taylor had won his seat on the issue of hospital 

facilities, and as some of his constituents were being 

treated in an overworked hospital some distance 

away, he witnessed some terrible complaints. One 

constituent’s elderly mother had spent twelve hours 

in a hospital bed with a corpse next door to her that 

hadn’t been removed. One gentleman with mild 

dementia had been admitted to hospital, during 

52


which time his false teeth went missing. The hospital 

staff asked his wife, who did not know where they 

were, and no one could find them. LMI members 

gasped in horror as Dr Taylor revealed that it had 

taken three weeks in an acute hospital ward for them 

to discover that his false teeth were stuck at the back 

of his throat. Dr Taylor had obviously pursued that 

case very vigorously. However in his experience the 

NHS complaints process is a total complete dead loss 

from the patient’s point of view. The patients are not 

allowed to choose the independent advisor and 

somehow the independent advisor allocated in that 

instance produced a whitewash. There was a worse 

occasion, where a little boy of seven and a half died 

because his parents couldn’t access the right urgent 

care facility for him, which Dr Taylor would discuss 

later in the talk. 

There were obviously many non-medical issues as well. 

One of the strangest of these, and one of the first 

people who had come to see him was a rather oddlooking 

lady who claimed to represent a coven of 

Wyre Forest witches, who complained that they were 

being discriminated against. Dr Taylor, nonplussed, 

did absolutely nothing about this and three weeks 

later was surprised to receive a thank you gift of a 

book of dubious poetry from the same lady, who was 

delighted because the discrimination had stopped. So 

that was one of his successes! 

However, his best success was the case of a lady who 

had come to him in desperation. Her husband had run 

up debts of £44,000 which were absolutely nothing to 

do with her. She was in the process of divorcing him 

and he had hung himself the day before the divorce 

became absolute. Because the divorce had not gone 

through she was liable for his entire debt, £29,000 of 

which was owed to HSBC Bank. Dr Taylor had written 

what must have been the best letter of his life to HSBC 

and managed to convince them to waive the entire 

£29,000 debt. 

After that brief glimpse of what happens at home, Dr 

Taylor moved on to work in Westminster, which 

consisted of paperwork, debates, divisions, 

parliamentary questions and committees. In debates, 

a Bill is heralded by the manifesto and announced in 

the Queen’s speech. Dr Taylor confessed to feeling 

some sympathy for the Queen, who every year has to 

wear a desperately heavy crown and read out things 

she must think are absolute drivel. He felt even more 

sorry for her handmaidens, the two ladies of uncertain 

age who had to stand either side of her dressed in 

white bridesmaid’s frocks, looking sadly out of place 

and a little embarrassed. MPs were heralded to go to 

the House of Lords by Black Rod, and it took quite a 

long time to get there. The Queen was usually 

halfway through her speech by the time MPs arrived, 

and it was always very crowded. Only because Dr 

Taylor is quite tall was he able to just make out the 

top of her crown. 

The first reading of a Bill is literally just a reading, with 

no discussion. Following this is the second reading 

and the first important debate. The debate is always 

opened by the relevant minister, who is followed by 

the relevant opposition shadow minister. 

Contributions go from side to side, government to 

opposition, so when there are three parties, after the 

opposition minister, a government back bencher had 

a marvellous opportunity to come in, and then the 

opposition in the form of the Liberal Democrats. On 

some occasions, the people opening debates seemed 

to almost be competing in length, and if one went on 

forty-five minutes, the next one had to do fifty, and 

the third one had to do fifty-five. This became very 

tedious, because if an MP wants to contribute they 

must be present in the house for the opening 

speeches, wait until they are called, and remain for 

two speeches afterwards. 

To be called you must write to the Speaker stating you 

seek to catch his eye in a particular debate and deliver 

it to the Speaker’s office. There was never an 

indication of when he might be called, so Dr Taylor 

had developed some techniques to gauge this. In 

debates where many backbenchers have registered an 

interest in contributing, there are time limits for how 

long members can speak. This could be used to 

estimate the amount of time you had and whether it 

was safe to slip out for a coffee or a comfort break. 

For example, if each side has twelve minutes and the 

opposition is called, you know you have twenty-four 

minutes to spare. Another method was to walk 

around the back of the Speaker’s chair whisper into 

one of his ears, is it was safe to go and get a cup of tea 

and come back in? He always hoped he would get 

some inkling of when he was likely to be called, but in 

his nine years at Westminster he had never ever seen 

the Speaker’s list with the order in which people 

would be called. 

However, the Speaker evidently valued the presence 

of a medical man, as soon after Dr Taylor got in, the 

Speaker invited him for a cup of tea, asked how he 

was settling in, and stated his intention to call him on 

53


medical matters. Mr Speaker followed through on 

this, and almost every time he stood on health 

questions or medical debates he was called, so much 

so that some of the ordinary party backbenchers 

began to become envious. However, during Dr 

Taylor’s maiden speech there was what he termed a 

“slight disaster” - a mobile telephone rang. The 

Speaker, outraged, leapt to his feet to give the person 

with the phone a rocket, but Dr Taylor, who had not 

yet realised that the minute the Speaker stands up all 

others sit down, remained standing, and therefore 

received the rocket intended for the owner of the 

phone. It was, he remarked, one way of learning 

things. 

Before becoming an MP, Dr Taylor had always assumed 

that the point of a debate is to try and persuade 

people to your way of thinking, but fairly rapidly 

realised that because of the strength of the whips, an 

Independent was unlikely to change anybody’s mind 

on the Party line. He was reminded of a quote from 

AP Herbert, who was the Independent MP for the 

University of Oxford from 1935 until 1950, when the 

University seats were abolished, who had written this 

during the Munich debates: 

‘I have even thought that, on great occasions when 

the parties were furiously raging together, that the 

votes of independents, (cast with, of course, more 

conscience), might be as straws in the wind, and show 

the party leaders which way the pure air of free 

opinion blows.’ 

Dr Taylor had quoted this in a debate once, which 

unfortunately went down rather like a lead balloon. 

He did however know for sure that he had once 

managed to change one person’s mind. During the 

debate on the smoking ban in public places he was 

called to speak, and proceeded to go into vivid details 

of the effect particulates inhaled in a smoky pub had 

on blood platelets, and impressed on everybody that 

their coronary arteries were narrowing and plugging 

as he spoke, a description which convinced one Labour 

MP and inveterate smoker not only to give up the 

habit, but also to support the Bill. As a result of that 

legislation being passed, asthma in children and heart 

attacks had decreased and the overall rate of smoking 

is probably decreasing. 

Once the second reading is passed, a Bill then goes 

into the committee stage, formerly known as the 

Standing Committee, now called the Public Bill 

Committee, which is constituted with members in the 

ratio of members in the parties. Dr Taylor had sat on 

a couple in the place of the Liberal Democrats but 

rapidly became disillusioned with this stage of the 

process, as there was always a whip present to ensure 

no amendments other than government ones had any 

chance of getting through, no matter how sensible. 

Dr Taylor recalled his unsuccessful proposal to amend 

the wording of an indecipherable section of the 

Human Tissue Bill from gobbledegook to something 

more meaningful. In addition, Public Bill Committees 

are “guillotined”, which means that when the 

scheduled time period is over, the debate stops, 

government amendments that haven’t been reached 

automatically pass, and opposition amendments that 

haven’t been reached automatically fail. As he was 

not under pressure from whips to sit on these 

committees, Dr Taylor had decided to concentrate on 

more productive Parliamentary functions. 

After the committee stage there follows a debate on 

the report from the committee, then a third reading 

of the Bill. If it is passed on the third reading, the Bill 

goes to the House of Lords where there is no 

“guillotine” and considerable number of experts to 

pore over the contents. This is important because the 

Bill can be taken through literally word for word. 

After being passed by the House of Commons, the Bill 

receives Royal assent. 

The most exciting times for Dr Taylor were the division 

votes and rebellions. One method of voting is a 

division of the assembly, during which MPs can walk 

through either the ‘Aye’ or the ‘No’ division lobbies to 

indicate their vote. On the Iraq war division, 

approximately 139 Labour rebels, all the Liberal 

Democrats, 17 Tories and Dr Taylor voted against. The 

atmosphere in the ‘No’ Lobby had been absolutely 

electric, because most of those Labour rebels had 

never rebelled about anything before. It is an 

unspoken agreement that MPs never shake hands, but 

in that lobby everyone shook hands as though they 

needed some sort of physical contact to reassure them 

after taking the huge step to rebel. The Whips could 

be quite terrifying, standing in the gangways to the 

‘wrong’ lobby looking foreboding. On one occasion as 

Dr Taylor was politely saying “excuse me” to a Labour 

Whip who was blocking his way, Gwyneth Dunwoody 

came sailing past from behind him, elbowed the Whip 

out of the way, and declared “this is the way for true 

Labour”. She was his best friend ever since. 

During his after dinner speeches at one stage Dr Taylor 

always used to say, “I am dreaming of the time when 

54


one vote makes a difference,” and that time did 

eventually come. At the beginning of 2006, the 

Religious and Racial Hatred Bill came up, and it came 

back from the House of Lords, which had suggested 

some sensible amendments. The Government put up 

a Motion to Disagree with the amendment, but in the 

subsequent vote, the House of Lords amendments 

were voted through by one vote. Dr Taylor likes to 

think of it as his vote! What made it even better was 

that the Labour whips had told Tony Blair that he did 

not need to attend that particular vote. 

A huge weapon for the backbencher is the 

adjournment debate, which is usually a thirty minute 

debate at the end of the day. The backbencher has 

fifteen minutes to state their case, and the Minister 

has fifteen minutes to respond. These can be on any 

issue, and most of Dr Taylor’s had been health related. 

One of these debates had been regarding the small 

boy mentioned earlier, who died because his perfectly 

sensible, articulate parents did not know where to 

take him, noting that there was no A&E in the area. 

They tried the GP, who missed everything, they tried 

the Minor Injuries Unit, which wouldn’t see him 

because it wasn’t an injury, they tried the out of hours 

service, which again completely missed the diagnosis, 

and because they were reassured, they did nothing 

else and this poor little boy died. This and other 

similar instances were the beginning of the institution 

of services like the 111 telephone number and NHS 

Direct, which are of huge importance providing 

guidance to those needing urgent care, but not 999 

emergency care, and who don’t have an A&E nearby. 

Parliamentary Questions are another process. Prime 

Minister’s Questions are an absolute circus, and the 

sad thing is even if the government says something 

everyone agrees is right, the opposition have to argue 

against it and vice versa. There was a memorable 

occasion when Fathers for Justice broke into the 

Gallery. Dr Taylor thought they should have been in 

the England cricket team, because they managed to 

land all three of their flour bags on Tony Blair’s 

shoulders from the Gallery. The opposition side all 

thought it was a huge joke. Parliament had also been 

invaded by the foxhunting people, who actually 

managed to get into the Chamber. There was a 

tremendous uproar, the Sergeant at Arms fell over his 

own sword as he tried to reach them and a very large, 

very pompous senior MP waddled down from his seat 

to try and grab them, which was hugely entertaining 

to the rest of the MPs. Dr Taylor described it as “the 

best pantomime you have ever seen”. 

One of the more effective types of committee is the 

Select Committee. There is one for each department 

and the Health Committee was appointed by the 

House of Commons to examine the expenditure, 

administration and policy of the Department of 

Health and its associated bodies. Dr Taylor sat on the 

Health Committee for the duration of his time. Select 

Committees try to work on consensus rather than on 

party lines, and certainly with the Health Committee 

this worked almost entirely. Latterly, the Health 

Committee had done three extremely useful bits of 

work on patient safety, commissioning and value for 

money, and one of Dr Taylor’s regrets about losing his 

seat was that those crucial three reports, which told 

the incoming government exactly what needed to be 

done to the Health Service, had just been shelved. Dr 

Taylor was very modest about the differences that he 

had made in his time in Parliament, but he had clearly 

had a strong hand in a lot of Health Committee work, 

for instance highlighting venous thrombo-embolism 

in hospitalized patients, which was causing 25,000 

deaths a year. A session in the Health Committee had 

raised awareness of this and put systems in place to 

manage the risk of it in hospitals. 

Another part of the Parliamentary function is All Party 

Groups. Dr Taylor had served on groups for patient 

and public involvement, local hospitals and floods. 

After being woken up on Christmas morning by some 

very angry people from a housing estate where all the 

sewage was coming up in their back gardens and 

kitchens, he also joined the All Party Group for sewers, 

which successfully secured improvement in the sewer 

maintenance systems. 

Lastly, there were twenty Private Member’s Bills 

allowed per session. Dr Taylor instigated one, the NHS 

Public Interest Disclosure Support Bill (he had been 

hoping to entitle it the NHS Whistleblowers’ Support 

Bill, but was told that ‘Whistleblowers’ is not a 

Parliamentary term). Copies of the Bill were printed 

and it came up for debate, but even though it had 

support across all three parties, certain philibustering 

right wing Tories were determined to impede the Bill. 

If any MP, without standing, shouts the word ‘Object’ 

loud enough for the speaker to hear, everything stops. 

Unfortunately Dr Taylor’s Private Members’ Bill was 

objected to, so it was not passed. 

Dr Taylor felt that MPs were held in pretty low 

opinion. Whilst the recent expenses scandal had not 

helped matters, this was certainly not a new thing. Dr 

Taylor quoted Dickens’ description of Mr Gregsbory, 

55


Member of Parliament from ‘Nicholas Nickleby’: “a 

loud voice, a pompous manner, rhetorical command 

of sentences with no meaning in them, in short, every 

requisite for a very good Member indeed.” Dr Taylor 

noted that the tradition continued, with some graffiti 

found underneath the Commons: “Guy Faulkes was 

the sanest man who ever went into Parliament, and 

look what happened to him.” Paul Flynn, a Labour 

MP for Newport, had written a book called ‘Commons 

Knowledge’, which featured ten commandments for 

back bench MPs, and one of which was: “Neglect the 

rich, the obsessed, and the tabloids and seek the silent 

voices.” 

He also couldn’t resist quoting Groucho Marx: “Politics 

is the art of looking for trouble, finding it everywhere, 

diagnosing it wrongly and applying unsuitable 

remedies.” And lastly, Tony Benn: “when there is a 

great cry that something should be done, you can 

depend on it that something remarkably silly probably 

will be done.” The absolute example of that today is 

Lewisham, where every doctor, every MP and every 

patient involved has told Jeremy Hunt that he is doing 

exactly the wrong thing for the wrong reasons, and 

yet Lewisham is to be closed. Dr Taylor was 

campaigning for a judicial review on this. The simplest 

thing to stop this from happening would be to have a 

lot more free votes in Parliament, because free votes 

would show that the government is listening, they 

want to know what their MPs think. But also we need 

to mobilise the medical profession. David Boyd, a 

retired physician from Edinburgh, wrote a book called 

‘Straying from the Path’ – a catalogue of all the 

doctors in politics, from the time of Queen Elizabeth I 

onwards, which draws attention to a letter in the BMJ 

of 1909: 

“The attitude of most medical men towards politics 

was summed up by a picture in Punch, when the 

doctor informed the patient that his politics depended 

on who he was attending. We have a Labour party in 

parliament, why not a medical party? As a profession 

we are too fond of ‘taking a back seat’, as the saying 

is. In many countries often medical men are great 

leaders in the political world, and I contend that 

should be the case here. We have through our work 

a vast knowledge of the lives of the people, of their 

wants and their work, and yet year after year, our 

noble profession neglects a most sacred duty in not 

taking an active part as a whole at any rate the 

domestic politics of the nation.” 

A number of medics are now forming a new political 

party called the National Health Action Party. The 

object with which the party is established is to 

campaign through the democratic process to improve 

the health of the nation and the restoration and the 

preservation of the NHS for the benefit of the people 

of the UK. Dr Taylor referred the audience to the 

website www.nationalhealthaction.org.uk for more 

information, and left us with two of his favourite 

quotes: 

The first is Václav Havel, the first President of the 

Czech Republic, 1993-2003, who said: 

“Politics can be not simply the art of the possible, 

especially if this means the act of speculation, 

calculation, intrigue, secret deals and pragmatic 

manoeuvring, but it can also be the art of the 

impossible, that is the art of improving ourselves and 

the world.” 

The second is Bryce Courtenay, a South African who 

was banned from returning to South Africa during 

apartheid because at the age of 18 he had been trying 

to set up a weekend school for Africans, and who 

became an Australian citizen and a very famous 

novelist. Dr Taylor was influenced by this right at the 

beginning of his career as an MP after encountering it 

in the office of a good teacher in a failing secondary 

school: 

“Dare your genius to walk the wildest unknown way. 

Go where you've never been before. Dream up a 

destination, a path to follow, the wildest unknown 

way...Dream the impossible dream and start walking 

towards it.’ 

That is what we want from the medical profession, 

from interested lay people who know about the NHS, 

Allied Health Professionals, nurses, anyone who is 

prepared to try and stand up for the NHS. Thank you. 

Questions: 

Q. Could Dr Taylor explore what the National Health 

Action Party’s position was going to be vis à vis 

standing candidates and influencing the policy review 

on the NHS and social care integration? 

A. At the current stage in the party’s development the 

focus was on establishing its organisational structure, 

to improve the handling of resources and 

communication with members. NHAP might possibly 

56


have an influence on the Labour Party, but Dr Taylor 

revealed he was dubious about trusting them in the 

light of some of New Labour’s actions. The NHAP was 

hoping to stand candidates for the European elections 

in 2014. With general elections, their position would 

be not to stand candidates where they would simply 

split the vote and thereby waste votes, and not to 

cause a risk to any candidate or sitting MP who 

represented the best interests of the NHS. To be 

elected, they would need the right person, the right 

time, and the right issue. A well known local 

candidate was helpful, and if that well known local 

person happened to be a doctor it helped 

tremendously - one’s successes were still here to vote 

for you, and one’s failures possibly were not! 

Q. Dr Taylor was asked for further details about the 

111 number he had mentioned during his lecture. 

A. If you lived in an area without an A&E, and the 

situation was not serious enough to dial 999, there 

were a number of services available: NHS Direct, local 

GP practice, the nearest Minor Injuries Unit, the 

nearest Walk-in Centre and so forth. The 111 number 

was intended to be connected to a triage system 

called NHS Pathways, which was tailored for each 

area, and designed to inform the caller which one of 

those was appropriate for their situation, or whether 

their condition was serious enough to make the 

journey to A&E. 

Sir Bruce Keogh, Medical Director of NHS England 

seems now to be envisaging a four-tiered structure, 

similar to the Northern Irish system, as follows: 

Tier 1 - Major Trauma Departments 

Tier 2 - Standard A&E departments based in District 

General Hospitals 

Tier 3 - Urgent Care Centres, which are carefully 

designed to deal injuries via simple medical 

procedures. 

Tier 4 - Minor Injuries Units 

Unfortunately, due to the current drive towards 

privatisation the 111 service was being offered out to 

various different private providers regionally, so it 

would not provide a standard service across the 

country intended under NHS Pathways. 

Q. A questioner noted that there seemed to be 

relatively few medically qualified people in the House 

of Commons, and these experts were not always 

consulted or their advice heeded, nor did they, with 

one noticeable exception, rise in the hierarchy of the 

Department of Health. He even had the impression 

that most politicians secretly thought that if there 

were no doctors in the Health Service it would run 

much more smoothly. Did Dr Taylor have the same 

impression from his time in Westminster? 

A. There had been only 7 doctors in Parliament when 

Dr Taylor first got in, and even less the second time. 

Dr Taylor had been staggered in his first weeks in 

Parliament to learn of the low esteem and even scorn 

that doctors were held in by most MPs. He had been 

grateful for the support of Dr Howard Stoate, a 

Labour MP and GP, alongside him on the Health Select 

Committee. At the moment there were still relatively 

few medical people with informed perspectives in 

Parliament; Dr Taylor could think of Dr Andrew 

Murrison, Conservative MP and an ex-services doctor 

and Dr Daniel Poulter, Conservative MP and obstetric 

registrar, who was one of the junior health ministers. 

A few more health professionals, informed patients or 

doctors in the House of Commons could make a huge 

difference. 

Q. A questioner expressed the opinion that he might 

be in a minority of one in thinking MPs are not 

overpaid, and asked Dr Taylor for his comments on this 

subject. 

A. Dr Taylor raised a wry laugh from the audience by 

saying that the MPs salary had been a marvellous way 

of supplementing his NHS pension. He thought that if 

MPs ‘allowances’ had been called expenses, and 

justification for spending sought at the point of 

claiming, the whole expenses problem could have 

been avoided. MPs pay did allow one to have a 

reasonable place to live for the four or five days it was 

necessary to be in London. However MPs were 

becoming younger and it might not be enough to 

support a young family. He did not claim to know the 

answer – means testing would be problematic and 

there were some individuals who obviously had 

independent means to support themselves and did not 

require extra pay - but thought that there should 

either be a slightly higher salary and very, very, tight 

control of the expenses, or a high salary and no 

expenses. 

Q. How were the aims of the National Health Action 

Party, i.e. the defence and the improvement of the 

NHS to be achieved? A market system or a nationally 

funded system? 

A. The National Health Action Party was utterly 

against marketisation and wanted to see the abolition 

57


of the purchaser/provider split. Dr Taylor took this 

opportunity to quote a recommendation from the 

Health Committee report on commissioning: 

‘Whatever the benefits of the purchaser/provider split, 

it has led to an increase in transaction costs, notably 

management and administration costs. Research 

commissioned by the Department of Health, but not 

published by it, estimated these to be as high as 14% 

of total NHS costs. We are dismayed that the 

Department of Health has not provided us with clear 

and consistent data on transaction costs, the suspicion 

must remain that the Department of Health does not 

want the full story to be revealed. We are appalled 

that four of the most senior civil servants in the 

Department of Health were unable to give us accurate 

figures for staffing levels and costs, dedicated to 

commissioning and billing.’ 

Q. What were Dr Taylor’s thoughts on the European 

Working Time Directive and the comments of the 

President of the Royal College of Surgeons, who had 

recently told his junior doctors that they could either 

follow the rotas as set out by the Directive, or they 

could get on with the job, actually get trained and 

become surgeons? 

A. Dr Taylor felt it was very, very clear that the 100 

plus hours that housemen did in his time was too 

much, but that 48 hours including on call was far too 

little. The second most common complaint he had 

received as an MP after lack of communication had 

been lack of continuity of care. How could you have 

continuity of care with a 48 hour week and 

inadequate time for full handovers? How could juniors 

become surgeons without enough surgical 

experience? He thought that there should be a 

campaign to relax this rule. 

Q. Would Revalidation prevent doctors from entering 

Parliament, apart from those who had retired? 

A. The answer was difficult, as being an MP was a full 

time job in itself. Dr Dan Poulter did a session or two 

as an obstetric registrar in London. Dr Sarah 

Wollaston had been a GP in Totnes, but was no longer 

practising. Howard Stoate had kept a couple of 

sessions per week as a GP, but whether this would be 

enough to revalidate Dr Taylor did not know. 

However, doctors were retiring earlier, so there might 

be lots of people who might feel that they want to 

supplement their pension and do a little interesting 

job on the side. 

The President gave the Vote of Thanks, praising Dr 

Taylor for going beyond the call of duty to improve 

the health of the nation, entering Parliament and not 

only speaking on health issues but many other matters 

- there were 28 things on the list of issues he had 

concerned himself with in Parliament - and to become 

involved in the founding of the National Health 

Action party. He thanked Dr Taylor for entertaining 

the audience and bringing them insights into the 

processes by which they found themselves governed. 

Miss Sam Pickup 

58


Minutes of the Tenth Ordinary Meeting 

Held on Thursday 7th February 2013 

‘Disaster at Sea’ 

Mr Ian Murphy, Curator, Liverpool Maritime Museum and 

Professor Charles Deakin, Adviser to the Royal National Lifeboat Institution 

and Anaesthetist, Southampton Hospitals 

The president welcomed both speakers and apologised for missing the opportunity to celebrate the centenary 

of the sinking of the Titanic in the last session 2012. 

Ian Murphy, deputy director of the Merseyside Maritime Museum, concentrated on Liverpool's role in the disaster 

of which he had first become aware watching the 1958 film "A Night to Remember". Titanic was built in Belfast 

by Harland and Wolff, sailed from Southampton on her maiden voyage, and was registered in Liverpool by her 

owners The White Star Line whose head office Albion House is still at the bottom of St James St. 

By the first decade of the 20th century, Liverpool had transported 9 million emigrants westwards, and was 

handling a third of world shipping. The city was rightly called the second city of the Empire. The chairman of 

White Star was Thomas Ismay, a Cumbrian who lived in Waterloo. He made a deal with Harland and Wolff to 

build exclusively Oceanic class vessels to capture back the lucrative trans Atlantic trade which was threatened by 

UK competitors, based in Liverpool such as Cunard and Harrison Line as well as Germans from Hamburg and 

Bremerhaven. For the Titanic maiden voyage the commodore of the fleet and the chief officer, as well as many 

crew were from Liverpool, some of whom gave evidence to the disaster enquiry. 

Many crew were lost but a proportion of first class passengers survived on the basis of "women and children 

first". This very interesting "take" on the Titanic was well illustrated with original paintings, sketches and 

photographs. 

Prof Charles Deakin is a paediatric cardiac anaesthetist from Southampton who also advises the RNLI and Air 

Ambulances. Drowning accounts for 40,000 deaths globally with 200 annually in the UK, many of whom are 

children chasing pets into ponds, rivers and pools. In 2011 the RNLI rescued circa 8000 souls from engine failures, 

injuries and medical disorders as well as capsizes. He defined drowning as respiratory submersion, which 

generates a cascade of patho-physiological events consisting of shock, hyperventilation or laryngospasm, fatigue, 

respiratory failure, hypoxia, unconsciousness and death. The professor debunked the theoretical notion of 

drowning differences in fresh water (haemolysis) and salt water (pulmonary oedema) whilst stressing the 

importance of cold water temperatures. 

Very cold water drowning has resulted in unexpected survival such as the Swedish skier who plunged headfirst 

into a frozen lake. She was rescued after an hour, taken by air ambulance, warmed by cardiopulmonary bypass, 

and discharged well, after 6 weeks. Men and children are more susceptible to cold immersion than women and 

he emphasised the value of prompt CPR by bystanders and rescuers alike. The presentation concluded with a 

spectacular video of a lifeboat rescue with on board resuscitation, leaving us with a final adage of "Nobody is 

dead until they are warm dead". 

There was a lively discussion and members retired with the strong impression of ‘A Night to Remember!’ 

Dr C C Evans 

59


Annual Dinner 


Guest Speaker: Mr Roger Phillips, Broadcaster 

Mr Roger Phillips 

Our Annual Dinner on St Valentine's day 2013 turned out to be very much a “family affair”. 

The President Mr Roger Franks and his charming wife Andrea formally welcomed some 53 of us all in our Council 

Room. We proceeded to consume sherries and have a most convivial chat, as members reunited for this pleasant 

event. The dignitaries of the County of Merseyside soon followed including our very own The Lord Lieutenant 

Dame Lorna Muirhead and the Presidents of our sister societies, too numerous to mention by name, but a most 

impressive "chain-gang". 

My Salmon Dill Soup was truly delicious as was the Guinea Fowl in Calvados Sauce, followed by English and 

Continental Cheeses and looking around, all alternative courses were much appreciated. 

After this tasty dinner and lovely wines the relaxed atmosphere continued with our Speaker Dr (Hon) Roger 

Phillips broadcaster extraordinaire of BBC Radio Merseyside, a notable friend of the LMI. He addressed - head 

on - several issues pertaining to the current problems of the NHS, their press representations, asking us all to be 

forthright in putting forward our own "takes" on them and to respond vehemently, in case of disagreement. All 

this, with great humour and aplomb. 

The nicely informal Vote of Thanks was proposed by our President and the response by one and all reflected their 

obvious enjoyment of this joyous event. 

Dr Andrew Zsigmond 

60


Minutes of the Eleventh Ordinary Meeting 


Joint Meeting with the Institute of Physics (Merseyside Branch) 

‘Medicine & Physics: Image Analysis in Cancer’ 

Professor Sir Michael Brady, FRS, Department of Oncology, University of Oxford 

The meeting was opened by the Vice-President, Prof 

Linda de Cossart who introduced the speaker. 

Professor Brady began by reviewing the many noninvasive 

ways of imaging the body organs that had 

been developed over the past twenty years, including 

brain, liver, heart and breast. They can demonstrate 

abnormal anatomy and physiology as well as how the 

body responded to drugs. 

Very often a single imaging method is not enough and 

further information can be obtained by adding others. 

CT scanning may give very good demonstration of the 

anatomical site whereas others, such as PET, have less 

sensitive resolution but show the site of the disease 

better. “Deformable registration” permits bi-modular 

fusion (CT and PET) or even tri-modular fusion also 

incorporating MR images. It is often of value to 

demarcate and calculate precisely the amount of 

abnormal tissue. Experienced radiologists can estimate 

dense tissue in the breast but this can be inaccurate as 

the images produced are altered by changes in 

imaging techniques such as contrast, brightness and 

other exposure factors. So he had developed a 

mathematical model to allow quantitative evaluation 

of this dense tissue, termed Standard Mammogram 

Form (SMF) for each image pixel. 

The first technical development he discussed was 

Deformable Image Registration so lesions can be 

demonstrated much more accurately by eliminating 

movement e.g. if near the chest wall. As the intensities 

of typical image features are not directly comparable 

for CT and MR, he developed a mathematical way of 

making them so - Modality Independent 

Neighbourhood Descriptor (MIND). With this 

combining method, good results have been obtained 

and application has progressed from laboratory to 

various clinical diseases including empyema. 

Dynamic Contrast Enhancement has been used in MR 

scanning. They have applied this in lesions of the 

breast, colon and rectum. This is related to the 

neovascularity associated with tumour growth and 

involves analysis of the signal enhancement with 

suitable contrast agents. It can help in assessing the 

results of treatment. He showed an example where 

there was still apparently tumour but their 

quantitative analysis showed that it had been 

eliminated, thereby avoiding repeat biopsies or more 

treatment. 

Dynamic PET uses Spatio-Temporal Regularisation and 

pharmacokinetics. PET gives information about 

metabolism and the preferred agent is 18 F labelled 

glucose. Previously one would start scanning 20-40 

minutes after injection: they begin acquisition 

immediately and obtain frequent, early, images as 

well. As there is considerable noise, particularly at the 

start of the measurements, image analysis techniques 

were developed to reduce this and give a far better 

picture of the uptake dynamics. 

He discussed quantitative studies in mammography 

distinguishing the different breast tissues: fat, fibrous 

tissue, glandular tissue and tumour. Denser breast 

tissues are more likely to develop a carcinoma. In 

clinical mammography this relies on the judgement of 

the radiologists but, being an engineer by training, Sir 

Michael had a greater interest in obtaining numerical 

information - the SMF and an interesting integral to 

calculate the volume of dense tissue. Using the 

evaluation programme they had developed, it is 

possible to give a personal breast density score for each 

patient after they have a conventional mammogram. 

This is now mandatory in some US states. On the basis 

of this numerical information, the woman herself can 

decide if she wants to proceed to further breast 

investigations such as ultrasound or MR scanning. 

The Oxford Cancer Imaging Centre contains 

departments whose most important feature is that 

they do not respect departmental boundaries and 

compulsory collaboration is the most important aspect! 

Many people work there including clinicians, materials 

scientists, mathematicians and engineers as well as a 

61


wide range of laboratory specialties. They are in six 

interacting groups: chemistry, antibody-based 

imaging, mathematical modelling, image analysis, preand 

post-treatment assessment and image guided 

radiation therapy. Research projects included labelling 

drugs and proteins to study intracellular processes, 

penicillin binding proteins (and the use of 

nanoparticles) for tumour detection especially minute 

metastases, and MR imaging to assess the effectiveness 

of Vinflumine in treating mesothelioma (of increasing 

incidence, especially in the Third World). They have 

developed a near-infra-red fluorescence kit, which can 

be used with certain injected chemicals to demonstrate 

the sites of some cancers. He illustrated this with a 

video of the detection of a sentinel lymph node at 

laparoscopy in a patient with carcinoma of the cervix. 

He concluded by mentioning the Oxford Targeted 

Cancer Research Centre, which has recently received a 

grant of £35 million from the government and a 

further £70 million from private sources including 

industry. This is going to be widely collaborative to 

include a wide breadth of expertise and enthusiasm in 

the treatment of cancer. 

After much applause, he answered questions. The 

wide changes in imaging techniques over the years 

were commented upon. Some of these imaging 

procedures are expensive e.g. about £1000 a time for 

a PET study. However so are the drugs and if these 

quantitative methods are able to select only the people 

who will respond, it will be a worthwhile investment. 

He regretted that the various software programs, 

though accepted widely in the United States, have not 

been so popular here, yet. Addressing, particularly the 

many younger members of the audience which 

included physics students from local schools, he 

stressed how important it was to DO SCIENCE. [His 

emphasis]. 

Prof Newsam from the Institute of Physics thanked the 

speaker for his very interesting and valuable 

contribution. 

[Prof Brady displayed various equations on some of his 

slides. They have not been included in this account but 

are available at LMI for those interested]. 


62


Minutes of the Twelfth Ordinary Meeting 

Held on Thursday 7th March 2013 in Manchester 

Joint Meeting with Manchester Medical Society 

‘Advances in Aortic Surgery’ 

Mr Aung Oo, Clinical Lead in Aortic Surgery, Liverpool Heart and Chest Hospital 

and 

‘Advances in Control of Arrhythmias’ 

Dr Derick Todd, Consultant Cardiologist, Liverpool Heart and Chest Hospital 

The meeting was opened by the President of the 

Manchester Medical Society, Dr D K Whitaker. The LMI 

President, Mr Roger Franks, introduced the first 

speaker, and Dr Whitaker the second. 

Advances in Aortic Surgery 

Mr Aung Oo, Clinical Lead in Aortic Surgery, LHCH 

Aortic aneurysms have been described as early as 

second century A.D, and surgical treatment first began 

in the 1800s with attempts at ligation. However 

effective treatment and prophylactic measures to 

prevent rupture had to wait. In 1888, Matas 

introduced endoaneurysmorrhaphy to reinforce 

defective vesslels, however it wasn’t until the 1950s 

that synthetic graft materials such as Dacron were 

available for direct repair. Cardio-pulmonary bypass 

techniques started in 1953 and stents were used from 

1976 onwards. 

The incidence of aortic aneurysm is 5-10 per hundred 

thousand and occurs in 3-4% of patients aged over 65. 

This is increasing. 40% occur in the ascending aorta, 

10% arch, 35% descending and 15% are thoracoabdominal. 

The five-year survival rate is 7-20% 

without surgery. 

The aetiology includes genetic causes, connective 

tissue disorders e.g. Marfan's syndrome and Ehlers- 

Danlos syndrome, infections, aortitis, dissection and 

trauma. Risk factors include hypertension, increasing 

age, smoking, bi- or unicuspid aortic valves and 

atheroma. Aortic diameter greater than 5cm increases 

the risk. About three patients per week are referred 

to the LHCH for surgery. 

He discussed the various forms of operation that can 

be used: one is the Bentall operation replacing an 

aneurysm of the aortic root and the coronary arteries 

are reinserted. External Aortic Root Support has 

synthetic material, which is wrapped around the aorta 

to reinforce it. It supports rather than replaces the 

diseased vessel, conserves the aortic valve but may 

reduce the size of the aorta to some extent and also 

the risk of dissection. However it is not a simple 

operation and its potential benefits are, as yet, 

unproven. If surgery does become necessary, it will be 

more difficult. An alternative is the David operation, 

which preserves the aortic valve. 

The basic technique is to use deep hypothermia with 

circulatory arrest. The patient is cooled to 18-25°C and 

the circulation stopped. The type of replacement 

depends upon the anatomy of the aneurysm. On 

many occasions though, aortic valve replacement is 

also necessary. Cerebral perfusion and arterial 

saturation must be monitored, especially in difficult 

cases with prolonged circulatory arrest. 

In repairing the aortic arch, half can be replaced - a 

hemi-arch replacement or a total arch replacement 

which includes the origins of the great vessels 

themselves. The "elephant trunk technique" has an 

additional appendage [yes, it does look like one!] 

from the graft, which can be used for more peripheral 

perfusion distally. It is valuable in extensive disease of 

the ascending and descending thoracic aorta. 

Sometimes a combination of graft and stents has to 

be used in the less fit patients, particularly those with 

a chronic dissection. 

For thoraco-abdominal aneurysms, a multidisciplinary 

team is used including vascular surgeons, 

interventional radiologists and cardiologists and of 

course anaesthetists with a special aortic interest. He 

discussed the various methods of bypass support, 

spinal drainage, temperature management and the 

variety of techniques used to maintain spinal cord, 

63


visceral and limb perfusion. Special emphasis was 

made of the risks of spinal cord injury and the 

monitoring that they use so that in 163 operations 

they have the low incidence of 2.8% of paraplegia. 

He reviewed the variety of different aneurysms that 

they had repaired, and their steadily increasing 

workload both from within this and other regions. 

One slide showed that LHCH does far more aortic 

surgery than any other centre in the country! He 

hoped that a fourth surgeon would be appointed to 

join them in the near future. 

[There were a large number of illustrations of the 

surgical procedures and their post-operative imaging.] 

Advances in Control of Arrhythmias 

Dr Derick Todd, Consultant Cardiologist, LHCH 

Dr Todd would talk about the control of cardiac 

arrhythmias, particularly using ablation techniques. In 

the Wolff-Parkinson-White syndrome there is an 

abnormal conducting pathway from the right atrium 

to the right ventricle through the Bundle of Kent. 

Their task is to find and destroy this pathway with a 

radio-frequency method of coagulation, achieving 

more than 95% success rates. 

More difficult problems have been tackled over the 

last 5 to 10 years. One is atrial flutter where the 

abnormal rhythm source lies between the tricuspid 

valve and the IVC. He described the various imaging 

techniques that have been used including MR with 

small magnets in the tip of a catheter and surface 

coils, and CT scans with highly developed computer 

programmes to give an exquisite demonstration of 

cardiac anatomy so precise ablation sites can be 

selected. One technique uses a balloon with 64 

recording electrodes on it. The anatomy and 

abnormal areas can be stored digitally for use during 

the ablation procedures. 

Ventricular tachycardia had been treated over the last 

20 years with implanted cardiac defibrillators. They 

are successful but an unpleasant experience. Some 

patients have a slower rate of about 110 beats per min 

- "capture and fusion beating". The ECG shows the T 

waves gradually becoming enveloped by the QRS 

complex. One clinical sign is "cannon waves" in the 

neck, the results of atrial contraction against closed 

exit valves. Amiodarone may be useful to suppress or 

slow it but more success comes with ablation therapy. 

Some of the patients have had previous infarcts and 

in the older and sicker there is a greater mortality and 

morbidity (up to 1%). However the ablation 

technique reduces the occurrence by about 50% and 

they have been repeating it in some patients where 

the first attempt failed. 

He described one patient with recurrent episodes of 

Premature Ventricular Contractions. An implanted 

intracardiac device had attempted to control it and 

the patient received some 25 shocks in a three-month 

period. Ablation therapy was then used. 

Some new drugs have recently come into clinical 

practice including Apixaben, which was more 

successful than Warfarin in reducing the complications 

of AF. In a series of 18,000 patients the incidence of 

stroke was reduced from 3% to 2.3% and there was 

less bleeding as a complication. It is expensive but its 

potential is still being evaluated. 

He concluded that although new drugs will be 

developed, ablation therapy will continue to be very 

effective where medication fails. 

Mr Franks gave the Vote of Thanks to both speakers, 

and expressed our appreciation to the Manchester 

Medical Society for their hosting of this meeting. 


It is estimated that approximately 40-50,000 patients 

suffer from atrial fibrillation in the region. However, 

they only treat between 500 and 600 AF patients a 

year, thus only representing the tip of the iceberg. 

Those not adequately controlled by medical means 

should be considered for ablation techniques: the 

abnormality starts in the region of the pulmonary 

veins. In paradoxical AF, medication gives 10% 

permanent freedom but 70% with ablation therapy. 

However, with persistent AF, cardioversion may be 

required. 

64


Minutes of the Thirteenth Ordinary Meeting 

Held on Tuesday, 12th March 2013 

Joint Meeting with the BMA (Liverpool Division) 

‘What is the Good of Medical Science?’ 

Professor John Harris, Professor of Bioethics and Director, Institute for Science, 

Ethics and Innovation, School of Law, University of Manchester. 

Two truths about the future: 

In future there will be no human beings and there 

will be no more planet earth 

Are these alarming or should we do something 

about this, to mitigate worst effects? 

Let us hope that humans will be more resilient but 

they will still need somewhere safe to live. Thus when 

the planet dies, we will have to find another place to 

live or develop an alternate way to build a planet. 

The reason for these ideas remains the importance 

and value of science. It is to the scientists we will look 

for remedies for our illness and to give a nudge to 

Darwinian evolution, slow and random as it is. But 

there is a problem with the scenario. Science is a great 

creator of our problems and there is a tension and 

paradox in welcoming science as well as being 

suspicious of it. 

Humans are an endangered species and are a threat 

to the planet. 

In 2011, two publically funded scientists tinkered with 

avian flu, sending papers to ‘Nature’ and ‘Science’ for 

publication. The editor of ‘Science’ referred the paper 

to the authorities, using the pretext that it might 

present bioterrorists with an opportunity. The NASSB 

recommended that ‘Science’ should redact some parts 

of the paper. Should ‘Nature’ do the same? A 

meeting at the Royal Society debated this last year, 

including the two groups who had developed the 

viruses Wisconsin and Rotterdam. The decision was 

made to redact the text and a version of the paper is 

what is being presented today. However, while 

consensus moved towards redaction, the data 

protection officer for President Obama then actually 

described how data storage worked and made several 

points. He questioned: How was this work done? 

Could it have been down on computer? Was the 

paper submitted on line? If so, anyone who wants the 

data can already know it’s there and get it. While we 

accept the assembled audience is boring and grey, by 

holding a meeting we draw attention to the whole of 

the problem. Some of the audience represented those 

for freedom of speech and freedom of science but 

they were matched by those who saw science as a 

danger. 

The debate I present therefore considers these two 

polarized positions. 

In the literature, there is a famous paper, seldom cited 

and written by Congreve July 4 1776 that set out the 

basis for rights including life, happiness etc. Consent 

of the governed drives the concept of liberty. Liberty 

is an unalienable basic right and thus, it is an implicit 

requirement that government is one of consent, 

established for the freedom of the people. 

However the explanation of this view is not entirely 

unquestioned. The scope and extent of this freedom 

is the freedom of speech and action. Mill stated that 

no one pretends that action is not as free as opinion, 

but one can lose these freedoms as a result of a 

mischievous act. 

Corn merchants are starvers of the poor but it is wise 

not to say this to a mob outside your house, 

illustrating the point that assertion of free speech is 

balanced by its application as instigation. This 

instigation is more insidious today. The responsibility 

of risk calculation includes compromise to held values, 

which will include liberty etc. It is all of us as citizens 

in this context. 

In a paper commenting on the virus science, two 

lawyers, John Crame and Larry Austin, noted that the 

First Amendment affords protection to artistic and 

scientific freedoms. Prior restraints are now seen as 

65


threatening the First Amendment, as they restrict 

freedom of speech. Redaction is effectively 

censorship. Thus the citizen never gets to know if the 

censorship is reasonable. 

Free speech is valued but the state and judiciary have 

a powerful responsibility. Thomas Hobbes, in 

‘Leviathan’ (1651), established the foundation for 

most of Western political philosophy from the 

perspective of social contract theory. He was a 

champion of absolutism for the sovereign but also 

developed some of the fundamentals of European 

liberal thought such as the right of the individual, the 

natural equality of all men and the artificial character 

of the political order. All legitimate political power 

must be "representative" and based on the consent of 

the people; and a liberal interpretation of law which 

leaves people free to do whatever the law does not 

explicitly forbid. Thus, the office of the monarch or 

an assembly is equated with the procurement of the 

safety of the people. Today, this is the main 

responsibly of a Government and which defines a 

sovereign state. Hobbes also implied that the practice 

of medicine, social security or the feeding of the poor, 

lasts only as long as the power to protect lasts. If it 

cannot protect, the sovereign (or state) loses the right 

to protect, thus limiting the power of the sovereign 

(or state). 

In which direction lays the security of the people? 

Hobbes echoes the US Declaration of Independence, 

with the consent being conditional on the 

government delivering a range of things to protect 

the people and rights as well. It is the balance which 

is critical and was at issue in the flu debate. 

The balance between scientific freedoms may reflect 

this fact. Look to science as a solution to our 

problems. 

Curiosity and the desire for understanding have a 

strong claim to be a distinguishing feature of our 

species. Our chance of survival thus relies on these 

points. Technology and engineering are the problems 

as well as the solution. Bioterrorism is an example, 

and humans are an endangered species. 

Science holds out our best hope for the future and the 

challenge is for science not to lose sight of the social 

contract, the role of securing the safety of the people, 

and knowledge is good only as far as good admits 

itself in degrees. Thus the issue turns on an answer, 

which is best when all things are considered. The 

solution to pandemics is bound up with the risk of the 

likelihood of a pandemic. 

Society cannot work with zero risk in society. The 

challenge is to take responsible for this in pursuit of 

public safety. 

Nature is itself the prime terrorist and we need to be 

prepared for the appearance of a range of infectious 

viral agents. Research is in the interests of public 

health. 

In a similar text from 1985, the author describes 

medicine as a way to frustrate nature and to prevent 

nature killing people in its usual way. 

We need a dual use solution, with the principle 

objective of containing freedoms. We cannot prevent 

bioterrorism at the cost of viral research. Such 

terrorism, being attributed to natural mutation, is 

misunderstood as a case of academic freedom versus 

public safety. 

My liberty too extends my arm, stops short of hitting 

your nose! JS Mill. 

The problem of the cloud Internet. 

Do you know who you are addressing on the web? 

Mill thought you acted to control what you say and 

the danger of thinking about your audience. I am 

giving lectures from time to time and appear on radio 

and in popular press. Impact data relates to how the 

University appears in press, but try asking the press 

office which utterance made it into the public press! 

An example was making a remark to release as a press 

release. A quote was provided and the University 

informed of the quote relating to the activities of 

Novartis. When it was released, the quotation 

received 35 million hits over the world! This is 

staggering but represents the state of today's world. 

A data security expert will say this is a problem. What 

is in the cloud exists not only in all places but also for 

all time. There is no delete button... This increases 

the stakes on information and is a game changing 

factor in repositories related to public talking. The 

side of caution and of safety is thus not to say 

something controversal. 

Our successors will be here. We will find somewhere 

else to live. 

66


Suggested advancement might come about by 

increased intelligence. Moral enhancement is on one’s 

mind all the time. Moral enhancement other than by 

cognitive enhancement is unlikely. An account must 

be given relating to how good is achieved by doing 

what is right, all things considered. Moral 

enhancement is thus a dimension of cognitive 

enhancement. 

The Royal Society talk would still have concluded by 

the dual multiple uses of all technology and to 

distinguish between right and wrong. It should be 

noted that Royal Society meetings are freely available 

on line. 

An interesting experience related to open discussion 

on a Texas plan for the dead. It was set in the context 

of abortions, but led to the suggesting that cadaver 

organs should be freely available without permission. 

Courts and coroners examine the dead legally to reach 

the cause of death as it is in the public interest. 

Speaking about this provoked death threats that 

knocked David Beckham off the front pages of the 

Manchester Evening news! 

We worry about rationale being in pursuit of the ideas 

but is the scientific pursuits that should be the primary 

outcome. Prima facie presentation is a danger! Pros 

cite bias in the approach but it is not at any price. The 

Pugwash movement arose to stop the nuclear 

physicists advance towards a bomb, and perhaps this 

is a good idea. 

Thus there are two sorts of bioethicists. One set goes 

to see what they do and get them to stop while the 

other thinks about it! 

Perhaps Darwin’s evolutionary concepts are too slow? 

How could we speed it up without mimicking 

creation? Eugenics attempted to make fine healthy 

offspring, and under this description it is a benign 

obligation. What is unacceptable is elimination of 

undesirable people. Evolution can be nudged in other 

ways, of course, and there are many of these. 

Cognitive enhancement can be achieved using drugs, 

and we perhaps should be using them more in healthy 

individuals. Any activity that confers advantage risks 

problems of justice. But is it unethical to be better 

than others, such is in education? Equal opportunity 

of access must be there. All these considerations need 

to be achieved by levelling down rather than levelling 

up since this leads to inequalities. 

In the vote of thanks, the President commented on the 

death threat issue alluded to by the speaker, and now 

hoped to come away with full justification of why he 

had undertaken a career in cardiac surgery in children. 

Prof P Dangerfield 

67


Minutes of the Fourteenth Ordinary Meeting 

Held on Thursday, 21st March 2013 

‘Current Developments in Health and Safety Policy’ 

Mr Geoffrey Podger, Chief Executive of the Health and Safety Executive 

Mr Roger Franks and Mr Geoffrey Podger 

Mr Roger Franks introduced Mr Geoffrey Podger, Chief 

Executive of the Health & Safety Executive. Mr Podger 

was brought up in Worthing and resided in Bromley in 

the famous Orpington. He joined the Civil Service 

straight from Oxford, starting in the Ministry of 

Defence as Principal Private Secretary to the Secretary 

of State for Social Services, and subsequently the 

Principal Private Secretary to the Under-Secretary for 

Health Promotion. He was the Project Manager for 

the NHS review in 1988, a subject which Mr Franks 

suspected he would stay well clear of this night! He 

worked in the Ministry of Agriculture, Fisheries & 

Food, was the Chief Executive of Foods at the Food 

Safety Agency, but left to become the Chief Executive 

of Health & Safety Agency and Health & Safety 

Executive in 2005. 

Mr Podger thanked the President for having invited 

him to speak and announced that he would talk about 

the changes and challenges faced by the Health & 

Safety Executive at the current time. He likened the 

Health & Safety Executive to the Royal Marines - if you 

can’t take a joke, you shouldn’t have joined! One of 

the great joys of being the Chief Executive of the 

Health & Safety Executive was that everybody was 

under the impression that they were absolutely 

enormous and everywhere spying on people, causing 

endless unnecessary bureaucracy and trouble. He 

would attempt to persuade the audience that in 

reality they cause very little bureaucracy and trouble 

(although others do) and are actually quite small. 

They are a body of 3,000 people covering all of Great 

Britain (which does not include Northern Ireland) and 

are based in Bootle. They have a total income of 

around £290 million, of which £160 million comes 

from the Government, the rest raised in cost recovery 

from the industries they regulate. 

The HSE is known as a “Non-Departmental Public 

Body”, which injects an air of mystery to the whole 

thing because nobody knows what an NDPB is, 

including most of the people who work in HSE. It is 

68


what is known as an “Arm’s Length Body”, a 

government organisation covering a specialist 

function that is not under day to day direction of 

Ministers. This slightly curious constitutional 

arrangement gives it some important legal functions, 

which he would touch on later. HSE had emerged 

from the concepts outlined in Lord Robens’ report 

prior to the Health & Safety at Work Act 1974. Robens 

had identified the aim of having goal-setting 

regulation rather than masses of law and bureaucracy, 

which he rightly predicted would be unhelpful. The 

fundamental principles were to run premises safely 

and protect the health of workers. Robens proposed 

to set up a body, which would oversee this and 

provide guidance, but the responsibility for Health & 

Safety would rest with the people on the premises (or 

‘duty-holders’, as they were rather pompously 

known). 

With a typically rational approach, ministers in 1974, 

had taken one look at this proposal and declared 

aghast that there was no telling what damage a single 

body might do. Mr Podger added sardonically, that 

they therefore decided to set up two bodies, who 

would hopefully fight each other all the time, leaving 

ultimate control in the hand of the Ministers 

themselves. Two bodies were promptly set up: the 

Health & Safety Commission, which was full of 

external people concerned with providing regulation, 

and the Health & Safety Executive, which was full of 

civil servants and designed to enforce the Act. 

Whilst he did not wish to denigrate the many good 

things achieved by both the Health & Safety 

Commission and the Health & Safety Executive, it was 

undoubtedly a very odd and uneasy relationship, as 

the roles and authorities of the two bodies were not 

clearly defined and their visions seemed to conflict. 

The Commission complained that the Executive never 

really did what the Commission wanted, and the 

Executive was never quite sure why the Commission 

existed! Shortly after taking his role at HSE, Mr 

Podger had proposed that the two should be 

amalgamated, a heretical suggestion, which had been 

received with deep shock. He had had to accept that 

people would naturally resist change and respect their 

views, but fortunately HSE was a very traditional 

organisation with a belief in the principles of the 1974 

Act, and responded to persuasion when it was pointed 

out that Lord Robens’ original vision prior to 1974 had 

been for a single body. So after a consultation in 2006 

the two organisations were merged into a single body 

in 2008. 

The Board were comprised of representatives from 

industry, employees, employers, trade unions and 

people representing the public interest (although Mr 

Podger was and is deeply suspicious of people who 

claim to represent the public interest). The Board do 

two things - they determine policy and have the 

responsibility for managing the Chief Executive (Mr 

Podger termed it “the misfortune of having to look 

after Geoffrey”). 

So what on earth does the Health & Safety Executive 

do? The first thing, which was very unusual in 

Government, is that they actually do determine Health 

& Safety policy. The process was very open, with 

public meetings and papers available on the Internet. 

HSE recommended to Ministers what they think needs 

to be done, and was usually successful in convincing 

them to do it. This was good because the important 

sectors are represented on the Board, which was 

therefore well informed and able to produce 

appropriate and sensible solutions to problems. 

One of the main bits of policy that the bodies have to 

deal with is further regulation. The great virtue of 

Robens was that he saw that legal regulation means a 

whole lot of rubbish bureaucracy - the emphasis 

should be on guidance and good use of resources, not 

legislation. This was fine up until we joined the 

European Union and needed to incorporate masses of 

additional Health & Safety legislation. At first the 

system had been easier to work with - the European 

Union passed legislation, then Member States came 

into compliance by writing their own Directives, 

applying the sensible parts and determining how the 

law would be applied in that country. The new system 

was more difficult. Quite a lot of it was perfectly 

sensible and followed the Robens principle, but this 

was regretfully discredited by the proportion which is 

completely barmy. Unfortunately there are some 

individuals within the European Union who are very 

much into legislating about their pet subject, as 

opposed to drawing up reasonable and proportionate 

guidance, and therefore HSE have to bring forward 

and codify a lot more than we are inclined to in order 

to meet the new requirements. HSE has worked with 

successive Governments and negotiators in the UK 

trying to keep things which are not sensible, evidence 

based, or proportionate out of UK law. 

HSE regulates probably around 900,000 businesses. 

They have no idea where the majority of them are, 

and have never visited them. Their prime means of 

getting people to do what they need to do is actually 

through information, guidance and a consultative 

69


approach. They talk to industry experts to expose 

problems and find sensible solutions. It is very 

important to stress that the thing that really 

influences Health & Safety more than anything else is 

encouraging people to take their responsibility 

seriously and giving them tools to do it. That is very 

much part of the Robens philosophy. But of course no 

one is remotely interested in this aspect and businesses 

are only fixated on those HSE Inspectors who keep 

turning up. Before the present Government arrived, 

HSE used to do 30,000 ‘pro-active’ (or surprise) 

inspections a year, they now do around 20,000. The 

likelihood of an inspector turning up on the average 

premises is pretty remote. HSE is also a Crown 

Prosecutor, which is a privilege they have to work very 

hard to keep. In England and Wales, (though not in 

Scotland) HSE actually prepare cases, bringing around 

500 to 600 prosecutions a year. It is a relatively small 

but important aspect of their work. 

HSE also have strict sets of sanctions to monitor ‘high 

impact’ industries, for example, nuclear installations, 

North Sea oil rigs, the chemical industry, petroleum 

gas - or as Mr Podger described them, “things that go 

bang in the night.” This was no subject for frivolity, as 

there was on average an explosion in a chemical plant 

approximately every six weeks. Whereas most of the 

900,000 businesses would hardly ever see HSE, these 

rather high-risk industries actually encourage visits, 

because they realise that a challenge from HSE at the 

emergence of a potential problem is preferable to the 

loss of life, income and reputation caused by a 

disaster. These activities were inherently dangerous, 

but were still important to the UK economy, which 

meant finding a balance between the necessity of the 

activity and regulating the risks. The money lost 

closing down an oil rig or a nuclear installation is 

huge, but so are the consequences of something 

going wrong, so it is a very tricky specialist area and 

these industries want a sensible regulator with expert 

people, who know when to say stop. Fortunately HSE 

works very closely with industry to keep things 

running as safely as circumstances allow. 

Another resource HSE has is the Health & Safety 

Laboratory in Buxton- what Mr Podger liked to call the 

“toy shop”. He claims it is located in Buxton because 

his is the only laboratory in the UK which has 

successfully applied for an explosives license, as there 

are only sheep there to object! Blowing things up is 

now a major enterprise for the Health & Safety Lab, 

for the very sad reason that with the increasing threat 

of international terrorism, people are very interested 

in actually understanding what happens during an 

explosion. It could be deliberate, or an accident, but 

when a large scale explosion occurs, the debris is 

labelled up and carted off to Buxton to be carefully 

examined by experts, who are usually successful in 

identifying what happened. The lab also provides HSE 

with the evidence to prosecute people who allow 

explosions to happen in their facility, because HSE 

doesn’t encourage that! Buxton is also home to the 

famous Larry, which is a totally revolting robot dummy 

which simulates spitting and projectile vomiting, used 

in all sorts of hygiene experiments and research, for 

instance it was used to research into how the winter 

vomiting bug Norovirus spreads. There is a lot of 

other occupational health research, including the 

testing of protective equipment. So the Health & 

Safety Laboratory, with around 400 people, really is a 

very important and interesting place, supporting HSE 

but with a very different character from the rest of the 

organisation. 

Mr Podger moved on to talk about some of the 

challenges faced by HSE. Statistically the UK has one 

of the best records on safety in Europe. In fact, we 

quite often take the top rank, although currently 

Slovakia had beaten us to the top spot. Occupational 

health was one of the greatest challenges, because the 

risks were less conspicuous and therefore less well 

understood by both employers and employees, and 

the solutions required constant caution. With 

exposure and latent diseases, you can’t see the effect, 

or immediately notice it, and employees are less likely 

to blow the whistle. Although they should be 

cautiously interpreted, statistics suggested that 

around 20,000 deaths a year are caused by 

occupational health disease. Around 4,000 of these 

were related to asbestosis, perhaps one of the better 

known occupational health diseases. What was 

perhaps more worrying, and absolutely unforgivable, 

was that even with awareness and regulation people 

are still being affected. 

HSE also get involved in the problem of stress - 

increasingly a real issue, but peculiarly difficult to deal 

with. Obviously many people use stress as an excuse 

when they are not stressed at all. For example, Mr 

Podger recalled one HSE worker - now no longer in 

their employ - who went absent due to stress because 

he wanted to go to the post office at 4pm and his line 

manager refused to allow it. As a consequence of this 

type of abuse, it is quite difficult to get people to take 

stress seriously where it is genuine, and difficult to 

recognise where it is not. 

70


Stress inspections were one initiative which HSE 

quickly recognised as a complete disaster and 

discontinued. One Chief Executive encountered Mr 

Podger at a meeting and said, “You know Geoffrey, 

we had a stress inspection by HSE when you first did 

them,” and he immediately knew what was coming as 

the man continued, “it was all right when you came 

but by the time you left we were all totally stressed!” 

HSE changed its approach, which is now to provide 

tools people can use to identify and deal with 

“stressors” in the workplace, and these tools are 

generally thought to be a world class product. In 

many instances the problem very often can be solved, 

it is just that the employer never thinks to ask the right 

questions and identify it. 

Enforcement is a tricky issue for HSE. The principle of 

the whole system is instead, to get people to take 

responsibility for their own Health & Safety. It is 

certainly not their intention to become a sort of 

workforce police, popping out from behind everyone 

working on a lathe and pointing out their mistakes. 

Such a system would be phenomenally expensive and 

ineffective. Mr Podger spoke from experience, having 

worked in the Food Standards Agency where the 

government actually ran this sort of system, called the 

“Behind You Service”. Invariably, it was unsustainable. 

The employers refused to do any meat hygiene work 

themselves as they were paying for the service and the 

inspectors went native because they wanted the 

factory to continue. What was needed was a Health & 

Safety system that people recognised the need for and 

wanted to operate themselves. 

When inspections take place, they are done 

‘proactively’ which means people never know when 

HSE might turn up! HSE can gain a genuine idea of 

where people are doing well, and where 

improvement or enforcement needs to take place. 

When an inspector finds an individual or organisation 

breaking the law, or neglecting a particular aspect of 

it, sometimes a verbal rebuke is enough, but if not, 

HSE have the power to serve notices on people 

requiring them to improve in a certain time frame, or 

in extreme cases to cease work until the problem is 

dealt with. Appearances are deceptive; HSE have 

found people working in poor, dingy, back of beyond 

premises who run perfectly good Health & Safety 

systems, and conversely also people who have invested 

millions and millions in plant but have actually never 

met their legal obligation to check whether it 

operates safely. 

It is not the case that everybody HSE proceeds against 

is some sort of rogue who is concerned only for their 

profits and not for their employees; some are well 

intentioned but dangerously ignorant. Not all of 

these would face such stringent action, but there does 

come a point in the Health & Safety system where the 

consequences of what they have done or might do are 

such that HSE brings a prosecution. There are around 

600 prosecutions a year and HSE succeeds in roughly 

93% of them. HSE consider prosecution to be 

important for two reasons, firstly justice for those 

affected, and secondly because penalties, prosecution 

and conviction are a very strong deterrent. 

At this point Mr Podger paused for questions. A 

questioner asked whether the HSE’s remit extended 

into the Armed Services. He replied that this was the 

case to some degree. Actions abroad were completely 

outside their remit, but HSE would become involved 

with regard to training incidents, of which there were 

too many. This was also true of the police and the fire 

services. He cited a case where live ammunition was 

used in a training exercise, resulting in a policeman 

being accidentally shot dead. A problem with the 

armed forces was that it is necessary to teach them 

how to resist what are euphemistically known as 

‘interrogation methods’. Of course these exercises are 

necessary, and HSE understands that it is reasonable 

that if people have to be exposed to high risk 

situations they must be trained. However, it is one 

thing for an incident to happen in the line of duty on 

the battlefield, and another thing entirely for it to 

happen in Catterick. 

HSE does not prosecute the armed forces, but there is 

a process called “Crown Censure” where they would 

be expected to explain what had happened. HSE 

actually found MOD entirely co-operative and helpful, 

because they don’t want to lose people in stupid 

training accidents. In the conflicts in Afghanistan and 

Iraq there have been well publicised accidents in 

combat, such as being fired on by your own side, but 

this was beyond HSE’s remit, resources and 

responsibility. HSE did also have a strong interest in 

the nuclear fleet, although Mr Podger was unable to 

elaborate on this “because it is too secret for me to 

know anything about it”. 

A questioner asked Mr Podger to elaborate on the 

nature of HSE inspections. HSE inspectors usually 

joined as graduates and for some industries, especially 

high risk ones, were expected to spend a period in the 

industry first, gaining insight before undertaking 

inspections. HSE insists that inspectors should be 

71


‘robust’ people for the obvious reason that people will 

try and hoodwink them. They need to be intelligent, 

with good judgement, because they are going to have 

to take some very tricky decisions on their own. The 

inspector will arrive on site, assess the responsible 

person, then tour the facility and look for any serious 

breaches. They can find some unbelievable things 

going on, for example, flammable liquids being stored 

next to flame sources. At the end of this tour they talk 

to management. How the inspectors react to a 

problem will depend partly on its severity and partly 

on the attitude and motivations of the responsible 

person. Inspectors do not waste time issuing penalties 

for minor faults, instead merely pointing them out. If 

there is a more serious problem they may say “we 

want it sorted and if by the end of the week, and if 

you can send us a photograph to show that it has been 

done, that is fine”. If there is a dangerous situation 

they may serve a notice ordering that equipment or 

area not to be used, or for it to be improved within a 

certain period of time. In a worst case scenario they 

may consider prosecuting, because it is such an unsafe 

system that even though there are no casualties yet, 

that it is only a matter of time or they have found 

something so incredibly irresponsible action needs to 

be taken. These are difficult cases to win because if 

there is no perceived victim people are more likely to 

want to defend them. 

The extraordinary thing is in some cases HSE people 

manage to keep on terribly good terms with people 

whilst enforcing against them. Mr Podger 

remembered one firm that was very keen on the 

welfare of their employees and very open, but 

absolutely clueless on safety. Only halfway through 

the tour, his inspector colleague had already served 

four notices. When they got to the fourth one they 

were absolutely looking at him in adoration as he was 

ruining their business and the Inspector gave up 

serving notices. That firm is now receiving special 

attention and help to correct their mistakes. For this 

reason it is better for HSE to keep a working 

relationship with those they enforce against, to ensure 

that they understand how to bring themselves back 

into conformity. Their inspectors have good relations 

with firms they have prosecuted over deaths. The key 

to HSE’s work was “the science of understanding what 

needs to be done, coupled with the art of getting 

people to do it”. 

HSE also get very involved in the regulation of the 

health and social care sector, and of course following 

Mid Staffs this is very high profile. HSE prefer not to 

get involved if there is already a knowledgeable 

specialist regulator. However in the Health Sector, the 

problem with the Healthcare Commission, and 

subsequently the Care Quality Commission, is that 

they lacked any significant enforcement powers. They 

could close hospitals, but it is much more difficult to 

close a hospital than a factory - there is the minor 

matter of what you do with the patients! They could 

give advice but they had no powers of prosecution. 

At Mid Staffs an investigation was done on the basis 

of medical statistics. The audience will know the 

limitations of those. The result was a much-quoted 

figure comparing expected and actual mortality rates, 

and on that basis they concluded quite correctly that 

the hospital was a shambles. HSE got involved but 

there was no basis for prosecution under the Health 

& Safety at Work Act, as it had not been proven that 

a single named individual was actually killed - how 

could HSE bring a prosecution based on an artificial 

figure? HSE takes quite strongly the view that a 

regulator should have a whole gamut of powers 

which ranged from doing absolutely nothing right 

through to prosecution. There are ways in which HSE 

can be brought in earlier, but the present 

arrangement is unsatisfactory, as there is another 

regulator applying different standards, and from the 

point of clinical staff this must be an absolute 

nightmare. 

In contrast, moving from the profoundly serious to a 

slightly funnier aspect, people are capable of imposing 

the most bonkers requirements on other people in the 

name of Health & Safety. This drives HSE absolutely 

mad, as these people are a thorough nuisance and a 

threat to the credibility of the entire system. HSE 

receives huge numbers of these cases, for example 

somebody who worked in a cafe was told that they 

couldn’t move cups with hot liquids in from one side 

of the cafe to the other unless they had had Health & 

Safety training, people are prevented from putting up 

Christmas decorations and cheese-rolling competitions 

are cancelled on the grounds that someone might fall 

down a hill. 

Case enquiries generally fall into three categories, 

firstly those where there is a genuine reason for a 

precaution, on which HSE reinforces the advice. 

Secondly there are cases which are obviously complete 

rubbish, on which HSE asks for the source of erroneous 

advice and tells the questioner to disregard it. Lastly, 

there are grey areas, where it is perfectly arguable 

that you should do ‘x’ or ‘y’ or nothing, on which the 

regulator will engage in discussion, but they do not 

engage in discussion with killjoys and bureaucratic 

72


jobsworths. HSE used to produce regular cartoons on 

the loony things that people do. Something else 

which Mr Podger had invented was called the Myth 

Busters Challenge Panel, which is on the HSE website. 

People can write in via this and ask if the insane thing 

they have been asked to do is really good Health & 

Safety practice, and in 90% of cases it is a load of 

rubbish. Conversely it is quite scary that some people 

write in about things that are perfectly sensible 

restrictions, but that is another story. HSE then publish 

their answers on the website, so everyone, not just the 

questioner, can see it. So far they have dealt with 

nearly 200 cases. What is clear is that there is a quite 

deeply rooted cultural propensity for people to quote 

Health & Safety as a reason not to do things. 

Whilst HSE are the regulator, Local Authorities are 

actually responsible for running 50% of the Health & 

Safety system in what are called ‘low risk premises’, 

for example supermarkets and retail premises. 

Unfortunately, many of the organisations imposing 

the most ludicrous and unnecessary restrictions in the 

name of Health & Safety are Local Authority enforced. 

Currently there was a tussle between retailers and 

government to try and get the Local Authorities 

removed from this activity, in favour of a centralised 

system, but perhaps surprisingly Mr Podger was still in 

favour of using the Local Authority function - 

provided the staff were trained to have sufficient 

expertise and judgement, and the Authority was using 

its resources sensibly. It is sensible to inspect premises 

on the basis of the amount of risk involved, as simply 

wandering around a load of low risk premises is not 

going to do much good. 

Chain retailers faced particular difficulties in that they 

have premises all over the place and get all the 

different judgements that Local Authorities make. 

They now have a system called the Primary Authority 

System, which enables them to choose one Authority 

to regulate them and achieve a degree of consistency. 

Mr Podger thanked the audience, and hoped that 

they now had a slightly different opinion of how 

Health & Safety actually works rather than the various 

normal perceptions, and also a more positive 

impression of HSE than when they came in, although 

he was willing to concede that HSE was not perfect 

under prolonged questioning. 

The audience took this as their cue for questions, and 

one listener enquired how HSE managed to keep their 

guidance up to date? Mr Podger responded that the 

honest answer was “badly”. HSE had made a major 

effort to clean up, update and computerise their 

guidance, but it was a struggle not only to keep it up 

to date but to keep it intelligible. One of the risks 

with an expert organisation is that you can easily fall 

into anorak-jargon, which does not help small 

businesses with a limited amount of time to 

understand the guidance easily and quickly. One of 

the things he was determined to do during his time 

there was to make sure there was a system in place to 

keep this task of revision going. 

A member of the audience reminded Mr Podger that 

he was speaking in the Liverpool Medical Institution, 

and asked how many medics were actually involved in 

Health & Safety? 

Mr Podger responded that HSE had a relatively small 

medical staff (less than 10, some part time) but that 

they also took quite a lot of external medical advice, 

especially on policy matters. There was a preference 

for doctors who were working in the profession and 

therefore aware of current trends and issues. HSE 

attempted to use its medical resource, internal or 

external, for questions that required a level of 

judgement, rather than just common sense. 

Conversely, there are questions which they would not 

dream of seeking to resolve without getting external 

medical advice. 

HH Nigel Gilmour had dealt with many of the Crown 

Court prosecutions for HSE in Merseyside over the past 

30 years, of which around 20-30 prosecutions were 

involving a fatality. It had been a matter of despair 

that historically some cases were brought anything up 

to 6 years after the fatality, and expressed a concern 

that HSE did not appear to have enough people to 

prosecute these cases in a reasonable timescale. 

Mr Podger agreed that to have to wait this long for a 

resolution was totally unacceptable and indeed HSE 

have a current goal of being finished, at the worst, in 

2-3 years at the absolute outside. What usually 

happens is that when there is a fatality on work 

premises, the death at work protocol comes into play. 

The police will take over and consider first of all 

whether there is a case for manslaughter. The police 

sometimes hold onto the case and it only comes to HSE 

after two years. That is the explanation for some of 

the delays, but some of it is simply that HSE has been 

juggling too many balls in the air. There is also a slight 

conflict of objectives when HSE and the police force 

work together, as the police are focused on finding 

the individual responsible and are not terribly 

concerned with investigating why it occurred, other 

73


than it is useful in proving the charge. HSE on the 

other hand are desperately interested finding out in 

why these things happen, to try and prevent them 

from happening again in the future. 

A questioner observed that HSE had obviously trained 

their inspectors very carefully. Were HSE also 

responsible for supervising the training of Local 

Authority enforcers? 

HSE was not responsible for this, although they did 

actually provide the training and materials for HSE 

Northern Ireland. Local Authority inspectors normally 

took a professional qualification and became 

accredited as Environmental Health Officers (also 

known as Public Health Inspectors). One of the 

problems that Local Authorities had is that while HSE 

had a central management structure largely composed 

of people who used to be inspectors themselves, Local 

Authority inspectors are usually managed by people 

who have no experience, and are not necessarily 

either supportive of bright inspectors, nor proactive in 

responding when problems arise. So whilst 

Environmental Health Officers were usually well 

trained, the problem was they were not necessarily 

well managed. Being an inspector was quite isolating, 

you spent most of your time dealing with people who 

made a loss out of your activities, and it was a difficult 

environment. HSE people came back to an office 

populated by other inspectors, and worked with 

people who used to be inspectors, so everyone had a 

commonality of interest. Local Authorities’ officers 

were more isolated and it was harder to keep up to 

date, which was the real training issue. 

Dr Bill Taylor asked if Mr Podger was aware of the 

reason for the closure of the cement factory on the 

Kirby Industrial Estate? The reason he enquired was 

that he was an amateur pilot and for years had used 

the nice constant plume of white smoke produced by 

that factory to navigate whilst flying into the 

Liverpool Air Traffic Control Zone from the north. 

Now it was no longer there he got lost! He added 

that there was also a very useful factory at Chirk so 

please could they try and keep that one open! 

Mr Podger apologised for handicapping his flying 

activities. He looked forward to having great fun 

telling his colleagues that they had upset aviationists 

in the Liverpool area, which was a new complaint! He 

noted that there certainly was one site in that area 

that had a long history of problems, including at least 

one fatality, and it had been an endless problem, not 

just to HSE but other agencies such as the 

environment agency. HSE had been involved in 

arguments over whether it could be kept open, and 

many were reluctant to close it due to the potential 

employment consequences of a closure for the local 

area, but in the end there was no choice. 

HSE would much prefer to keep places going rather 

than close them down. However, one of the worst 

mistakes they had ever made was in a Glasgow 

factory, where an inspector had very cleverly 

diagnosed a potential problem, but investigating it 

would have involved ripping out a lot of piping and 

tanks. The investigator allowed himself to be moved 

by the management, who convinced him that actually 

this would ruin the business, they couldn’t afford it 

and it would mean the closure of the site, and it 

stayed open. Sadly, about ten years later the entire 

thing exploded with significant loss of life and injury. 

It was a very depressing experience for the whole 

organisation, and a horrible lesson that if you are too 

concerned trying to save people’s jobs they can 

sometimes end up keeping their jobs but losing their 

lives. 

HSE was one of many authorities charged with 

inspecting hospitals. Some of these authorities tended 

to come and inspect theoretical concepts and policy 

which take a lot of time but don’t make a great 

contribution to the safety of patients. How could 

inspections be improved so that they actually pick up 

on sites that are failing? 

HSE no longer did proactive inspections on hospitals, 

and tried not to get involved in clinical matters, but 

what they did get involved in, for example, were 

situations where there were repeated complaints. The 

fundamental error with hospital inspections was the 

bizarre basis on which the Care Quality Commission 

were asked to inspect. Firstly asking everyone to fill 

out questionnaires to declare themselves wonderful 

was a waste of time and an annoyance. In Mid Staffs 

they had made a great mistake in relying on medical 

statistics to determine whether there was a problem 

or not. This was not to say that medical statistics 

weren’t incredibly valuable, but what happened in 

Mid Staffs was that people were over-reliant on 

statistics, whilst not listening to the people who 

complained, and it was clear from the Francis report 

that no shortage of people complained. The thing to 

watch out for was the same complaint turning up 

more than once, which indicates there is something 

wrong. 

74


Mr Podger thought that there was no need for a 

plethora of regulators in the same sector. Where 

there is more than one regulator, HSE has always 

attempted to arrange joint inspections, or one 

inspector to serve both. On the other hand, 

occasionally firms have such extreme specialist 

facilities that there may be justification for a specialist 

regulator because it would be unreasonable to expect 

a standard regulator to do it. In his view, the answer, 

which had not yet been achieved, was to rationalise 

regulators, and get regulators to concentrate on the 

things that mattered and stop fiddling around with 

minor processes. 

The President gave a Vote of Thanks. He recounted 

an incident which had taken place in a hospital not so 

far away. The hospital hired a cherry picker to stand 

a 30ft Christmas tree. The cherry picker arrived, and 

the Christmas tree arrived, and the driver set to work 

extending the cherry picker whilst the local workmen 

stood the tree up. All was going well until the whole 

thing collapsed, tree, workmen, cherry picker and all! 

It transpired that the man manipulating the cherry 

picker was not the cherry picker driver (who was too 

busy to do it) but the van driver, and the hospital staff 

had not thought to check. Luckily no one was injured. 

Mr Franks thanked Mr Podger for entertaining the 

listeners, giving his views on how to instigate change, 

his insights into European Government and for 

demonstrating that Health & Safety can be both 

sensible and also interesting and fun. 

On a final note, Mr Podger mentioned that one of the 

things that Oscar Wilde had been known to do at his 

plays was to review the audience. Mr Podger’s has 

been an admirable audience to whom it had been a 

pleasure to speak. 


75


Minutes of the Fifteenth Ordinary Meeting 

Held on Wednesday 27th March 2013 

Joint Meeting with the Athenaeum Club (held at the Athenaeum Club) 

‘Weird and Wonderful Liverpool: A Funny Introduction to Scouse Humour’ 

Mr Ken Pye, Liverpool Historian 

In the opulent surroundings of the Athenaeum 

Newsroom, Athenaeum and LMI members gathered 

for an evening of Liverpudlian larks. The meeting was 

opened by the President of the Athenaeum, thanks 

were given by the President of the LMI, and Mr Pye 

proceeded to regale us with tales of Scouse characters 

ancient and modern. 

Beginning with a medical slant, Mr Pye described the 

entrepreneurial efforts of the infamous Dr Samuel 

Solomon (1745–1819). Dr Solomon had gone into 

business manufacturing a particular panacea, the 

‘Cordial Balm of Gilead’, and placed an advertisement 

in the local newspaper which claimed it to cure, among 

other things “...discomfort in the bowel, excessive 

production of bodily waste, aches of the head and 

confusion of the vision, scrofula and related ills, all 

nature of venereal afflictions, all forms of female 

afflictions and the incapacity of, or over activity of 

certain male organs...” As Mr Pye put it, “who needs 

Viagra when you’ve got Cordial Balm...?” 

Perplexingly, hordes of scrofulous Scousers failed to 

stampede into his practice and buy this wonderful 

cure-all. Dr Solomon, having had the benefit of an 

education, had failed to take into account that only a 

very small percentage of the population of eighteenth 

century Liverpool could read, and had wasted his 

money. Nothing if not persistent, Dr Solomon changed 

his approach, and used the more productive method 

of paying someone to stand on a street corner 

‘drumming up business’, preaching about the 

wonderful miracle cures effected by the Cordial Balm 

of Gilead. The Balm provided a salve to medical 

anxieties of the era, and also a free source of 

entertainment. This marketing tactic proved 

devastatingly effective, with locals appearing in their 

hundreds for a free night out. Dr Solomon was one of 

the first people in Liverpool to market a product using 

the satisfied customer, who would declaim the 

wondrous effects of this medicine. A newspaper 

report of the time gives a verbatim quotation from one 

of these people, to whom no doubt Solomon had 

simply slipped a few bob: 

“For six years I was afflicted with a nervous disorder, 

but hearing of your famous Cordial Balm of Gilead, I 

have given it a fair trial. The symptoms of my disorder 

were that I oftentimes found my head heavy, with my 

vision strangely uncertain, and an odd sensation in my 

forehead. All liquors disagreed with my stomach, I 

was also frequently troubled with a continual belching 

and hiccupping oftentimes for weeks together which 

have lasted for these three years past. And to add to 

my afflictions, I frequently suffered from a great 

passing of wind from my other bodily orifice, much to 

the annoyance and discomfort of my family and 

friends. However, the wondrous benefits of three 

bottles of your Cordial Balm of Gilead have so cured 

my afflictions that I intend to buy a five pound case.” 

How could they resist? 

Dr Solomon employed another technique to 

guarantee sales and profits – he recognised that 

people viewed cheap as nasty, and made sure that his 

Balm was reassuringly expensive at half a guinea. It 

worked. He sold the Balm by the thousands of cases, 

over Liverpool and the North West then all over 

Britain. There was almost a strike at Liverpool docks in 

the early years of the nineteenth century because 

sailors were refusing to take to sea without a supply of 

Cordial Balm of Gilead. The sailors spread the 

reputation of the Balm, selling cases overseas, and 

Solomon ended up with agencies for the Cordial Balm 

of Gilead in 26 countries. He became very wealthy and 

built himself two great estates. In Kensington, he 

constructed a big stately home called Gilead House, 

and his estate ran from present day Sheil Road to West 

Derby Road. He later moved to the suburbs, Allerton 

and Mossley Hill, to the area around Booker Avenue, 

and built Mossley Hill House. He also spent a fortune 

on a great mausoleum, large enough for himself, his 

wife and three daughters and their husbands out of 

fine white sandstone. This mausoleum is described as 

being like the seven wonders of the world all rolled 

into one, with ziggurats, globes, pyramids and 

columns, and Solomon was buried there as planned. 

76


Unfortunately, the 1830s saw the expansion of the 

railway network across Britain, and by 1840 suburban 

railways were being built, one of which was the 

Liverpool loop line calling at Aintree, West Derby, 

Broad Green, Knotty Ash, Old Swan, Wavertree, 

Aigburth and Mossley Hill, at which point this 

wondrous mausoleum was demolished to make way 

for the development. The rail company claimed to 

have exhumed the bodies and buried them in the 

great Necropolis of Liverpool, which is now under 

Grant Gardens at the end of Atherton Road and West 

Derby Road. Mr Pye noted that to this day brides 

come out of Brougham Terrace, in their wedding 

dresses, cross over West Derby Road and have their 

pictures taken in front of Grant Gardens, without 

realising they were standing on top of 80,000 corpses 

that are still there. 

There are apparently some, however, who believe that 

the railway company could not be bothered with the 

expense of shifting the corpses and left them where 

they were. According to a map of old Mossley Hill 

overlaid with modern roads, the Mausoleum stood 

precisely at the junction of Cooper Avenue North and 

Brynmor Road in Mossley Hill. Mr Pye had given this 

talk at a Women’s Institute meeting and had the 

unfortunate consequence of causing an excitable WI 

member who lived in that area to become convinced 

she was haunted by the spectre of Dr Solomon. He 

attempted to reassure her by saying, “don’t worry, you 

just have to buy a bottle of Cordial Balm of Gilead and 

he’ll soon leave you alone.” 

Gilead House was demolished in 1846, and in 1865 the 

site was covered over with the terraced houses 

characteristic of Kensington, 21 streets in all, including 

Solomon, Balm and Gilead Streets. They also 

demolished Mossley Hill house, and after Solomon 

died, a rhyme did the round of the taverns and pubs 

of Liverpool: 

“Great Solomon has gone, 

His home and sepulchre and balm, 

If his mixture did mankind no good, 

At least it did no harm.” 

So what was in this wonderful concoction? Why was it 

selling so well? Did it really work? The recipe was 

found a year or so after Solomon had died, and the 

Balm was found to consist of several things. Minor 

ingredients were strongly flavoured herbs like mint 

and coriander, strong spices like cloves and cinnamon, 

and the finest Demerara sugar. However 95% of the 

Balm of Gilead was nothing more than a nice French 

brandy. 

Moving on, Mr Pye characterised Liverpudlians as 

belligerently independent, determined, creative and 

imaginative, attributing this combination of qualities 

to the nature of the people who first settled in the 

area. Scousers in one form or another had been 

around for a very long time. Camp Hill is named after 

an iron age encampment was discovered on its 

summit. It is now recognised that that was an 

encampment of the Brigantes who were local 

tribesmen at the time of the Roman invasion. The 

port of Meols was trading with Rome before Julius 

Caesar invaded in 55BC. This invasion was not so 

successful, but the Romans returned in AD43 under 

Claudius. There is some debate among historians and 

archaeologists as to whether there were any Roman 

settlements in the area. Some believe that there was 

a settlement in what is now Woolton. This may be 

feasible, as we know the Brigantes lived on Camp Hill 

and on Everton Ridge on the other side of the river. 

The Brigantes were a fiercely independent people, 

largely hunter-gatherers but determined defenders of 

their property, territory, family, livestock and crops. 

When the Romans came the Brigantes fortified the 

top of Camp Hill. Mr Pye observed that the Brigantes 

were so fierce that when there was no one else to 

fight, they fought amongst themselves – which was a 

VERY Scouse thing to do. The Romans first invaded 

Britain in 55BC - Julius Caesar attacked the Kent coast 

with 98 ships and 2 legions, each of 20,000 men. The 

response from the native Britons was severe and 

brutal and they were soon repelled. They came back 

the following year with 800 ships, 50,000 soldiers and 

2,000 cavalry, and conquered the south eastern Celtic 

tribes, but left again after 3 months with their entire 

army. When the Romans came North, however, they 

found us even tougher, because the Brigantes had a 

secret weapon which they didn’t keep secret for very 

long. 

Mr Pye continued describing the scene: “I have a 

wonderful mental image of the Romans standing at 

the foot of Camp Hill, on what is now Hillfoot Road, 

determined to capture this hill. The Brigantes, us, our 

ancient forefathers, on the hill, and the Romans in 

serried, organised, disciplined ranks, with their 

sandals, tunics, burnished breastplates, javelins, 

broadswords, helmets – all disciplined and precise - 

what have we got up on the hill? Iron-age Scousers, 

doing the early ancient Briton equivalent of (shouts 

77


tauntingly) ‘Come on you Ities...if you think you’re 

hard enough...’ and that is when they brought their 

secret weapon into play – because the Brigantes 

fought naked. Men, women and children, as soon as 

you were big enough to hold a sword, you fought. 

They strip off and paint themselves with blue wode, 

and then they charge, screaming, flailing, flapping 

and flashing down the hill. Can you imagine that? I 

don’t know what it did to the Romans, but it puts the 

fear of God into me! It must have been like Goodison 

Park on Saturday afternoon!” 

Liverpool and Liverpudlians were known for many 

things, some good and some bad. Stereotypical 

criticisms surprisingly seemed more prevalent among 

our fellow Britons than overseas, perhaps because it is 

comfortable to perpetuate a stereotype of a lazy, 

work-shy thieving, ignorant, thick Scouser, when that 

is obviously not the case. Scousers are actually very 

sharp and very witty, courageous and loyal. Family, 

neighbourhood and community mean a lot. Scousers 

don’t suffer fools, and title, status, rank is of no 

relevance whatsoever - it is who you are, what you do 

and how you live your life that matters. What you see 

is what you get with Scousers, and their ability to 

come back with a sharp, pointed, witty rejoinder 

shows how bright they are. They just enjoy sometimes 

being seen as thick. Ken Pye’s mother used to say as 

he was growing up, “act soft, son, and the world’ll fall 

into your lap.” Having said that, there are some 

unique characteristics of the way Scousers go about 

life, particularly their sense of humour – the problem 

is, sometimes Scousers are at their funniest when they 

don’t intend to be. 

Being on Radio Merseyside every morning in the 

Shaun Styles Show, he received many letters, stories, 

and tales, and was constantly amazed at the quality 

of these and how people can be very creative and 

poetical. He acknowledged, though, that there is 

another side to the coin, and people can entertain in 

different ways. One of the most popular 

entertainment shows on Radio Merseyside was a 

phone in quiz run by Billy Butler and Wally Scott, 

called ‘Hold Your Plums’. Locals would phone in to 

compete by answering general knowledge questions 

in front of a live studio audience. Ken Pye is convinced 

that they had “a farm somewhere that was breeding 

thick Scousers especially for this programme” because 

the contestants were always hopeless, much to the 

hilarity of the audience. 

He recounted a genuine question and answer heard 

on one of these shows: 

Billy Butler (suspenseful): “All right Tommy, final 

question now, you get this one right and you get the 

prize...What was Hitler’s first name?” 

Contestant (seriousness mixed with elation and 

triumph): “Oh I know that Billy ... (pause)...Heil!” 

(laughter) 

There was also the woman who had been struggling 

for ages to get the title of a famous film: 

Billy Butler (exasperated): “Ethel, for God’s sake, Ethel, 

‘Mutiny on the ___’ ...everybody knows this film. You 

know, Charles Laughton, (Billy does an impression of 

Charles Laughton in Mutiny on the Bounty) ‘...Mr 

Christian...’ and then the guy with the ears, Clark 

Gable, it’s a very famous film...” 

Contestant (wheedling falsetto): “Aww, I know who 

you’re talking about Billy but gi’s a clue...” 

Billy Butler (exasperated): “Ethel, I have given you so 

many clues, I just can’t give you any more...” 

Ethel (frustrated): “Err, it’s hard Billy, it’s tough this, I 

know the film, I know the film, I just can’t...” 

Billy Butler (magnanimous): “All right I will give you 

one more clue...Ethel, ‘Mutiny on the ___’ ...it’s a 

chocolate bar.” 

Ethel (ecstatic): “Ahhhh I know what it is Billy, ‘Mutiny 

on the Mars Bar’” (laughter) 

Liverpudlians are fundamentally optimistic, and it 

takes a lot to get them down. After a torturous 

exercise, one woman actually won the prize. When 

she got the final question right, bells and whistles and 

hooters went off, the studio audience cheered and 

Billy and Wally were delighted: 

Billy Butler: “You’ve won, Gladys, you’ve actually 

won!...The star prize!” 

Contestant (swooning, interrupting): “Oh my lord, the 

star prize, oh isn’t that wonderful, that’s fabulous!” 

Billy: “And I’ll tell you what it is, Gladys, you have won 

a million pounds!” 

Gladys: “Oooh my goodness me, a million pounds, 

well I’d never believe I’d win that in me life...” 

Billy: “And Gladys, (pause) we’re gonna pay it to you 

one pound a week!” 

Gladys: “Oooh isn’t that wonderful...(laughter) if God 

spares me...” (laughter) 

At which Mr Pye remarked: “I said we’re optimistic, 

but that’s pushing it.” 

Mr Pye recounted his experiences from a Saturday job 

in TJ Hughes’s in the basement in the wallpaper dept, 

78


which he had at the age of 15. He would dread the 

inevitable scenario which would replay itself every 

Saturday – a lady would come in, walk around the 

wallpaper department, go through all the rolls 

stacked on the shelves, pick one, unroll it, inspect it, 

then present it with the question: 

“Ere y’are see have a look at that, love, will that go 

with the paper in our lobby?” 

They would always get very upset when he didn’t 

know the answer. 

One of the best ways to understand the mentality of 

people going about life was the personal ads, the 

births, marriages and deaths in the local paper. 

Perhaps it was a reflection of the great sense of 

community and heritage that Liverpudlians seem to 

have, that the Liverpool Echo made more money from 

the personal ads than they did from the cover price, 

and the purchased advertising accounts, which is quite 

rare. A colleague commented that he had never 

known a provincial newspaper to have so many pages 

of births, deaths and marriages. Perhaps the good 

humoured, no-nonsense mentality of many Scousers 

comes across in these announcements, which is why 

you find things like this in the death notices in the 

Echo: 

“To David, Loving Father and Devoted Husband 

You Never Heard No One What You Didn’t ‘Ave To” 

The simple things touch Scousers and affect them 

deeply, like this death notice: 

“Dad – I’d give anything to hear you call me 

Mallet-head once more.” 

Or this one: 

“The angel sang Amazing Grace, 

As God reached down and touched your face, 

And then he whispered very low, 

Come on Bill, it’s time to go.” 

To Ken Pye this was very Scouse, simple, 

straightforward. He could picture that woman writing 

it from the heart and he liked it. Perhaps the same 

could not be said for this one: 

“I’ll never forget the night you were ill, 

You sat up in bed and said ‘Ta-ra, Lil!’” 

Or this one: 

“Goodbye Uncle Fred, you were one of the best, 

We all lost a good one when you went West!” 

Or his all-time favourite, which displays some classic 

Scouse optimism: 

“To Billy, who died on June the 7th - don’t worry 

mate, you’ve bounced back from worse than this!” 

It even starts at birth. Some of the names given to 

children are ludicrous. Mr Pye gave some genuine 

examples taken from the pages of the Echo: 

The Breeze family were proud to announce the birth 

of their young daughter, Summer. The White family 

were delighted to welcome into the world their little 

girl, Snow. There was the example of the traffic 

warden, who proudly declared himself to be a man, 

and announced the birth of triplet daughters, Scarlett, 

Amber and Jade. The Pipes family in a moment of 

folly chose to call their little boy Dwayne... Dwayne 

Pipes! 

What possessed the Bacon family to call their 

daughter Megan was beyond him...Megan 

Bacon...Egg and Bacon? Teachers would have had a 

field day with that, never mind the kids! The Long 

family named their son Miles, but Mr Pye’s personal 

favourites were the Smart, Hurt and Burn families, 

who all called their son Darryl... which in a Scouse 

accent comes out as, “that’ll hurt!’, ‘that’ll smart!’, 

‘that’ll burn!’” The list went on, with Warren Peace, 

Hazel Nutt, Cherry Topping, Tina Coffee, Dalton 

Towers and Katya Fish. 

There is a telephonist pool in the Echo dedicated to 

receiving and processing these notices and adverts 

over the phone – births, deaths, marriages, personal 

columns and so on - which takes up a whole floor in 

the building. A colleague had been walking across 

this telephonist pool, and as he was walking through 

he came across a knot of six or seven telephonists, all 

collapsed in pleats of laughter, with tears streaming 

down their faces. When death notices are taken over 

the phone, firstly the telephonist types it out, then 

reads it back very carefully to make sure that it is right. 

Once they have confirmed it is right, they push the 

button and it is sent through to the typesetter to be 

placed in the Echo that evening. In the process of 

phoning in a death notice one caller had caused this 

hilarity: 

79


Telephonist (kind but businesslike): “OK, Mrs 

Thompson, I’m gonna read back what you’ve got now. 

You tell me if this is right and the advert will be in the 

Echo tonight. So this is what you’ve got – you ready?” 

Lady placing notice (gentle voice): “OK love, yeah I’m 

ready” 

Telephonist: “Norman Thompson, died peacefully, 

Fazakerley Hospital aged 77. Funeral St Peter’s Church 

Thursday noon. No flowers please.’ Now, is that it?” 

Lady placing notice: “Oh yes, I think so love.” 

Telephonist: “Now do you think I’ve got it right, is that 

exactly what you want it to say?” 

Lady placing notice: “Oh yes, no that’s fine I’m happy 

with that.” 

Telephonist: “OK, I’m going to push the button 

(pause). Oh hold on, just a minute Mrs Thompson, 

you’re paying for this by the line, aren’t you?” 

Lady placing notice: “Oooh, I think so, I’m not really 

sure...” 

Telephonist: “Well if you are, you know for the same 

money you could get, hang on let me see, you could 

get another seven words.” 

Lady placing notice: “Could I love? Oh right, hang on 

then just a minute (pause). All right put this on the 

end: (pause) ‘Ford Escort for sale. Best offer 

accepted.” 

Scousers are entrepreneurial – they never miss an 

opportunity to make a few bob! The last one was 

taken from the personal columns: 

“For Sale: offers invited, complete set of 

Encyclopaedia Britannica – genuine reason for sale, 

wife already knows it all!” 

Mr Pye finished by saying that being Scouse is 

something joyous, something to celebrate and be 

proud of, especially now, as the city rises from the 

ashes of the 1980s Toxteth riots, containerisation and 

all the dockers’ strikes, and Liverpool is back with a 

vengeance. Not only was Liverpool European Capital 

of Culture in 2008, it has the record of being the most 

successful Capital of Culture in the entire history of the 

competition. The format is now being replicated in 

South America and Asia, and the shortlisted cities are 

actually coming to Liverpool to find out how to do it. 

Liverpool has its World Heritage Site, which ranks it 

alongside Venice, Barcelona, the Pyramids, the Taj 

Mahal and the Grand Canyon - and quite right too. 

This is the year we start to climb out of recession, but 

we will only do it if we are prepared to make room 

for entrepreneurship, to drive ourselves forward, not 

to listen to the negatives and the gainsayers, and to 

remember that lesson that we have repeatedly learnt 

over the centuries: you can’t do it on your own. 

He left us with a final thought: ‘You can always tell a 

Scouser, but you can’t tell him much.’ 

A Vote of Thanks was given by the Athenaeum 

president. 


80


Presidents Guest Lecture 

Held on Thursday 4th April 2013 

‘The Art and Science of Yacht (and Lifeboat) Design’ 

Dr William Collier, Chairman, G L Watson & Company 

approached the secretary of the company to enquire 

if Dr Collier would accept an invitation to speak, her 

immediate response was "I am sure he will be 

delighted to come, he absolutely loves talking about 

it [his passion for boats]". With the audiences 

expectations raised the speaker was invited to take 

the floor. 

Dr Collier thanked the President and introduced his 

talk by saying he would give us an overview of the 

history of yachting, the company GL Watson &Co and 

lastly the key restoration projects. 

The History of Yachting 

He began by explaining that the academic definition 

of a yacht is a vessel for pleasure and not for business. 

However in the past it had been a vessel of state and 

was a means of 'showing off' wealth and status and 

as such usually resulted in a vessel which was “large 

expensive and useless; not an asset but a liability”. 

Mr Roger Franks and Dr William Collier 

Roger Franks, our President introduced the speaker Dr 

William Collier, and shared his own reminiscences 

about his childhood and his memories of jetties and 

lifeboats. He recalled a time when lifeboats actually 

looked like lifeboats! 

His research into the ‘Watson Class Lifeboat' led him to 

the ship design firm GL Watson & Co which he was 

delighted to find still in existence and now in 

Liverpool, with offices at the old Barclays Bank in 

Water Street. The company is currently involved only 

with the restoration of old craft and that since 2001 Dr 

William Collier has been the managing director of the 

company. 

Dr Collier served his apprenticeship working for 

Canberra and Nicholson working at Cannes and has 

written a thesis entitled 'Yacht Builders: A Study of 

Canberra and Nicholson 1782 - 1939'. When Roger 

He continued that yachting in England can be traced 

back to Charles II. When King Charles came out of 

exile in the 17 century he came back to England with 

a yacht called 'Mary', a present from the Dutch 

government, a country with a tradition in yachting. 

Yachting as we know it however, really only started at 

the end of the Napoleonic Wars and the founding of 

the Royal Yacht Squadron in 1815. This remains the 

premiere yacht club and is based at Cowes on the Isle 

of Wight. 

He explained that in general there are two types of 

yachts - big ones and small ones. In the early days 

yacht racing was a focus for gambling and it was a 

buccaneering style race with no holes barred in 

putting off the opposition. There was however a 

growing body of more visionary yachtsman who saw 

racing as a way of developing seamanship and 

yachtsmanship. There were regular races between 

yachts and naval frigates and the yachts often won! 

In 1851 the Royal Yacht Squadron put up a 100-guinea 

trophy and invited all comers to a yacht race around 

the Isle of Wight. This was the start of the America's 

81


cup. There was only one foreigner in the first race, a 

US Yacht, The America. To the dismay of the British, it 

trounced all other entries and won by a mile. Queen 

Victoria is purported to have asked 'But who came 

second?' the response was that there was no second; 

no other yachts were in sight! 

The British were determined to improve their 

competitiveness but their response was suppressed by 

the start of the Crimean War because yachting was 

deemed unpatriotic. Some aristocrats however, sailed 

their yachts to the Crimea and used them as 

accommodation. They were also used to deliver 

balaclava helmets to those on the front. 

GL Watson and Company 

The war period allowed much thinking about yachts 

and the importance of design and the quality of their 

construction. After the war the independent yacht 

designers grew in number. In 1873, at the age of 22 

years George Lennox Watson, from a Glasgow and a 

medical family, set up the first yacht design office on 

Clydeside. The young Watson was a fine artist and 

painted many of his yachts. His first yacht, a five ton 

vessel 'Frill' beat everything on the Clyde and set his 

company on a firm foundation. 

The company went on to design steam yachts (to tow 

sailing vessels) but he remained faithful to not only 

big yachts but small ones too. His great commission 

from the Prince of Wales, for the Royal Yacht Britannia 

in 1893 was a defining moment for the company and 

stimulated much international work. Steam yachts 

were important for trade and commissions came from 

all over Europe including the Kaiser who in thanks, 

sent a bust of himself to the company. Other clients 

included the Imperial Family of Russia, the Rothschilds, 

Monsieur Menier, the French chocolatier and then the 

Americans. The first presidential yacht, the 

'Mayflower', was a Watson design. Britannia was a 

fine racing yacht but was scuttled on the instructions 

of King George V following his death. 

Watson's largest yacht, with cabins on every deck was 

designed for the eccentric James Gordon Bennett who 

entertained lavishly on his yacht often sailing away 

unexpectedly taking the entertainment troupe who 

he had invited on board to entertain his guests, 

because he thought they were good! He kept his pet 

cow on the ship to ensure fresh milk! 

The steam yachts were the mainstay of the companies 

business and the largest 'Warrior' was built for the van 

der Bilt family in 1902. The design very much reflected 

the clipper ship. ‘Shamrock’, the largest racing yacht 

(120 tons), was commissioned by Sir Thomas Linton 

and entered the America's Cup for many years but 

never successfully. 

Unexpectedly in 1902, Watson, now 54 years of age, 

died. The cause was felt to be overwork. During the 

thirty years of the company a yacht was launched 

every four weeks. Condolences poured in from all 

over the world. James Rennie Barnett successfully 

continued the business until the First World War when 

the company was taken over by the Admiralty for uses 

that were never revealed. 

After the First World War yachts became smaller and 

diesel began to replace steam. JRB retired in 1952 and 

lived until he was 102 years old. In the 1960s a new 

partner introduced high-speed vessels to the company. 

Big Moose was a ground breaking hull design. 

Lifeboats were a Watson design but a big falling out 

between RLNI and the company in the 1980s still 

persists. The importance of Watson and lifeboat 

design followed the disaster, in 1896, when a German 

ship floundered off Southport, with great loss of life. 

Two spinsters of Southport, Edith and Annie, paid for 

the design and building of a new lifeboats named 

after themselves. These vessels were propelled by 

wind and oars and there was much call for a steam 

propelled lifeboat. However there was first a need to 

devise a way of minimising the problems of rescuing 

people from the sea in a propeller driven boat. 

In 1997 'Queen' was launched with a new water-jet 

propulsion system, which was a technological advance 

allowing the vessel to move as well as stay still in the 

water. A later version reintroduced the motor 

propeller, now housed in a tunnel in the hull, which 

was safer for the boat approaching people in the 

water. Watson Class lifeboats were succeeded by the 

Barnett Class lifeboats and more recently by the Arun 

Class lifeboat. 

Restoration Projects 

Dr Collier went on to describe firstly the principles by 

which restoration projects were undertaken. If a yacht 

had existed and been lost after being 

decommissioned, the company would look for it and 

try and find a sponsor to support its restoration. The 

82


craft were restored following the design and 

construction, which had been the blueprint of the 

original design. The aim was to restore them to their 

former glory and beauty. He described a series of 

restorations including: 

• the 'Avel' commissioned in 1896, was 

decommissioned in 1920. It was found up a creek 

in Florida where it was now a home for an elderly 

lady its keel having been flattened and much of its 

working parts sold off. The time when the lady 

moved out of the boat happened to coincide with 

the Goochie family looking for a yacht. GL Watson 

under the direction of our speaker restored this 

yacht to her former glory for the family. 

• Other restorations have included 'Mariquita' a 

large racing vessel fully restored to its original 

specification; Sir Malcom Campbell's ‘Bluebird’ 

commissioned in 1936 to search for buried treasure, 

it never got there but served in Dunkirk; the 

'Narlin' built in 1930 and commissioned by Lady 

Yule who spent £120,000 and then used it to sail 

the world. Following this she chartered it to 

Edward, Prince of Wales who sailed with Wallace 

Simpson on the infamous cruise that exposed their 

affair. It was rescued by our speaker when it was a 

ferry and then a floating restaurant on the Black 

Sea. She was brought to Liverpool for clean up 

and then to Germany for refit; 'St Patrick’, 

commissioned in 1919 (one of three small yachts 

named after the British saints including ‘St David’, 

‘St Andrew’). 

The speaker undoubtedly demonstrated what his 

secretary had predicted...his passion and love and 

devotion to yachts and their restoration to beautiful 

and functional vessels. The art and science of yacht 

and boat design. A lively question session followed 

and then all retired for dinner. 

Prof L de Cossart 

83


Minutes of the Sixteenth Ordinary Meeting 

Held on Wednesday 17th April 2013 

‘Doctors and the Death of History: What’s the Future for Medical Libraries?’ 

Dr Simon Chaplin, Head of Wellcome Library, London 

Dr Chaplin was welcomed to the LMI by Dr Sally 

Sheard, Honorary Librarian. Dr Chaplin had previously 

been curator for the Royal College of Surgeons, where 

he oversaw the transformation of the Hunterian 

collection of the museum, and was now leading 

equally ambitious work at the Wellcome Trust in 

London. 

It had been an absolute pleasure for Dr Chaplin to 

spend the afternoon at the LMI perusing the 

collections and speaking to the Librarian, Adrienne 

Mayers. He praised the quality, care and condition of 

the collections and added that he felt that they were 

comparable with those at the Wellcome Library! 

Medical libraries such as ours faced many challenges 

in current times, and he intended to explore these, to 

suggest future ways forward. Perhaps reassuringly, we 

may find some of the answers to what we might do in 

the future by looking back at our history. 

Dr Chaplin began by outlining a grim scenario. The 

medical library was dying, and with it was passing a 

model of medical history that had, for over 250 years, 

been sustained by the bibliophile passion, pride and 

knowledge of generations of doctors. The computer 

screen had replaced the page as the delivery medium 

for biomedical information, and the expansion of 

electronic publishing had begun to drive a wedge not 

just between the printed and pixellated word, but also 

between medical libraries as physical institutions and 

the provision of medical information, to both 

practitioners and students. 

Whilst this change had been in progress for years, it 

was gathering pace. Times were lean and the pressure 

to change was increasing. Librarians were faced with 

increasingly difficult choices about how to allocate 

resources to accommodate new technologies. What 

was once seen as a pleasant luxury – collections of rare 

books, old journals, and the community of (often) 

retired medical practitioners who both contributed to 

and drew upon them - had come under threat in new 

ways. What medical student nowadays could afford 

the time to dabble in the history of medicine as purely 

an idle curiosity? Why would an overstretched 

practicing clinician take time out to visit a physical 

library distant from their workplace or home when 

online journal access, E-books, and portable tablets 

had reduced (if not removed) the need to travel to 

access information? 

In terms of the challenges to historic library collections 

like the LMI’s, the successful growth of medical history 

as a professional discipline, distinct within history, and 

disconnected from medical practice and medical 

teaching, presented another challenge. In the past, 

medical historians were doctors first, and then 

historians. The work of such key figures as Fielding 

Garrison, Henry Sigerist and Owsei Temkin at Johns 

Hopkins or Erwin Ackerknecht at Wisconsin - all of 

whom had taken medical degrees before turning to 

history – did much to establish medical history as a 

recognised academic discipline in the middle decades 

of the 20th century. In the process of building this 

discipline, they established journals, departments, and 

library collections to support their work, tracing the 

evolution of medical history, its professionalisation 

and specialisation as they did. 

As it evolved, however, the discipline began to hold a 

closer affiliation with the fields of social, economic or 

cultural history than the practice of medicine, and had 

thus appeared to distance itself at times from the role 

and point of view of the doctor. Whilst applying some 

objectivity in the study of the history of medicine, this 

had also led to a disassociation between medical 

historians and medics. Many practicing clinicians felt 

that much of the newer history of medicine literature 

was not written with them in mind, it used alien 

language, terminology and ideas and no longer spoke 

to them. 

Dr Chaplin highlighted three aspects of the change 

that has occurred over the past fifty years, during 

which medical history has shifted from the world of 

medicine to the world of humanities: 

1. Bibliographic studies, which were once important, 

have become largely peripheral to the work of 

historians of medicine, and the role of librarianhistorian/enthusiast 

has been superseded by 

professional medical historians. 

84


2. Medical history used to be an intrinsic part of 

medical training, but since the turn of the century, 

there had been an incremental diminution of this. 

It had not completely disappeared and still thrived 

in Liverpool. However in general terms pressure on 

the medical curriculum made it difficult to squeeze 

medical history in. Also the process of dissociation 

of medical practicitoners and lecturers from the 

history of medicine made it gradually harder for 

educators to introduce history of medicine into 

their courses without the confidence and 

familiarity that eminent physicians would once 

have had with the subject. 

3. There was pressure on medical libraries to make 

more and more material available electronically, 

whilst maintaining the huge stores of historical 

printed material, which were increasingly seen as 

a luxury. Whilst medical libraries with historical 

collections had continued to preserve the raw 

materials for research - historical resources and 

texts - they were unable to remain abreast of new 

published work on the history of medicine, which 

was increasingly published in a wider range of 

journals on social and economic history more suited 

to humanities libraries. 

All of the above issues combined to create a quite real 

and potent threat, one in which the role of historical 

collections was diminished and pressure to move or 

dispose of them was increased. How should we deal 

with that? Dr Chaplin felt that part of the answer lay 

in looking at the nature of the medical library. 

The Wellcome Trust was one of the world’s largest 

biomedical charities, with an endowment in excess of 

£15bn. Through the Sanger Institute, a centre for 

genomics research, the Wellcome Trust supported a 

community of over 650 researchers, pushing the 

boundaries of genomic research. A third of the human 

genome had been sequenced at Sanger. The Sanger 

Library invested over £800k annually in its library 

service. It was not a conventional library and was 

operated by three members of staff from a room that 

is only a few dozen square metres in size. The Sanger 

Library was largely unencumbered by books, after all, 

if genomics researchers were looking at a book, the 

information within was almost certainly out of date. 

Aside from a handful of print publications – the bulk 

of which, the Librarian gleefully admitted, served little 

more purpose than set dressing – the vast majority of 

their resources were delivered online, in the form of 

subscriptions to electronic journals, databases and 

reference resources. Even journal articles had an ever 

decreasing half life, being rapidly overtaken by new 

ideas, new data, new conclusions. This was an idea for 

what a library could be in the future; something 

existing more as an idea than a reality, providing 

access to information rather than a physical space 

within a building. Within the Sanger Institute, there 

was no single place acting as a locus for the history of 

the organization, let alone a place that connected the 

researchers at the Sanger with the longer history of 

researchers in biomedical science or in medicine. There 

was no place in the Sanger Institute for those who 

wished to dwell upon history and the work of the 

ancients – ancient, in this case, applying equally to 

Crick and Watson, as much as to Mendel or Darwin, 

let alone Galen or Hippocrates. 

Whilst few have moved away from paper as radically 

as the Sanger, for many the inexorable process of 

moving towards a world of electronic resources 

seemed inevitable. For research libraries, the explosive 

growth of online journal publishing – both chargedfor 

and Open Access – had necessitated a fundamental 

change in the way we worked, and the way in which 

our collections were used. For increasing numbers of 

users, access to a library was now a virtual, as much as 

a physical, process. Even a room full of computers as a 

library was outdated today with the emergence of 

portable tablets. However, the move to electronic 

publishing had imposed new stresses. There was an 

assumption that digital equaled free, that somehow 

there was no resource required, but delivering 

electronic resources still required infrastructure. Open 

Access did not equal free; electronic did not mean 

cheap; the online did not mean that we could simply 

shut up the physical shop. Even those journals which 

were truly Open Access have largely become an 

addition to, rather than a replacement for, traditional 

subscriptions, and the ‘ever-worsening squeeze’ on 

library budgets continued. 

In this brave new world, what would be squeezed 

out? It was in the nature of libraries that they 

accumulated, with the knowledge of successive 

generations accreting to that which had gone before, 

creating a tangible and legible historical record. We 

had been encouraged to add to our libraries not only 

that which was current, but the works of ages past, 

extending our collections back past our own dates of 

foundation, constructing lineages that connect us with 

the past. The genealogical analogy was not a trivial 

one, for implicit in this process had been a sense of 

profound pride in and engagement with history. But 

in today’s world, our collections were seen by some as 

unsupportable and this was a dangerous risk. 

85


So how might we look for some answers to this 

challenge? The LMI, for example, was worth 

cherishing as one of the oldest libraries in the United 

Kingdom. The books in the LMI library dated back to 

the foundation of the Liverpool Medical Library in 

1779, but they were more than a record of 

contemporary interest in medical writing over the 

course of two and half centuries. They were not just 

the history of the institution and the books it 

contained, but the ways in which the books had been 

used, and by whom. Dr Chaplin had chanced upon a 

copy of ‘The Byrth of Mankynde, otherwyse named 

the Womans Booke’ in the LMI catalogue. Dating from 

the 16th century, it was one of the most important 

early works in the history of midwifery, an English 

translation of a German text that enjoyed huge 

commercial success in Western Europe between the 

mid sixteenth and mid seventeenth centuries. What 

did we know about the copy in this collection? It had 

been given to the LMI by one of Liverpool’s most 

famous practitioners, William Blair-Bell, an eminent 

gynaecologist, who did much to create the discipline, 

as we know it today. The period in which Blair-Bell was 

working, at the turn of 18th/19th centuries, was when 

all of the medical specialties that we know today were 

emerging. There were some specialist roles, such as 

midwifery, which were by and large denigrated and 

marginalised, deemed unworthy of the highest 

diplomas of the London colleges. People like Blair-Bell 

were extremely active in carving out these new 

professional demarcations. 

By presenting this book to the LMI, Dr Chaplin guessed 

that Blair-Bell, one of the foremost gynaecologists of 

his era, had not presented the book to the LMI 

because he regarded it as a useful text for teaching 

(or at least, he hoped not); rather, it was a recognition 

of the value of books as both records of past practice 

– evidence of the changing nature of medicine – and 

as tangible heritage, a physical connection with the 

past. One could sense a desire to demonstrate the 

long history of obstetrics and gynaecology as a 

medical discipline, at a time when practitioners were 

still struggling to establish themselves as a recognised 

specialty (we should not forget that Bell was 

instrumental in creating the new British College – now 

the Royal College – of Obstetricians and 

Gynaecologists in 1929). Of course, with the passage 

of a hundred years, we were now able to see the book 

also as tangible evidence of Blair-Bell’s own drive for 

professional recognition. As was always the way, over 

time – as long as we were careful not to forget, or to 

ignore, the provenance of the books we care for – new 

layers of meaning, new stories, new histories, accreted 

to them as objects, especially in a collection like LMI’s 

where so many books were presented by practitioners. 

The Womans Booke was just one example, chosen at 

random from the many thousands of historic books 

and pamphlets in the collection here – a collection 

which was itself one of many hundreds of historical 

collections in medical institutions ranging from 

hospitals to royal colleges across the UK. So what of 

these collections? Were they an unhappy legacy of a 

model of medicine, and medical history, whose time 

was now past? Well, not necessarily. If we go back 

further still, we would see some other examples of 

how medical practitioners had mobilized books to 

support their different interests, examples we might 

still learn from today. 

Dr Chaplin’s particular period of interest was the 18th 

century. Most of his research had been on Dr John 

Hunter, the founder of the Hunterian museum at the 

Royal College of Surgeons. He was interested in the 

18th century because it was a period in which the 

medical profession that we recognised today began to 

evolve. It was a time of tremendous upheaval in both 

medical practice and medical training, and London 

between 1750 and 1800 could lay claim to important 

innovations many of which we still recognised in 

modern medicine, such as clinical observation, the 

study of pathology and the teaching of anatomy by 

dissection. In this vibrant and fluid environment, 

doctors and surgeons battled for position, 

professionally and socially, competing for students and 

patients. Within the metropolis there was a longestablished, 

but rather fragile, hierarchy of 

practitioners, at the apex of which were the Oxford or 

Cambridge educated, Church-of-England following 

doctors who made up the Fellowship of the College of 

Physicians. Excluded from this select band were many 

physicians who did not possess the right qualifications 

– because their medical degrees were from Edinburgh 

or Leiden or Paris, for example, or because they were 

religious non-conformists, such as Quakers. 

Dr Chaplin used John Coakley Lettsom (1744–1815), as 

his first example. Lettsom was a skilled doctor and a 

keen naturalist, but as a Quaker, was excluded from 

medical institutions such as the College of Physicians. 

With others, Lettsom campaigned against this 

prejudice, and was instrumental in founding the 

Medical Society of London in 1773, possibly one of the 

inspirations to establish a medical library in Liverpool. 

The first thing he did was to create a library, which 

was seen as the heart of this new society, providing a 

physical and intellectual hub for the nascent 

86


institution. The gifting of books to the Medical 

Society in London important to a group excluded from 

the London physician societies, keen to establish 

themselves as a new professional class and doing so 

by appealing to history through books. Incidentally, 

much of the Medical Society of London’s collection 

was now in the Wellcome Library – considered 

peripheral to their work, it was sold in 1984 – so in 

itself it formed part of the story of the death of 

bibliophilic medical history in medical libraries. 

It would be wrong, however, to think of the original 

Medical Society of London’s library as just a ‘working 

library’. It contained many works of great antiquity, 

and was as much a social space as a reference resource, 

a place for convivial sociability as well as scholarly 

study. As historians such as Clive Wainright have 

shown, the library of the 17th and 18th centuries was 

as much a space for showing as for reading, decorated 

with busts and paintings and housing cabinets of 

coins, medals and other antiquities intended to 

promote conversation. Libraries have been important 

to medical institutions over the years, not simply as 

places to come and remain abreast of literature, but 

also as places to come and meet, socialize and discuss 

ideas. Unfortunately over the years we had let a series 

of Draconian rules about not talking in libraries 

change this aspect, and needed to reconsider some of 

those rules, balancing the desire to read with the 

desire to engage in conversation. 

This was certainly the model for Lettsom’s own 

personal library, at his villa at Grove Hill, to the south 

of London. Set in landscaped grounds, his library and 

museum were 'a repository for natural history and 

other curiosities', crammed with cabinets of minerals 

and fossils, shells and insects. A library, museum and 

gardens were open to Lettsom's friends and to 

members of the medical profession on Saturdays, but 

were also opened to the public on certain dates. There 

was a great desire to share ideas, not just with peers, 

but with the wider public. At a time when medical 

authority – particularly for a dissenting doctor – could 

not be taken for granted, Lettsom’s willingness to use 

the material evidence of medicine to engage with 

different audiences was a powerful statement, 

establishing a foothold in society. Dr Chaplin might 

easily have cited the examples of many others, 

including Hans Sloane, Richard Mead, James Douglas, 

and William and John Hunter – eminent physicians or 

surgeons, but also collectors and exhibitors of the 

material, visual and textual culture of medicine in 

Georgian London. 

Despite a gap of over a century, we can discern a 

similar perception of the library as more than simply a 

space of quiet study in Dr Chaplin’s second case-study, 

Sir Henry Solomon Wellcome. Born in 1853 in Almond, 

Northern Wisconsin, he began his career as a travelling 

salesman for pharmaceutical companies. In 1879 he 

was invited to London to join a former colleague, Silas 

Burroughs, with whom he established the Burroughs 

Wellcome drug company. The company went on to 

enjoy huge success, not just through their skill as 

researchers in generating new medicines, but also in 

packaging and marketing their products (it was 

Burroughs-Wellcome that coined the word ‘tabloid’ to 

describe their compressed medicine pills). The 

company generated a substantial income for 

Wellcome that allowed him to indulge his passion for 

collecting and showing books and objects relating to 

the history of health and disease. At the time of his 

death there were over a million objects in Wellcome’s 

collection. 

In fact, as well as a library, Wellcome founded two 

museums – the Wellcome Historical Medical Museum, 

which focussed more specifically on the history and 

anthropology of medicine, and the Wellcome Museum 

of Medical Science, which developed out of the 

Burroughs-Wellcome company’s interest in tropical 

medicine and which was geared more explicitly 

towards modern medicine, teaching current students 

and research. The huge collection of drawings, prints, 

books and historical items from the Library were a 

resource for current medical education. 

After Wellcome’s demise, the medical museum and 

library came under the care of the Wellcome Trust, a 

charitable foundation created by Wellcome’s will with 

the aim of continuing his interests in research and 

dissemination of medical science and medical history. 

A new Wellcome Library was opened in 1949 and 

subsequently became part of the Wellcome Institute 

for the History of Medicine. 

Today the Wellcome Trust was a global charitable 

foundation whose mission was to achieve 

extraordinary improvements in health by supporting 

the brightest minds. They not only invested around 

£650 million a year to support cutting edge biomedical 

research, but also strived to embed biomedical science 

is its historical and cultural landscape. They had a 

fantastic resource and an amazing collection, but 

Wellcome still faced the same challenges as other 

medical libraries. It needed to adapt to survive, and 

was perhaps well placed to consider how a medical 

library might change to meet the challenge. 

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In 2007 the Wellcome Trust opened a new free public 

venue, the Wellcome Collection, designed to explore 

the intersection between medicine, life and art. It was 

also used as a venue for exhibitions and events, 

engaging members of the wider public. It was 

extremely successful, with around half a million 

visitors last year, and saw itself as a ‘Tate Modern for 

medicine’. 

The Wellcome Library continued to support its 

traditional audience of researchers, but had 

increasingly begun to reach out to new audiences, 

becoming a ‘free library for the incurably curious.’ 

They were sustained by the strength and breadth of 

their collections, ‘a rich tapestry’ ranging from over 

600 of the very earliest printed books, through to 

800,000 modern printed books, and 700 archives 

containing 1½ million items, including manuscripts 

dating back to prehistory. As a library, Wellcome have 

thrown themselves into digital innovation, with 

projects to digitise film collections and Arabic 

manuscripts, sharing them online and widening 

access. The Wellcome Library was also Managing 

Partner in the Europe PubMed Central consortium and 

had an active role in promoting access to current 

biomedical literature. 

To adapt, organisations needed to be more radical, 

build on their historical strengths to set a path for the 

future, to be bold and innovative and take risks. 

Whilst this was an intimidating prospect, Wellcome 

were uniquely financially placed to make it happen, 

and with this in mind they had developed an 

ambitious transformation strategy for next five years. 

They identified three aims to help them achieve their 

goals: 

1. Digitisation; the addition of 30 million pages of 

online books and archives to the website over the 

next five years and the use of Wellcome resources 

to support others with digitising. 

2. To become expert interpreters of their collection, 

to move beyond simply being passive facilitators of 

access to the resources available and instead use 

their expertise to share ideas with a wider, curious 

public audience. 

3. To be more strategic in collecting, to not simply 

regard their collections as closed, as static, but to 

look at what might be added in the future to 

enable the library to continue growing, and 

responding to changes in the external biomedical 

and cultural landscape. 

Dr Chaplin discussed some of the projects stemming 

from these three objectives, the first being the 

creation of new online projects. Three years in the 

making, the first of these was called ‘Codebreakers: 

The Makers of Modern Genetics’, and comprised 

around 1½ million pages of material from five 

archives, those of Wellcome, Francis Crick, James 

Watson, Rosalind Franklin and Maurice Wilkins. 

Partner institutions were based in the US, Glasgow, 

London and Cambridge. This project made all five 

archives available online in one place for the first time. 

Alongside that, Wellcome were working to digitise 

around 14,000 early European books, and over 7,000 

printed London Medical Officer for Health reports 

covering a period from 1840 to 1970. The next phase 

of this work would add another 8 million pages, 

mainly around neuroscience and mental health but 

also looking at medical journals, themes connected to 

exhibitions and events, promoting open access for 

their researchers and using their collections to support 

public engagement. 

It had been a great challenge but it had also shown 

what can be achieved. Wellcome library were in a 

lucky position to be able not only to do it themselves 

but also to actively fund the development of other 

institutions. Digitisation sounded extremely attractive 

but it should not be viewed as a panacea for all the 

problems facing medical libraries. Digitising doubled 

costs rather than halving them. It didn’t solve the 

problem of having too much stuff to look after and it 

didn’t address the issue of what to do with your 

physical space. And of course there is always a 

considerable amount that is simply not suitable for 

digitisation. 

The second strand of Wellcome’s transformation plan 

therefore is to look at adapting their physical space. 

Initial fears that digitisation would result in a lack of 

interest in the physical Library had been assuaged; 

instead it appeared that digitisation was helping to 

draw a new audiences in, deepening engagement and 

stimulating a desire to see original material. The 

Wellcome Collection Development Project sought to 

create a hybrid, integrated exhibition and library 

space where the public could come and look at 

objects, but also browse books and journals and 

engage in conversation. To this end they look at 

acquiring items not just for research but for 

exhibition, sharing and debate, echoing the earlier 

18th Century model of Lettsom and Hunter. 

They have also begun to consider the preservation of 

areas that might become lost to future generations, 

for example contemporary bioscience, which poses the 

88


unprecedented question - how do you preserve an 

archive that has no papers? This was a challenge they 

encountered during a collaborative project working 

to create an archive of the Human Genome Project 

with partners in the United States. Human Genome 

research was a relatively recent occurrence, and many 

of the researchers who worked on it have left no 

paper record, only electronic data. All of this work 

should be recorded; not just the end product, the 

sequence of the Human Genome, but also twenty 

years worth of emails, plans, documents and oral 

history, to give an insight into what went on behind 

and around the project from day to day. That required 

them to think differently about how a library and 

archive works. 

Only recently one of Francis Crick’s letters sold for £5.3 

million at auction. This showed that there was still a 

great interest in things historical and that biomedical 

science wasn’t as careless of its history as we might 

have feared. Dr Chaplin could not resist mentioning 

however that if the audience didn’t fancy paying £5.3 

million for a letter, they could view it free online via 

the Wellcome Library website! 

Dr Chaplin concluded that answers to the challenge 

facing medical libraries and their historic collections 

could, at least in part, be found from within. There 

was in our history enough to inform us about how we 

might think about the future, there were models that 

we could recycle and adapt and re-use to enable us to 

meet the challenges of the 21st century. 

As historians we needed to be sensitive to the ways in 

which history had been, and continued to be, used in 

the service of medicine. As librarians we needed to 

not simply manage change, but embrace it, and find 

new ways for libraries to work. As medics, we needed 

to stop thinking of historical collections as an 

encumbrance, and of library spaces as redundant 

entities. Together we needed to look at how 

collections and spaces might be reworked to serve 

different needs, new audiences – for public 

engagement, for inspiring students, as places that 

encourage and stimulate social interaction and the 

exchange of ideas, as well as just solitary studies and 

the absorption of information. 

The crux of the matter was that for Wellcome and 

others like them, medical history was never an end in 

itself, something to be compartmentalised and 

separated from either medicine or the humanities, but 

something they do to help people see medicine in its 

social and cultural context. We could use medical 

history, our collections, museums and libraries as ways 

to really engage, enthuse, entertain and educate a 

much wider audience, as well as serving our own 

interests as doctors, as librarians, as people who care 

for collections, and bring the history of medicine, and 

with it the historical medical library, back to life. 

Q: The LMI has many beautiful and fascinating books, 

which are kept in the basement, not readily accessible 

to anyone, treasure remaining hidden. Was there an 

innovative way to make these accessible? 

A: Dr Chaplin answered that access must be the 

priority; choosing conservation over access was 

heading towards a dead end and the death of the 

library. A book lost its purpose locked away where noone 

could read it. There were numerous options to 

balance the desire for public access with the need for 

conservation; digitisation, development of exhibition 

spaces to show more items, even creation of facsimilie 

copies. He concluded that one way might be to have 

a series of gradations – exhibitions for the public, 

access for researchers, and a conservation policy that 

balanced preservation and access over the long term. 

Q: Was there a time coming where all of these things 

should be amalgamated in one big institution, rather 

than being scattered across the country and the 

world? 

A: There would not be much to be gained by such an 

amalgamation, and it would have the effect of 

reducing access. In every collection there were some 

unique items, but the vast majority would be 

replicated elsewhere. What was interesting and 

unique was the provenance of each particular copy, in 

its own particular setting, which might be lost. A 

better question was - what can you do that makes the 

most of that particular collection? This was especially 

relevant for organisations like the LMI, which had a 

fabulous building as well as a wonderful collection. 

Q: The growing tendency towards e-books and online 

access had been mentioned, but the questioner, a 

librarian at the Women’s Hospital, came into contact 

with the students on a daily basis, and found that they 

preferred printed textbooks. 

A: There was a difference between students and 

researchers, and between those working in stem 

science and those working in the humanities. For a 

researcher books were outdated and therefore 

irrelevant, everything they refer to is current journal 

issue. He agreed that students still preferred to print 

out journal articles to read and annotate, but 

suspected that might change in the next five years as 

reading and marking up online becomes easier. 

89


Tablets were fundamentally changing people’s 

relationship to reading (rather than simply browsing 

or checking) digital content, but they were still very 

new devices. 

Q: What were Dr Chaplin’s thoughts on the quality 

and search ability of digitised books? 

A: A fully functioning e-book and a printed book that 

had been digitised were two very different things. E- 

books available from a commercial e-book supplier 

had been developed from scratch via a different 

process to digitisation. Most digitisation projects 

created images of existing pages; sometimes with an 

OCR of the text layered underneath to enable text 

search. There were recognized limitations of digitized 

content as opposed to e-books. 

Mrs Adrienne Mayers 


90


Minutes of the Seventeenth Ordinary Meeting 

Held on Thursday 18th April 2013 

‘Changing Roles in Nursing and Medicine’ 

Mrs Andrea Spyropoulos, President, Royal College of Nursing 

Mrs Andrea Spyropoulos and Mr Roger Franks 

The President welcomed and introduced Mrs 

Spyropoulos, the 38th President of the Royal College 

of Nursing, who had been re-elected to the office in 

2010. 

Mrs Spyropoulos told the meeting that from her first 

day as a cadet nurse, it became her ultimate ambition 

to be a ward Sister. Her SRN training was at Sefton 

General Hospital following which she was appointed 

Staff Nurse to the Vascular Unit at the Royal Liverpool 

University Hospital. She was made ward Sister to the 

Unit and held the position for ten years. However, her 

ambition had not ended there. She was appointed 

Sister Tutor, holds Degrees in Nursing and Medical Law 

from John Moores University, where she is a Lecturer, 

and in 2005 was elected President of the RCN. 

Mrs Spyropoulos quoted from a nurse job description 

for an American Hospital written in the late 

nineteenth century: 

“In addition to caring for your fifty patients, each 

bedside nurse will follow these regulations: 

i. Daily sweep and mop the floors of your ward. Dust 

the patient’s furniture and windowsills. 

ii. Maintain an even temperature in your ward by 

bringing in a scuttle of coal for the day’s business. 

iii. Light is important to observe the patient’s 

condition. Therefore, each day fill kerosene lamps, 

clean chimneys and trim wicks. 

iv. The nurses’ notes are important in aiding your 

Physician’s work. Make your pens carefully; you 

may whittle nibs to your individual taste. 

v. Each nurse on day duty will report every day at 7am 

and leave at 8pm except on the Sabbath, on which 

day she will be off work from 12 noon until 2 p.m. 

vi. Graduate nurses in good standing with the Director 

of Nurses will be given an evening off each week 

for courting purposes or two evenings per week if 

you go regularly to church. 

vii.Each nurse should lay aside from each pay day a 

goodly sum of her earnings for her benefits during 

her declining years, so that she will not become a 

burden. For example, if you earn thirty dollars per 

month, you should set aside fifteen dollars. 

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viii.Any nurse who smokes, uses liquor in any form 

gets her hair done at a beauty shop or frequents 

dance halls, will give the Director of Nurses good 

reason to suspect her worth, intentions and 

integrity. 

ix. The nurse, who performs her labours (and) serves 

her patients and doctors faithfully and without 

fault for a period of five years, will be given an 

increase by the Hospital Administration of five 

cents per day”. 

She noted the legislative landmarks in the transition 

from nineteenth century nursing to the present day: 

The 1902 Midwives Registration Act; the 1919 Nurses 

Act [which created the General Nurses Council]; the 

establishment in 1948 of the NHS; the 1970 Vision for 

Healthcare WHO; the Briggs Report on Nursing 

Education in 1972; the Nurses and Midwives Act of 

1979 and the establishment of the UK. CC in1983. 

The Speaker discussed the Brigg’s Report and the 

continuing debate it had provoked into nurse 

education, whether it should be an apprenticeship or 

university graduate based. The controversy had 

produced a reaction to graduate nurses in the press 

that characterised them as “too posh to wash” and 

which had encouraged the belief that they therefore 

lacked compassion for their patients. 

She agreed with Adelaide Nutting, founder of the 

John Hopkins School of Nursing, who wrote in 1887: 

“All good education anywhere costs, and it is bad for 

our schools, for our nurses, for Physicians, and for sick 

people everywhere, when the first question is always: 

“How little can we do it for? Rather than how well 

can we do it?” To this, Mrs Spyropoulos added her 

own view: “It is fundamental to training that the 

nurse must believe they are always doing the right 

thing in an environment where the trainee wants to 

perform, and the core values surround patient care”. 

The speaker noted, whilst treatment outcomes 

expected by the public had changed beyond 

recognition, patients also required that nursing skills 

remained the same. She agreed that times might 

change but nursing principles must endure. An 

employer could hold an individual accountable to 

their job description, but a nurse’s commitment, 

“compassion” and engagement with their patients 

must come from the heart. The problem was how to 

hold someone accountable for their level of 

“compassion”. Mrs Spyropoulos thought that 

“compassion” could be created if there was a culture 

of caring. “Compassion levels” might be discussed by 

politicians and the press but was it possible to deliver 

“compassion” to patients if the prevailing political 

culture in the NHS was quantity and cost 

containment? She noted that for the last ten years, 

the focus in the NHS had shifted from care to financial 

probity and meeting targets. Simply saying that 

nurses were required to be “compassionate” would 

not change the culture. The most important way of 

changing the culture was to put pride back into 

nursing. She thought that the profession needed 

creative, inspirational leadership that encouraged 

nurses to have a desire to achieve. 

Mrs Spyropoulos described pilot studies where senior 

nurses, wearing uniform that clearly identified their 

position, were made supernumerary ward Sisters. 

They led by example; undertook the supervision, 

education and support of student nurses and were 

responsible for the nursing budget. She said it was 

self evident that this approach could change a culture 

of poor quality of care. 

She emphasised that ward staffing levels must equate 

to patient needs. In Australia, there was one 

registered nurse to four patients, whereas in the UK, 

in care for the elderly wards, this was one nurse to ten 

patients. Understaffed wards led to loss of nursing 

morale. The RCN study (2012), “What Nurses Say”, 

reported the percentage of nurses who confirmed, 

due to lack of time in their last shift, what they 

considered they had left undone or performed 

inadequately. This included: “comforting/talking to 

patients: 78%; promoting mobility and self-care: 59%; 

oral hygiene: 48%; falls prevention: 45%; sufficient 

change of patients position: 41%; information given 

to patients and family: 38%; helping patients with 

food or drink: 34%; helping patients use the toilet: 

33%; preparing patients and families for discharge: 

30%; skin care: 30%; pain management: 19%; care of 

the dying: 17%”. 

The Francis Inquiry (2013) into the Mid Staffordshire 

Hospital debacle had been driven by achieving Trust 

status. It cost the public purse over thirteen million 

pounds and yet had not recommended that money 

was ring fenced for ward staffing. Mrs Spyropoulos 

noted that whereas in the airline industry, if there 

were not enough pilots, the plane did not take off, in 

the NHS, patient day-to-day care was expected to 

continue irrespective of the number of ward staff. The 

inquiry had, however, explicitly set out the standards 

of care required in the NHS and emphasised, if a nurse 

92


thought this fell short, it was their duty to speak out. 

It was the speaker’s experience that “when nurses and 

doctors worked together, they are a very formidable 

political combination”. 

Mrs Spyroupolos concluded that whilst Florence 

Nightingale had written to Sir Henry Bonham-Carter 

in 1867: “I look to the abolition of all hospitals. But it 

is no use to talk about the year 2000”; she had later 

and presciently stated that the changing roles of 

Nursing and Medicine could be summed up by: 

“Tradition is precious as long as it helps conserve true 

values for the coming generations; useless if it 

hampers the growth of methods to meet changing 

needs”. 

The speaker answered questions from the audience: 

She discussed “Project 2000”. In her view, the 

concept was right. It had, however, removed 

clinical tutors who worked on the wards training 

student nurses. That generation of clinical tutors 

“had earned their stripes on the ward. Clinical 

exposure with experienced senior nurses was what 

a student nurse needs”. Mrs Spyroupolos noted 

that whereas previously there had been two ward 

Sisters covering the shifts, this was reduced to one, 

who worked from nine to five. The post of ward 

Sister was later abolished and replaced by a ward 

Manager. 

The State Enrolled nurse [SEN] had been replaced 

by the Health Care Assistant [HCA]. The Royal 

College of Nursing’s opinion was that the position 

of HCA must be standardised and regulated. This 

view had been taken to Government. The RCN had 

“a history of delivering on legislation”. 

In Mrs Spyroupolos’ opinion the “ward Manager” 

should be called “Sister”. She noted the average 

age of entry to the nursing profession had risen to 

the late twenties and she believed that reports in 

the media had had a negative effect on nurse 

recruitment. 

The President proposed the vote of thanks. He 

described Mrs Spyropoulos as “a very intelligent doer” 

and congratulated her on her re-election as President 

of the Royal College of Nursing. The audience 

responded with prolonged applause. 

Mr Gerard A McLoughlin 

93


Minutes of the Eighteenth Ordinary Meeting 

Held on Thursday, 25th April 2013 

‘Coronial Reform - 125 Years in the Making’ 

André J A Rebello OBE, HM Coroner for Liverpool 

Mr Roger Franks and Mr André Rebello 

The Liverpool Medical Institution predates the 

Coroners’ Society of England and Wales by 67 years 

but the actual Office of Coroner goes back to the time 

of Alfred the Great. The coroner always investigated 

sudden, unnatural or unexplained deaths but in 1192 

a ransom had to be raised for Richard I. Sheriffs were 

untrustworthy so the coroners got this financial role. 

The administration of criminal justice included the 

seizure for the Crown of the possessions of felons and 

suicides (self-murderers) plus the confiscation of 

deodands, (instruments defined by the coroner's jury 

as being used to kill a person). The coroner also dealt 

with shipwrecks and buried treasure. 

To deter the native English from killing Normans after 

the Conquest, any unexplained body was assumed to 

be a Norman and so a fine (the ‘Murdrum’ - source of 

the word murder) was imposed on the local village. 

An inquest could establish non-Norman origin. In the 

13th and 14th centuries, before the establishment of 

the police service, the coroners were the principal 

agents of the Crown to bring criminals to justice and 

the Coroner's Officer is still a policeman. 

In the 1830s the growth of railways had led to 

accidents and deaths for which little compensation 

could be obtained. After one tragic event on 

Christmas Eve 1841, the Coroner's jury decided the 

train was a deodand to provide for the bereaved. 

However this award was subsequently overruled. 

Until 1888 County Coroners were elected by the 

freeholders of the County but thereafter local 

government appointed them. They can only be 

removed by the Lord Chief Justice and Lord Chancellor 

for personal misconduct, though newly appointed 

ones have an age limitation of 70. 

The 1836 Births and Deaths Registration Act was 

prompted by concern over the accuracy of the 

numbers of recorded deaths from cholera and other 

epidemics. Easy and uncontrolled access to poisons 

94


might lead to undetected homicides. The financial 

responsibility of coroners had decreased but the 1887 

Coroners Act still required them to determine the 

circumstances and medical causes of certain deaths. 

The need to reform death certification and the 

coroners system had long been recognised. Some Acts 

had consolidated previous legislation even dating 

back to Edward I. Government reports in 1910, 1936 

and the 1971 Brodrick Report were largely ignored. 

However since 1977 and the Lord Lucan murder, 

coroners and their juries can no longer indict an 

individual for murder or manslaughter. 

In the 21st century one major problem was the 

retained organ issue where some centres were unfairly 

named and criticised for what was in fact widespread 

medical practice. The second was the activities of Dr 

Harold Shipman. The latter was investigated by 

Department of Health - Dame Janet Smith - and death 

certification by Mr Luce appointed by the Home 

Office. Unfortunately some of the enquiries ran in 

parallel, with little cross fertilisation, and produced 

different recommendations about death certification. 

So a further report “Reforming the Coroner and 

Death Certification Service” consolidating these had 

to be produced - at more public expense. It was 

welcomed by the then Home Secretary saying, "There 

is an irrefutable case for reform...". However after a 

General Election, the responsibility was transferred to 

a newly formed Department of Constitutional Affairs 

with a new minister so little progress was made. 

A draft Bill published in June 2006 was disappointing. 

Most proposals for reform were not included. The 

main aspect was limitation of cost and no solutions 

offered to three difficulties with death certification - 

difference in certification procedures for burial and 

cremation, a complex certification system with lack of 

training of medical practitioners hence a high coroner 

referral rate, and no definite solution to Shipman style 

abuse. 

Some did get into law in the shared Coroners' and 

Justice Act 2009. It proposed some coroner reform 

and training and a separate medical examiner service. 

Little was done but it may be rapidly implemented 

during this summer as the next General Election 

approaches. The Medical Examiners are senior doctors 

to scrutinise all deaths and medical records to provide 

a Death Certificate if necessary. They were to have 

been employed by Primary Care Trusts but now by 

local authorities. Their fees will have to be recovered 

from the bereaved relatives (unless the case is referred 

to the coroner) and hence called a "Death Tax". A 

Chief Coroner to oversee Coroners' work and to deal 

with appeals was approved, cancelled and then reinstated 

though with much reduced powers, and not 

dealing with appeals. 

Death certification and the high incidence of postmortem 

examinations (21-22% of deaths in England 

and Wales, 2-3 times the rate in comparable Western 

countries) is still a problem. If a person dies without a 

doctor able to issue a Medical Certificate of Cause of 

Death, (and this is much more likely as GPs are not 

available 24/7 and much out-of-hours work is 

contracted out), the death must be reported to the 

coroner whose responsibility is to investigate 

wherever there is a body in his/her area and the death 

is violent, unnatural, from an unknown cause or whilst 

in State detention. 

Post-mortem CT scanning has proved more accurate 

than MR imaging but the gold standard is still the 

autopsy. Some communities are prepared to pay for 

scanning. A consented autopsy is now extremely rare. 

The purpose of the coroner's autopsy is to identify 

who has died and the medical cause of death. Further 

information obtained for epidemiology or academic 

questions as in a careful and thorough autopsy, is not 

strictly within the requirements for a coroner’s 

autopsy, and it may be against the wishes of the family 

and even of the deceased who, in life, may have been 

opposed to any investigation or treatment but loses 

that right after death! 

The national average from the date of death to 

completion of inquests is 27 weeks: the draft Act 

suggests three months but Liverpool already has the 

admirable figure of 9 weeks. 

The new Act does have its limitations, and is 

particularly restrictive of costs, but like the curate’s 

egg, it is good in parts. 

After questions, the President, Mr Roger Franks gave 

the formal Vote of Thanks. 

The full text of Mr Rebello’s address is available at the 

LMI and on the website member area. 


95


Retired Members’ Group 

We had three talks at the Institution followed by lunch and our summer outing was to the Liverpool Anglican 

Cathedral. 

Paul Nolan: The Mersey Forester 

2 October 2012 

Few members were previously aware that there was a Mersey Forest, let alone a Forester. Paul told a compelling 

tale of planting and conserving deciduous trees in the county. He went into some detail about the Jubilee Tree 

Project to plant trees, chiefly in schools to celebrate the Diamond Jubilee of Her Majesty the Queen. 

Iolo Thomas, Chairman Liverpool River Pilotage Services 

4 December 2012 

Iolo revealed some of the many mysteries of the pilots’ work to keep the Mersey free and safe for its once again 

burgeoning shipping traffic. The work is not for the faint hearted but Iolo’s enthusiasm made it seem almost easy. 

James Carmichael: The Arnolfini Portrait 

12 March 2013 

James is indeed the doyen of our group. He shared his almost life-long love for this treasure of our National 

Gallery. It was painted by the Dutch master Jan van Eyck in 1434. Undaunted by the challenge of Power Point, 

James revealed some of the amazing detail of this masterpiece. 

Ian Tracey, Organist Titulaire, Liverpool 

21 May 2013 

We mustered over 50 members and friends and were spellbound by Ian’s telling of the history of the organ. We 

were treated to a visit to the blowing room and then to a display of the tonal range of the instrument and two 

classic items from the organ repertoire. A festive lunch followed in the Sir Giles Gilbert Scott Suite. 

The group flourishes. I try to recruit speakers and topics with little or nothing to do with medicine. The meetings 

are also a chance to meet old friends. You don’t have to be retired or even really old to take part and guests are 

welcome. It is all very informal. 

Dr Austin Carty 

96


Report of Council (SMC) 2012/3 

Once again, the session from 2012 to 2013 has been a 

year of change and development for the Institution. 

The new governance structure of both the Strategic 

Management Council and the Membership and 

Education Committee are now well-established and 

functioning well. There have been extensive 

maintenance works carried out on the building’s 

exterior with plans afoot for improving the 

conference facilities. 

At a time when the NHS is undergoing yet more major 

change, the relationship between doctors and hospital 

trusts continues to evolve as does that between 

primary and secondary care practitioners. The role of 

the LMI could never be more relevant in providing a 

forum for education, discussion and communication 

between all of medicine’s disciplines, independent 

from our place of work. Whilst its role as a 

postgraduate medical education centre has 

undoubtedly declined over the last few decades, it is 

this independent society of doctors that remains at its 

core and our focus is to strengthen this and invite a 

new generation of doctors to enjoy the benefits of 

membership of The Liverpool Medical Institution. 

Mr Roger Franks was inaugurated as President for the 

174th Session of the LMI and we would like to thank 

him for organising the 2012-2013 programme. 

Highlights include the lecture series on the future of 

the NHS, which was very well attended, and the 

presentation by the President of the Royal College of 

Nursing Ms Andrea Spyropoulos. We also look 

forward to welcoming our new president, Professor 

Linda de Cossart who will be organising next year’s 

programme from 2013 to 2014 and Mr Max 

McCormick has been nominated for President for the 

176th Session. Mr Austin McCormick has joined as 

Honorary Secretary. 

Few will have failed to notice the shrinking car park, 

the Everyman development and scaffolding around 

the younger part of the LMI building. This year a 12 

week maintenance project to repair the concrete 

exterior, which was extensively eroded, has been 

completed, on schedule and under budget. In 

addition redecoration of the windows and paintwork 

on the 1965 building was completed in January 2013, 

and the building is now safer, looking much better 

and cleaner. Internally the Main Hall was repainted in 

2012, and the Gallery and Oak Study will be repainted 

this year. The Everyman building has progressed 

without major disruption to the LMI’s functions and 

further parking facilities have been secured at the 

Catholic Cathedral. 

The Librarian continues to explore pathways to 

museum status, which could open up new avenues 

and activities for the LMI. Thanks to all those 

members who have assisted in the modernisation and 

reorganisation of the existing collections. 

Conference hosting remains a strong part of the LMI’s 

business model despite challenging economic 

conditions. We welcomed back the Mersey School of 

Anaesthesia’s FRCA and Selective Course amongst 

many other regular and new bookings. We are always 

keen to welcome new users, and if members can 

remember us to any social or professional groups they 

are part of, who may wish to use the facilities, this 

would be much appreciated. 

The LMI is committed to engaging with younger 

members and is in the process of developing a short 

lecture programme for the coming year, to feature 

speakers on a range of subjects of interest to medical 

students and doctors in training. Topics are likely to 

include: exam and interview technique; expedition 

medicine; forensic medicine; Médecins Sans Frontières; 

Sports medicine. This will complement the main 

lecture programme, on a different night of the week 

and membership of the LMI will be promoted after 

each talk. 

The digital revolution progresses relentlessly and the 

Institution continues to modernise its information 

technology. New audio visual facilities to aid teaching 

and presentations have been installed in the Council 

Room, which will be helpful to those who hire the 

room for workshops and meetings. The new 

videoconference facility has enabled the regular RCP 

teach-ins to be broadcasted to the Isle of Mann, and 

many more connections are being established with 

links to Aintree, Leighton and Llandudno to name 

a few. The LMI are now on Facebook and 

Twitter (facebook.com/LIVLMI-@LMI114). We would 

encourage any members who use these social 

networking services to follow us, as this will enable 

the Institution to keep you up to date with lectures 

and functions. A card payment facility has been 

installed, and can be moved throughout the building, 

97


enabling LMI to take payments by card and over the 

telephone. This has proved very useful and allows 

members greater choice and convenience in making 

bookings. The member login area on the website is 

live, and members can also now book onto LMI events 

using the website. 

The Institution would like to thank the following for 

their time and enthusiasm this year: Dr Bethan Jones 

for her work on the LMI Transactions; Dr Tony Ellis for 

his work as Treasurer; Dr Sally Sheard for her work as 

Hon. Librarian; Mrs Claudia Harding-Mackean and 

Professor Terry Wardle for their efforts with the Sixth 

Form Conference. 

Of course, a special thank you should also be given to 

all the staff of the Institution, without whose hard 

work the LMI’s activities could not continue; SMC 

thanks the Finance Officer, Jim, the manager Sam, the 

administration team Audrey, Sharon and Lynne for 

their tireless efforts for the membership and 

conferences, Adrienne and Sue for their expert 

assistance in the library, Joyce who manages the bar 

and Tom who controls the car park during evening 

meetings. Lastly, let us not forget the outstanding 

services of our regular caterers, Real Food, who are 

continually outstanding. 

We would also like to thank Mr Andrew Swift for his 

continued dedication and able Chairmanship of the 

SMC, which have been instrumental in the formation 

of the initial SMC structure and its continuing success. 

Last but not least, the support of members in these 

challenging economic times is appreciated now more 

than ever, and we love to see members using and 

enjoying the building. 

Mr Austin McCormick (Hon Secretary) 

98


Report of the Honorary Librarian 2012 

I am very pleased to report that the library re-classification project is almost complete. Over 7,000 books have 

been carefully checked against their existing catalogue entries, key search terms added along with a new National 

Library of Congress classification, and the retained books moved to their new locations in the library. Adrienne 

and Sue have been fortunate to have assistance from small band of loyal volunteers and from LMI members who 

have visited the library to assess the quality of books relating to their specialisation. This has helped to rationalise 

our holdings by removing duplicate items and books that do not meet our requirements. We have also found a 

considerable number of books that were not listed on the catalogue. The feedback from members and guests 

on the newly refurbished library facilities has been very positive. We have added some comfortable chairs to the 

reading room and we also hope to improve the heating and insulation in the library in the coming year. 

In April 2013 Dr Simon Chaplin, the head librarian of the Wellcome Trust library in London, accepted an invitation 

to visit the LMI to discuss our collections, policies and development plans. Simon had previously been responsible 

for the refurbishment of the Hunterian collection at the Royal College of Surgeons, and is now leading a large 

project to re-configure the Wellcome Trust’s library. Adrienne and I gave Simon a tour of the LMI library and he 

provided some very helpful suggestions for inclusion in our forthcoming reading room feasibility study. He was 

impressed by the LMI’s collections and their conservation, which he cited as good practice in the public talk 

‘Doctors and the Death of History: What’s the Future for Medical Libraries?’ that he gave that evening to an 

audience of over 50 members and visitors. 

The LMI has been accepted onto the programme for museum accreditation. This process, which Adrienne will 

lead over the next two years, will enable the LMI to participate in touring exhibitions and access funding to 

develop LMI’s collections and their display. There have been several public tours of the LMI during the year, and 

we will participate again in the Heritage Open Day scheme in September. The medical students continue to use 

the library for their studies, especially for history of medicine projects. The annual History of Medicine Prize 

Evening was held on 4 December 2012. This has become a very popular event in the students’ calendar, and 

provides an excellent opportunity for them to visit the LMI . Abstracts of the five presentations are printed in 

this issue. 

Dr Sally Sheard 

Honorary Librarian 

99


Obituaries 

GEORGE ANSELL 

Consultant Radiologist 

George Ansell, born 1921, 

was educated at Wallasey 

Grammar School. He 

commenced his medical 

studies at Liverpool in 1939, 

just as the War began. 

Thus his undergraduate 

career was totally in 

wartime - a chaotic, 

hazardous period, where 

death and destruction were 

daily accompanists. 

Teaching was “below par” 

due to staff shortages (so many called up to the Armed 

Forces) and students had to learn for themselves. In 

addition a student had to undertake at least three 

months work as house physician or surgeon whilst 

unqualified, bearing tremendous responsibility. At 

last, in June 1945, George graduated. 

This was a bad time to be a trainee in any speciality, as 

so many were returning from the war and were given 

priority. So it is not surprising that George took some 

years before he settled in diagnostic radiology as his 

future career. But the years were not wasted. First he 

obtained his MRCP in 1947 - no mean feat. At this 

time he undertook some of the earliest work in the 

medical use of radioactive isotopes. He is 

acknowledged to have performed the first thyroid scan 

in the UK. At this time his physics colleague was Joseph 

Rotblat, who had resigned from atomic bomb work 

during the war and was turning increasingly to medical 

physics. Rotblat later became the leader of the 

Pugwash Movement, and internationally known. 

George was a medical specialist in the RAF 1948-50, 

and during this time achieved his MD. Therefore, 

within four years of graduating, he had both MD and 

membership. From 1950-51 he was a research fellow at 

Sheffield University in the Department of Therapeutics. 

But there were no medical registrar posts available, 

even to one with his qualifications. So he entered the 

Liverpool University radiology course, achieving his 

Diploma in 1953, and his FFR in 1955. In late 1954 he 

was appointed Assistant Radiologist at Broadgreen 

Hospital. This was in the grade of SHMO. George had 

only three years in radiology by then, and was too 

short of time to be a Consultant. The ruse of SHMO 

was used by the boss, Percy Whitaker, as a means of 

keeping hands on good young radiologists until a 

Consultant job came up. Eventually in 1959, he was 

appointed Consultant at Whiston, where he remained 

until retirement. 

George was always good at the academic side, and this 

continued throughout his Consultant career. He gave 

“basic radiology” tutorials and this was eventually 

transferred to the academic radiology department at 

Liverpool University, where he became a part-time 

lecturer. But his most serious and best work was in the 

study of contrast media. This was prominently 

displayed in a paper in “Investigative Radiology” 

(subsequently described as one of the twelve most 

important papers published by them) and in the book 

he edited “Complications in Diagnostic Radiology” (in 

which he invited me to write a chapter). 

In his private life he was long married to Vera, a very 

lively lady and the opposite of the quiet George, but a 

perfect match. They eventually retired to London, to 

be near her relatives. She died in 2007 and eventually 

George, very frail, had to enter a nursing home where 

he died late last year. His health had always been frail, 

but he lived to the age of 92, outliving his 

contemporary George Scarrow from the Royal (90) and 

John Winter at Walton (91). I shall always remember 

him - we got on quietly, but well, and I am always 

grateful to him for stimulating me to write two book 

chapters, one in his book mentioned above. 

George Ansell. Born 11th December 1921. Died 4th 

November 2012. 

James Carmichael 

PETER DRISCOLL BOOKER 

Consultant Paediatric Anaesthetist 

Peter Booker was born in 

Devon; his parents were 

teachers. He studied 

medicine at the London 

Hospital Medical School, 

qualifying in 1974. 

Deciding on a career in 

anaesthesia, he was a 

registrar in Cambridge 

before coming to Liverpool 

as a Senior Registrar in 

1980. After a period as a Fellow at the Hospital for Sick 

100


Children in Toronto, he returned to the Royal Liverpool 

Children’s Hospital (Myrtle Street) as a Consultant, 

essentially following on from Dr G Jackson Rees. Thus 

his main clinical role was in providing anaesthetic care 

for infants and children undergoing surgery for 

congenital heart defects. He continued in this role for 

some twenty-five years, during which time the cardiac 

unit at Liverpool moved to Alder Hey Hospital, and 

Peter himself moved posts between the NHS and the 

University of Liverpool. He was Senior Lecturer in 

Paediatric Anaesthesia from 1992 -2005. This academic 

post allowed him more time for carrying out his clinical 

research on inotropic drugs and culminated in his 

being awarded an MD for his work on gut blood flow 

following cardio-pulmonary by-pass. He was the 

European co-editor of the major textbook Pediatric 

Cardiac Anesthesia, and he was, for many years, a 

College Examiner. 

In addition to his academic research, Peter made a 

major contribution to the work of the Mersey School 

of Anaesthesia, such that the School’s revision week for 

the final FRCA examination became known as the 

‘Booker Course’. 

Peter was an expert paediatric cardiac anaesthetist 

through an era which saw great increases in the 

complexity of work undertaken, improvements in 

outcome and ever closer scrutiny of such surgery. He 

was a superb clinical anaesthetist, famed for his speed, 

precision and bone-dry humour. 

He had honed his technique to eliminate unnecessary 

movement or effort; the net effect was that the sickest 

of infants would be safely, speedily and elegantly 

conveyed through their surgery. 

Peter was held in some awe and huge affection by the 

rest of the Department. He revelled in his reputation 

for parsimony and in his famed impatience with delay. 

When, in his later years, he widened his repertoire to 

include providing anaesthesia for MR scanning he 

proved conclusively that if it wasn’t for the surgeons, 

all lists would run smoothly in an atmosphere of 

serenity. He is greatly missed. 

He leaves his wife, Holly, a son from his first marriage, 

two daughters and grandchildren. 

Peter Driscoll Booker. Born 1950. Qualified London 

1974. FRCA, MD. Consultant Paediatric Anaesthetist, 

Liverpool. Died of metastatic renal cell carcinoma, 

19th May 2013. 

Frank Potter 

HUGH DOVEY 

Orthopaedic Surgeon 

I and other members of the 

Brandreth Club were 

privileged to have been 

close friends of Hugh for 

the past several years. This 

club, consisting of retired 

Merseyside medical 

practitioners, meeting once 

monthly, gave us the 

opportunity to get to know 

and appreciate Hugh’s 

erudition, encyclopaedic knowledge of poetry, wit, 

generosity, friendliness and his prowess as an after 

dinner speaker. With reference to poetry, I personally 

recollect being most impressed by him giving a critical 

opinion of the work of the poet C V Cavafy, relatively 

unknown except to his Greek community of 

Alexandria, Egypt and those like myself who grew up 

in that city. 

I am told that he was an experienced handyman who 

had rebuilt and renovated over the years and that he 

had had a great interest in classic cars. Sadly, because 

of illness, he had been unable to join us for over a year, 

and his absence was sorely missed, particularly at 

luncheons after our meetings when he kept us 

entertained with his wit. 

Hugh Dovey was born in Liverpool in October 1929, the 

son of Ruth & Reginald Dovey. His mother, Ruth, was 

for many years a GP in West Derby, and also a skilled 

anaesthetist on the consultant staff of the Royal 

Infirmary, the David Lewis Northern and Alder Hey 

Hospitals. Hugh qualified as a doctor from Peterhouse 

College, Cambridge, subsequently serving as a surgeon 

in the Royal Air Force for his National Service. Part of 

this period was spent in Aden in the Middle East. 

Following his training as an orthopaedic surgeon in 

assorted Liverpool and London teaching Hospitals he 

moved to Denmark where he spent some twenty years 

as an orthopaedic consultant. During this period he 

married Kirsten, and is survived by a son, Mark and a 

daughter, Pernille. An enjoyable year was spent as 

guest Senior Lecturer in Orthopaedics at Durban 

University, South Africa. 

Following Hugh’s return to England in the 1980s, a 

period was spent as Senior Lecturer in the University 

Department of Orthopaedics. He retained a keen 

interest in his chosen profession and I recollect 

101


orthopaedic meetings in which a fresh slant on the 

topic discussed was frequently brought up by Hugh. 

Having spent many years practising his specialty in 

several far reaches of the globe, he usually had 

something original to tell us about how such a matter 

was dealt with in Aden, South Africa, or Denmark! He 

joined the Liverpool Medical Institution and was a 

regular attender at its meetings. Ever seeking pastures 

new, he trained as an osteopath, setting up a practice 

in osteopathy which gave him much pleasure, and 

which I for one found of great value, as I was able to 

seek his advice on various aspects of that bugbear of 

orthopaedic practice, the problem of low back pain! 

Hugh died in January 2013 after a long illness bravely 

borne with his inimitable fortitude and optimism. 

I would like to acknowledge, with thanks, the 

contributions of Mrs Jane Grimes, Civil Funeral 

Celebrant, and Dr Nick Clitherow in the compilation of 

the above. 

Hugh Dovey. Born 22nd October 1929. MD. MCh 

(Orth). FRCSE. Died 10th January 2013. 

Murad Ghorbal 

ELISABETH REES 

Consultant Physician in Genito-urinary Medicine 

The death of Elisabeth (Betty) Rees on 29th October, 

2011 marked the end of many years of family 

contribution to Liverpool medicine from Betty herself 

and from her husband, the paediatric anaesthetist 

Gordon Jackson (Jack) Rees. She was a consultant 

physician who played a critical role in broadening the 

scope of genito-urinary medicine from one that simply 

treated venereal disease to one which promoted sexual 

health. In this she was an undoubted pioneer, albeit 

one who would have been reluctant and embarrassed 

to accept the accolade 

Born in 1919, Betty Schofield was the daughter 

Alexandrina McIver and John (Joe) Schofield, a 

successful Liverpool bookmaker who established AJ 

Schofield Turf Accounts Ltd after a long career as a 

footballer playing for Everton and then Manchester 

United. Despite severe illness that left her with 

bronchiectasis from childhood, Betty herself continued 

the sporting tradition and represented Lancashire 

Ladies at cricket. She was educated at Belvedere School 

before going up to study medicine at Liverpool in 

1938. She qualified in December 1942 as part of the 

accelerated medical programme to speed up the 

supply of doctors. Although she spoke of it rarely, her 

wartime experiences in Liverpool deeply influenced 

her. Liverpool was the principal port supplying the UK 

during the Second World War and its docks were 

extensively bombed. As a student, she drove 

ambulances during the blitz and, after qualifying, 

worked in the casualty department of Bootle Hospital 

close to the docks. What she saw reinforced her horror 

of violence and gave her first hand experience of the 

suffering of the local people and of their resilience in 

the face of severe poverty. She witnessed the particular 

strengths and needs of women in such circumstances 

and this greatly influenced her subsequent career. 

Betty met her husband, Jack, during her first year at 

Medical School (he was a student in the year above) 

and they married in 1942. Joanna, their first child, was 

born in 1944 and followed by Andrew in 1946, William 

in 1949 and James in 1951. After the war, she had 

intended to train in general medicine but this was 

precluded by her new family responsibilities and she 

decided to train in a wholly outpatient specialty 

instead. She opted for Venereology (as it then was) - a 

seemingly strange choice and an unprecedented one 

for a woman in Liverpool at the time. Her reasons were 

simple; her knowledge of the complete lack of 

provision for the needs of women with sexually 

transmitted diseases and the insight that women 

affected by them would be much more effectively 

treated and counselled by a woman rather than by 

male doctors, as was then the universal practice. 

In 1945, she joined the Venereology Department of the 

Liverpool Royal Infirmary and worked there 

continuously until her retirement in 1984. Initially, she 

trained under the guidance of Cecil Allergant and 

eventually succeeded as Head of Department. From 

the outset she was concerned to ensure the much more 

sympathetic treatment of women with sexually 

transmitted diseases and to combat the near universal 

ignorance and misconceptions about them amongst 

the patients themselves, the wider public, and indeed 

the medical profession. Her views were summarised in 

a lecture to the Liverpool Medical Institution in 1964 

with a provocative title taken from the nineteenth Irish 

novelist Samuel Smiles, “Women are mostly 

troublesome cattle to deal with….”. The paper was 

subsequently published in the BMJ rather more coyly 

entitled “Failure to Control the Venereal Diseases” 

(BritMedJ. 1964: 2; 47-49). 

102


Betty was an excellent teacher whose lectures, tutorials 

and clinical teaching made a huge impression on 

undergraduates and postgraduates alike – and not 

only because of the vivid subject matter. She was an 

outstanding mentor and made major contributions 

toward formalising training for junior staff in the 

Department which helped to break the mould of this 

previously male dominated specialty. One of her most 

important contributions was to catalyse evolution of 

the attitude of the profession (and the public) to those 

affected by sexually transmitted diseases. This led to 

the acceptance of Genito-Urinary Medicine (no longer 

Venereology) as a speciality whose patients were no 

different from any others. In 1978, she was delighted, 

as Head of Department, to be able to supervise the 

move that symbolised the changed attitude. No longer 

to be hidden away in the basement of the old Royal 

Infirmary, the Department migrated to the ground 

floor of the new Royal Liverpool University Hospital, 

close to the heart of its activities. 

Betty was a committed clinical researcher who made 

sure she and her trainees published regularly. She was 

recognised for her work on the epidemiology of 

sexually transmitted diseases especially in women, 

colposcopy and most notably in her latter years for 

work on chlamydial infection in women and neonates. 

This research was undertaken, with Anne Tait and 

Derek Hobson, when she had more time after her 

children had grown up and led to her amused 

recollection of being awarded her first MRC grant at 

the age of 55 – an elderly “primip” so to speak! Her 

professional standing was recognised by her election 

to the council of the Medical Society for the Study of 

Venereal Disease in 1964 and she became its President 

in 1982. She was made an honorary life member in 

1985 after it had transformed into the British 

Association for Sexual Health and HIV (BASHH). She 

was always an active member of the Liverpool Medical 

Institution - she was elected its president also in 1982. 

Chronic lung disease combined with family history of 

early death (her mother had died in her forties whilst 

Betty was a medical student) led her to assume she 

would be lucky to survive beyond middle age, and she 

lived life accordingly – something reflected in her 

driving which became legendary. No doubt influenced 

by her early experiences with ambulances and 

undeterred by a complete lack of stereoscopic vision 

(due to corneal scarring of her right eye, acquired as a 

teenager) she always, in the words of an ex-registrar, 

drove like a maniac - although apparently none of her 

children realised it. Not all the driving stories 

concerned speed and a particular favourite from near 

the end of her career reflected more on her 

commitment to patients. Late one evening having 

parked on the edge of Toxteth (shortly after the riots 

there), she returned to her car with a friend after a 

concert at the Philharmonic Hall to find a flat tyre. 

Unable to get the wheel off and seeing what looked 

like a local gang approaching, she and her friend took 

refuge in the car. One of the group sauntered up to 

the car, but rather than mugging the elderly ladies, 

simply smiled and said “Hello Dr Elisabeth, don’t worry 

we’ll soon have that fixed for you” He immediately 

took charge, changed the wheel and in no time was 

waving Betty and her friend on their way home. 

Betty had always had deep cultural interests especially 

in theatre, books and painting but never with enough 

time to pursue them. Retirement changed that and she 

was soon as busy as ever. She developed a passion for 

opera coupled with a love of Italy, its history and its 

language; the Etruscans were a particular interest. She 

became an inveterate attender at the Edinburgh 

Festival which combined a feast of culture with the 

additional pleasure of reunions with Anne Tait who 

now lived there. Retirement also allowed the 

opportunity for her and Jack, who had retired a year 

earlier, to travel together extensively throughout the 

UK. 

After Jack’s death in 2001 Betty lived alone in the 

family home until her death. For most of the time she 

remained very active and continued to travel 

throughout the UK and Europe. The last two years 

were more difficult after fracturing her femur. Despite 

this she retained the stoicism and determination 

needed to ensure that she was eventually able to die as 

she had always wanted, peacefully at home. Till the 

end she remained utterly bemused that she had 

survived into her nineties. 

In the words of a previous trainee, Betty Rees was a 

really lovely lady who was instrumental in changing 

the concept of venereal disease into sexual health by 

her care and respect for her patients. Her many 

patients and her colleagues owe her a great debt of 

gratitude. 

Elisabeth Rees. Born 1919. Qualified 1942. Died 29th 

October 2011. 

RF/AR 

103


JOSEPH JOEL RIVLIN 

Specialist in Manipulative Medicine, Liverpool 

Joe Rivlin was born in 

Liverpool and educated at 

Liverpool Collegiate 

School. He went to 

Liverpool University to 

study medicine in a 

compressed wartime 

course that saw him 

qualified in 1943. A keen 

rugby player, he was 

hooker for the University 

XV. Following house jobs in Walton Hospital, he went 

into the RAMC and served in India, East Africa and the 

Seychelles. 

After the war he was appointed registrar in pathology 

at Walton Hospital and then assistant pathologist at 

the Liverpool Maternity Hospital, but this career path 

came to an end when he met the medical student 

whom he subsequently married. In 1949 he became a 

partner in her father's general practice in Bootle, one 

of the poorest places in the country, working in a 

shop-front surgery close to the Mersey Docks. A few 

years later he gave up rugby and became a committed 

golfer. When his father-in-law died in 1957, his wife 

joined him in the practice, and two years later her 

brother became a third partner - making this a real 

family practice in which Joe was widely loved and 

respected by his patients as a reliable, caring and 

knowledgeable source of support. 

He was a member of LMI Council in 1960-61, and in 

1992 was made a Life Member of the Institution; he 

did indeed remain an active member for the rest of his 

life. He was also a keen member of the Liverpool 

Medical History Society. In 1963 he became an elected 

Town Councillor for the County Borough of Bootle, 

serving until 1966 on the Health, Welfare, Children's 

and Library Committees. 

Discovering an interest in manipulative medicine, he 

took time off to pursue it and in 1969 gained 

licentiateship of the London College of Osteopathic 

Medicine. For a few years he divided his time between 

this discipline and general practice, but in 1974 he 

retired from the practice and established himself as a 

full-time manipulative medicine specialist in Liverpool. 

He went on to train as an acupuncturist and became 

part of the Pain Clinic team in Walton Hospital. He 

worked with the Pain Relief Foundation from 1975 - 

1987 and finally retired from clinical practice in 1991. 

In retirement he obtained a Master's degree in the 

History of Medicine, travelled widely looking at 

European art, in which his wife was also taking a 

couple of Master's degrees, and strove to maintain his 

golf handicap. His wife predeceased him in 2003. He 

leaves two children and three grandchildren. 

Joseph Joel Rivlin. Born 12th November 1921. 

Qualified Liverpool 1943; MRCS, MLCOM, MSc. Died 

5th September 2012 from prostatic carcinoma. 

GEOFF ROBERTS 

Press and PR Photographer, Liverpool 

Conrad M Harris 

Geoff Roberts was one of Merseyside’s best known 

and most successful freelance press and public 

relations photographers for more than three decades. 

By virtue of his relationship with long-term partner 

Audrey Watson-Mattocks, of the Liverpool Medical 

Institution admin team, he was also the LMI’s honorary 

photographer for many years. 

Geoff was a much-admired character who combined 

his photographic talents with an engaging personality, 

a way with words (in conversation and on the page) 

and a head for business. 

Born in Anfield in 1948, Geoff was an only child who 

grew up in an enterprising environment, as his parents 

ran a small but successful grocer’s shop in Townsend 

Lane. He was educated at the Holt Grammar School in 

Childwall, where he did well in many subjects, but was 

particularly fluent in French and especially good at 

chemistry. As a result of these strengths, Geoff started 

his career as a medical representative, working for 

leading pharmaceutical companies like Pfizer during 

the 1970s. 

104


However, he had nurtured a lifelong interest in 

photography and as the end of the decade 

approached he decided to take the plunge and set 

himself up as a freelance. Thanks to his skills with the 

camera and his reliability, his new venture quickly 

became a success. 

During his career, Geoff had more than his fair share 

of experiences of the vagaries of conventional press 

work. Early on, he was injured whilst covering the 

Toxteth riots for the Liverpool Echo and Liverpool 

Daily Post. Much later, he took an exclusive photo of 

the first-ever National Lottery jackpot winner which 

appeared in almost all the national papers, only for 

the Liverpool claimant to be subsequently unveiled as 

a hoaxer. On the other hand, over the years a number 

of Geoff’s press shots were syndicated by the country’s 

top photographic agencies, subsequently appearing in 

leading newspapers and magazines around the world. 

Despite this track record on the press ‘front line’, 

Geoff’s natural milieu was PR work where his clients 

included local authorities, Government departments, 

major companies and leading banks and financial 

institutions. 

He shone in this environment, not just because of his 

undoubted photographic skills, but also because of his 

great personal charm. Clients liked working with him, 

because of the way he could talk and get on with 

people at all levels in their organisations, and his 

ability to put them at their ease when photographs 

were being taken. 

Geoff became a ubiquitous figure at corporate events 

in and around Liverpool. Wherever there was a press 

launch, an awards evening, an open day or a business 

conference, more often than not Geoff was there to 

cover it. In fact, he became such a familiar figure at 

major events that people waiting to welcome a VIP 

guest were often surprised when, on arrival, the 

Government Minister, Bishop or Lord Mayor walked 

over to Geoff and started chatting to him first. 

Unusually however, as well as being a good 

photographer, Geoff Roberts was also a very 

competent wordsmith. For a number of years he was 

the Liverpool Echo’s personal finance correspondent, 

and in early 2012 he published a controversial but 

well-received book - Jesus 888 - challenging 

conventional explanations of the origins of early 

Christianity. 

Not long after this book appeared, Geoff’s health 

started to fail. His family and close friends were aware 

that he had been fighting prostate cancer quietly and 

bravely for some considerable time, but as the year 

went on it became clear that the disease was resisting 

treatment and progressing much more quickly than 

had been hoped. As autumn turned to winter, he was 

eventually admitted to the Royal Liverpool Hospital 

where he married Audrey in a bedside ceremony, just 

eleven days before his death in early December at the 

Marie Curie Hospice in Woolton. 

Geoff’s popularity was clear from the attendance at 

his funeral at Allerton’s Springwood Crematorium. 

Several hundred people at the humanist ceremony 

heard speakers talk about the many highlights of 

Geoff’s 64 years. They remembered him enjoying the 

good food and fine wine that were such an integral 

part of his life, or sitting at a pavement cafe watching 

the world go by in Paris, the city he loved more than 

any other. They also referred to the pleasure and 

comfort he took from the late-flowering family life he 

enjoyed with Audrey and her daughter Kristen. After 

the formal ceremony, mourners returned to the LMI - 

where else? - to continue the celebration of Geoff’s 

life. As an accordion player performed a selection of 

classic French songs, they were able to view an 

exhibition of photos and videos of Geoff through the 

years, from schoolboy in short trousers to ‘elder 

statesman’ of Merseyside’s journalistic community. It 

was a particularly appropriate way to salute the 

passing of a man who died at a relatively young age, 

but lived well and packed so much into the years that 

he had been granted. 

Geoff Roberts. Born 23rd February 1948. Died 4th 

December 2012. 

Steve Lyon 

HAROLD WILSON 

Senior Lecturer in Pharmacology and Therapeutics, 

Liverpool University 

Harold (‘Harry’) Wilson was 

educated at the Royal 

Grammar School, 

Lancaster. He became a 

medical student at 

Liverpool University in 

1939 but was called up for 

military service in January 

1940. He was posted to 

Millbank to train as a 

radiographer in the Royal 

105


Medical Corps, at the height of the blitz. 

He was subsequently posted to Egypt and in 1942, to 

Malta, where he gained valuable experience in 

specialised units for thoracic and maxillo-facial 

trauma. In his spare time he learned the German 

language, and, after the army arranged for 

examination papers to be sent from the Institute of 

Linguists, he passed with distinction. 

Harry resumed his medical studies following the war, 

graduating in 1950. After a surgical house job at the 

David Lewis Northern Hospital, he joined the 

Department of Pharmacology and Therapeutics as 

assistant lecturer. He was appointed senior lecturer in 

1959, where he remained until retirement in 1984, 

and focussed on a science-based branch of medicine 

spanning pharmacology, physiology and clinical 

investigation. He met his wife, Ann, in 1952, when she 

was a research assistant in the Department of 

Veterinary Pathology and Bacteriology. They married 

in 1956. 

Harry had many opportunities for collaborative work. 

These included a year’s exchange to the Physiology 

Department of Iowa State University in 1957, an 

enjoyable and rewarding period. He also undertook a 

vacation consultancy at the Chemical Defence 

Establishment at Porton Down and spent six months 

at Cambridge University, working with Sir Arnold 

Bergen on salivary secretion. He particularly enjoyed 

his research with Professor Phillipu at the Universities 

of Innsbruck and Würzburg. Harry was by now bilingual 

and enjoyed lecturing to students in German. 

Harry’s specific research interests included 

hypertension, phaeochromocytoma and 

catecholamines, neuromuscular transmission and 

factors controlling nasolacrimal secretion, and he 

published widely. He was an external examiner and 

advised for various government advisory committees. 

In retirement he studied physics with the Open 

University, as well as continuing with his love of 

German and French. Harry was made a Life Member 

of the Liverpool Medical Institution in 1997. 

In 2009, Harry and Ann moved to Cranleigh, Surrey to 

be nearer to their two daughters and four 

grandchildren. 

Harold Wilson. Born 4th January 1920. Qualified MB 

ChB Liverpool 1950. MD, PhD. Died 11th June 2013. 

Ann Wilson 

106


The Life of Kitty Wilkinson 

Catherine (Kitty) Seaward was born in Derry, Ireland 

in 1785, and was the eldest of three children. Her 

mother worked in spinning and lace-making and 

could read and write. The occupation of her father is 

unknown, though it is possible he could have been a 

soldier. 

At the age of 25, Kitty opened a school and numbers 

between 10 and 90 attended, paying 3d per week. 

Unfortunately Mrs Seaward’s health failed, her mental 

health problems worsened and consequently Kitty had 

to close the school down. She then married her first 

husband Emanuel Demontree, but he shortly after 

drowned at sea. Once again she found domestic 

work. She was only just able to earn enough money 

to keep her family out of the workhouse. Kitty then 

found work for a family in Pitt Street, she was given 

her own mangle and she took in laundry. She 

continued her charity work and whenever she could 

afford she would send children to the Bluecoat School 

to be educated. She also had to then look after her 

mother whose mental health continued to fail. 

Kitty married again to Tom Wilkinson who was a 

porter at Rathbone’s Mill in Lancashire whom she 

knew from her early days. Tom was also very 

charitable and did not mind their door being open to 

anyone who was unfortunate. 

In 1793, the family decided that they were to leave 

Ireland, and the following year they set sail for 

Liverpool, a city that was fast becoming a huge 

seaport and many immigrants were arriving in search 

of their fortunes and a better way of living. Although 

it was winter, the weather was fine when they set sail 

on their voyage. However, the sea turned treacherous 

and Kitty and her family feared for their lives. Herself, 

her mother and siblings were placed in a lifeboat; 

there was no sign of her father. The horrific storm also 

claimed the life of her baby sister, sweeping her from 

her mother’s arms - a dreadful experience from which 

Mrs Seaward never recovered. 

Mrs Seaward and her family arrived in Liverpool with 

the awful worry of how she would be able to support 

them without her husband. She and Kitty managed to 

find work as domestic servants with a Mrs Lightbody 

who then gave Mrs Seaward the task of teaching the 

other servants to make lace and to spin. Mrs 

Lightbody was a great charity worker and Kitty loved 

to assist her in her charity work. Kitty and her mother 

then moved to the south end of Liverpool and found 

further domestic work. 

By the early 1800s, Liverpool was a thriving port but as 

hundreds of working class people settled in the city 

the wealthier moved away and living conditions 

became horrendous. Cholera became prevalent and 

claimed over 1,000 lives in Liverpool alone. Kitty and 

Tom had the only hot water boiler in their street; they 

offered their neighbours their cellar to wash their 

clothes and bed linen, having realised that only clean 

conditions would assist in stemming the cholera 

epidemic. Kitty and Tom asked their neighbours to 

contribute one penny per family to assist with the cost 

of new bedding. At that time Kitty and one of her 

neighbours opened an infant school in her bedroom. 

Young orphans would be taught here as Kitty and Tom 

believed they should have a chance for an education. 

Soon Kitty and Tom were recognised by the 

authorities as pioneers of the wash-houses - 

institutions that were springing up all over Liverpool. 

They were offered posts as Superintendents of the 

Frederick Street public baths and wash-house, which 

they accepted. 

107


In 1846, Kitty was presented to Queen Victoria on her 

visit to the city. It should be recognised that she was 

at the very forefront of what we now call infection 

control and without her contribution and knowledge, 

which she inevitably passed on, who knows what 

would have happened. 

Kitty Wilkinson died in 1860, aged 73, and she is 

permanently commemorated in a stained glass 

window in Liverpool's Anglican Cathedral, which 

honours heroines and noble women of Liverpool. 

Mrs Lynne Smith 

Assistant Editor 

Upper Frederick Street Baths and Wash-house 

108


Offices of Distinction, Awards/Honours 

Rob Barnett 

Received the BMA’s Association 

Medal at the BMA Annual Representative 

Meeting in Edinburgh (June 2013) 

Lord Darzi Fellow of Royal Society (June 2013) 

Professor of Surgery, Imperial College. 

A previous speaker at Liverpool 

Medical Institution - 19th April 2012. 

Peter Davies 

President of the European Section 

of the International 

Union against Tuberculosis 

and Lung disease. 

Andrew Drakeley 

BMA O&G Consultant Committee 

Chairman (2012/13) 

Dr Alastair Miller 

Chair of the Specialist Advisory Committee (SAC) 

on Infectious Disease & Tropical Medicine. 

Deputy Medical Director of the Joint Royal Colleges 

of Physicians Training Board (JRCPTB) with effect 

from 1st August 2013. 

Michael Orme 

Honorary Doctor of Medicine 

at Karolinska Institutet. 

Professor Munir 

Pirmohamed 

NHS Chair of Pharmacogenetics 

and Director of the Wolfson Centre for 

Personalised Medicine in the Department of 

Molecular & Clinical Pharmacology. 

Tony Robinson 

Knighted - June Birthday Honours. 

A previous speaker at Liverpool 

Medical Institution (March 2012) 

109


International Nepal Fellowship Ear Camp 

Anand Kasbekar, ENT ST7, Mersey Rotation 

my surgical experience. The element of adventure 

involved in travelling to a foreign and remote part of 

the world was also very exciting. I volunteered and a 

few months later I was chosen to attend the April 2013 

camp. 

INF arrange pretty much everything from flights, 

transfers, accommodation, food and Nepalese medical 

council registration and so preparation was relatively 

straight forward. Interested team members could add 

on a trekking holiday also if they wished. 

Getting to the camp 

I’ve just had a hot shower, unpacked my backpack and 

switched on the kettle for a cup of tea. I had until 2 

weeks ago, taken for granted running water, central 

heating and electricity. I have just returned from a 2 

week ‘Ear Camp’ in Nepal with the International Nepal 

Fellowship (INF) who are an organisation that 

undertakes surgical, dental, gynaecological, ear and 

other types of medical camps in the poorest and often 

remotest parts of Nepal where basic standards of 

living are frequently lacking. 

I was part of a group of 22 made up of ENT surgeons, 

anaesthetists, dentists, nurses, helpers and organisers 

who travelled to Chainpur, a small village in the far 

north-western mountainous Bhajang region close to 

the border with India and Tibet. The population of a 

few thousand is spread out into little settlements all 

over the mountainous region and walking on narrow 

treacherous paths is the only means of getting to the 

main village of Chainpur. Chainpur itself has very 

recently acquired a road, which allows a sturdy off 

road vehicle to reach it from the main town of 

Nepalgung where small commercial planes can fly 

into. 

Arranging the camp 

As an ENT junior registrar 2 years ago at a course I met 

an extraordinary consultant ENT surgeon by the name 

of Mr Mike Smith and through Mike I learnt about the 

Nepal Ear Camps that he leads twice a year since he 

started it in 1993. Mike usually takes one senior ENT 

trainee per camp whom he supervises. I had never 

undertaken work like this before but at the time 

thought it would be a good opportunity to help some 

of the poorest people in the world and also enhance 

Arriving into Kathmandu is an interesting experience 

with the melee of people, vehicles, sounds and smells 

that this part of the world brings. The temperature 

felt perfect, akin to a very warm summers day in the 

UK. The next day we were due to fly out to Nepalgung 

in the mid-west of the country but the unpredictable 

nature of Nepal meant that due to a strike, the new 

medical members of the group were unable to get 

Nepalese medical council registration. We therefore 

spent an extra night in Kathmandu before flying out 

to Nepalgung on a small 30 seater plane to eventually 

join the rest of the camp members. The following 

morning in Nepalgung, at the crack of dawn we 

started out on the jeep ride to the remote village of 

Chainpur. Two tyre punctures, a jeep change, stunning 

scenery and 16 hours later, we arrived at our 

destination about 1000 metres above sea level. 

The Ear camp 

Our accommodation was in a local hotel which was 

very basic but did have running water and 

110


intermittent electricity. The day started with a very 

cold shower followed by an omelette breakfast on the 

rooftop under the glorious sunshine. A ten minute 

walk to the nearby local hospital involved crossing the 

Seti river over a very long suspension bridge and 

navigating through the rocky terrain footpath used 

also by mule trains, sheep and goats. The basic local 

hospital, which serves a population of over 150,000, 

was usually staffed by a lone doctor who 

singlehandedly dealt with all emergencies regardless 

of specialty including all emergency operations. At this 

time there were also two GP trainees from 

Kathmandu. Part of this hospital was quickly turned 

into an operating theatre suite with three operating 

tables side by side, an ENT clinic room, an audiology 

room, a small dispensing pharmacy and a dental 

treatment room. 

A crowd of patients were waiting for us every 

morning at 9am outside the hospital entrance, some 

having walked for days to get to us. The depth of 

poverty in the region was clear to see and the 

everyday hardship these people endured was painfully 

apparent. The INF administrators and nurses acted as 

translators but learning a few simple words and 

phrases pertinent to ear problems soon speeded up 

the out patient consultation! Mike, having lived in 

Nepal for 10 years previously, was fluent in Nepali and 

as we saw patients in one room we were able to hear 

each others’ consultations and ask each other for 

advice. This was particularly important for me as a 

trainee and I felt appropriately supervised in the clinic 

and in theatre. Each operating table had an operating 

monitor mounted on the wall so that we could share 

in each others’ experiences. A portable generator in 

the background ensured continued electricity. The 

simpler cases such as myringoplasties (grafting of an 

ear drum perforation) were assigned to me but as I 

soon found out, none of the cases were simple given 

the chronic diseased state of the ears in rural Nepal! 

Operations and out patients took place 

simultaneously and we moved between the two areas 

as needed. As operations were carried out under local 

anaesthetic and sedation, the turn around time was 

extremely quick allowing us to see roughly 595 

patients in the 8 day camp and operate on 118 of 

them, an extremely high rate of conversion. This was 

probably due to the high level of ear disease prevalent 

in the area which had mainly gone untreated. A 

further 460 patients were seen by the dentists and 

another 254 by the audiologists who provided hearing 

tests and 75 hearing aids during the camp. Patients 

comprised of adults and children although surgery 

was restricted to children above the age of 5 due to 

the unavailability of general anaesthesia. Lunch was 

made up of samosas (potato deep fried in thick pastry) 

and dinner was “dal bhat” on most days. This is 

essentially rice and lentil curry with vegetables and the 

staple Nepali diet. 

The days were long and demanding but as a surgical 

trainee being exposed to a vast amount of ear disease 

and operating on difficult chronic ears was something 

I relished and which more than made up for any 

fatigue. Perhaps the most rewarding experience of all 

was the utmost gratitude of the patients that were 

treated and the feeling that perhaps one aspect of 

their health and life would improve after attending 

the Ear camp. 

The Nepalese 

The Nepali people are very friendly, welcoming and 

hospitable. The rural folk were extremely grateful for 

the camp and the children raised in these areas 

showed remarkable resilience that only their tough 

upbringing could have shaped. Children aged as 

young as 7 prior to any sedation were quietly 

compliant with all our procedures including the 

insertion of cannulae and injections such that they 

would not even flinch. Some needed more sedation 

than others during the sometimes long procedures but 

certainly I couldn’t imagine in the UK not having a 

battle on my hands when trying to insert a cannula in 

a young child! 

The 8 day camp ended with a postoperative clinic 

when all operated patients were reviewed, head 

bandages replaced and postoperative care reiterated. 

111


Work has already begun building an Ear hospital in 

Pokhara which will deliver high quality training to 

local Nepali doctors and also high quality care to the 

poor of Nepal. 

INF Nepal 

INF Nepal is based in Pokhara and the 2 other 

members of staff critical to the smooth running of the 

camp were Ellen Findlay (ellenfindlay@btinternet. 

com) and Eka Dev Dakota (camps@nepal.inf.org) who 

will be able to provide you with information on 

becoming part of a future medical camp. Please email 

Mr Mike Smith at mikesmith@talktalk.net if you 

would like to get involved with any of the ear camps 

specifically. If you want to find out more about the ear 

camp work go to www.earaidnepal.org. For general 

information about INF camps please visit 

http://www.inf.org/camps and you are also able to 

donate to this very worthwhile charity through the 

website. 

The two weeks had flown by and left me with a 

feeling of real achievement that I had undertaken 

something truly worthwhile. I have also made long 

lasting friends in the process. The experience is one 

that I will cherish and will definitely return to once I 

have completed my training. I cannot recommend this 

camp highly enough to those of you considering such 

work whether you are a doctor, nurse or dentist. 

Members Elected Since Last Transactions 

Lekharaju, V 

Lynch, K 

McLoughlin, T 

Middleman, M 

Sawbridge, D 

Sells, P 

112



Draft Consolidated Statement of Financial Activities 

for the Year Ended 31 December 2012 

113



Draft Balance Sheet at 31 December 2012 

114


Presidents of the Liverpool Medical Institution 

1840-65 James Dawson 1955 R.J. Minnitt 

1866 James Vose 1956 Bryan McFarland 

1867 John McNaught 1957 Margaret E. Thomas 

1870 Edward R. Bickersteth 1958 A. McKie Reid M.C. T.D. 

1872 John Cameron 1959 E. Noble Chamberlain 

1874 William McShane 1960 Philip Hawe T.D. 

1876 James Muter Turnbull 1961 Percy H. Whitaker 

1878 A.T.H. Waters 1962 R.W. Brookfield 

1880 Reginald Harrison 1963 Isabella Forshall 

1882 Thomas Shadford Walker 1964 A.W. Downie F.R.S. 

1884 Robert Gee 1965 J. Cosbie Ross 

1886 J. Birkbeck Nevins 1966 T.N.A. Jeffcoate (Kt) 

1888 William Carter 1967 J.W. Cheetham O.B.E. 

1890 William Mitchell Banks (Kt) 1968 R. Ronald Edwards 

1892 Thomas Robinson Glynn 1969 Goronwy Thomas 

1894 Chauncy Puzey 1970 C.A. Clarke K.B.E. F.R.S. 

1896 Richard Caton 1971 A. Sutcliffe Kerr 

1898 William Macfie Campbell 1972 John D. Hay 

1900 Edgar A. Browne 1973 Thomas Seager 

1902 Ruston Parker 1974 T. Cecil Gray C.B.E. 

1904 James Barr (Kt) 1975 Ivan Leveson 

1906 Frank T. Paul 1976 John A. Shepherd V.R.D. 

1908 Thomas Herbert Bickerton 1977 Donald C. Watson M.C. 

1910 Thomas Robert Bradshaw 1978 Colin M. Ogilvie 

1912 Robert Jones (Bt, 1926) 1979 Janet H. Smellie 

1914 Edward W. Hope 1980 Edgar W. Parry 

1916 Charles J. MacAlister T.D. 1981 James H.E. Carmichael 

1918 W. Thelwall Thomas 1982 Elisabeth Rees 

1920 John E. Gemmell 1983 N.O.K. Gibbon 

1922 J. Hill Abram 1984 D.N. Menzies 

1924 G.P. Newbolt C.B.E. (d. 9th March) 1985 R.B. McConnell T.D. 

1924 R.C. Dun 1986 Philip M. Stell 

1926 J.C.M. Given 1987 I. Keith Brown (d. 28.3.88) 

1928 John Hay 1987 Philip M. Stell (from 20.4.88) 

1930 K.W. Monsarrat T.D. 1988 Robert Shields (Kt) 

1931 W. Blair-Bell 1989 P.M.E. Drury 

1932 R.E. Kelly C.B. (Kt, 1939) 1990 Austin T. Carty 

1933 H.R. Hurter 1991 C.C. Evans 

1934 J. Murray Bligh 1992 William M. Mackean, R.D. 

1935 C.O. Stallybrass 1993 Helen Carty 

1936 G.C.E. Simpson O.B.E. T.D. 1994 Michael C.L’E. Orme 

1937 R.E. Kelly C.B. (Kt, 1939) 1995 Andrew Zsigmond 

1938 E. Gilbert Bark 1996 R.E. Cudmore 

1939 William Johnson M.C. 1997 R.A. Sells 

1940 A. Leyland Robinson 1998 Susan Evans 

1941 O. Herbert Williams 1999 Robin Walker 

1942 Robert Glover Wills 2000 Keith Parsons 

1943 Edmund I. Spriggs K.C.V.O. 2001 John Earis 

1944 R. Stopford Taylor 2002 C.A. Hart 

1945 Robert Kennon M.C. 2003 J.M. Rhodes 

1946 G.F. Rawdon Smith T.D. 2004 A.C. Swift 

1947 H. Wallace-Jones 2005 P.M.A. Calverley 

1948 T.P. McMurray C.B.E. 2006 R.G. Farquharson 

1949 Charles Wells C.B.E. 2007 P.D.O. Davies 

1950 David Johnston 2008 G.V. Gill 

1951 Robert Coope 2009 W. Taylor 

1952 Norman B. Capon 2010 P. Dangerfield 

1953 J.B. Oldham V.R.D. Q.H.S. C.B.E. 2011 I. Gilmore (Kt) 

1954 Henry Cohen C.H. (Kt, Baron 1956) 2012 R. E. Franks 

115


Charitable Donations 


(Registered Charity No 210112) 

As a registered charity, the LMI enjoys certain privileges for the receipt of gifts. 

GIFT AID 

This is the most popular form of tax-efficient giving. Where a donation is made under the Gift Aid scheme, the 

LMI can reclaim tax at the basic rate (currently 20%) from HMRC ie LMI can reclaim 25% of the basic donation. 

If a donor pays income tax at a higher rate the donor can reclaim the difference between his marginal rate of 

tax (40% or 50%) and the basic rate when he or his accountant prepares his annual tax return. This is not paid 

over to the LMI. 

Companies, donating cash or goods, may obtain tax relief through the Gift Aid provisions. 

Gift Aid declaration forms for individuals are available from the LMI Administration Department. 

GIVE AS YOU EARN 

This is scheme whereby regular donations may be deducted from a donor’s gross pay by his employer, before his 

PAYE liability is calculated. Unfortunately although most NHS employers operate the GAYE scheme the NHS 

itself does not. 

LEGACIES 

Legacies left to charity, including the LMI, are deducted from the gross value of the estate before the liability to 

Inheritance Tax is computed. The standard rate of IT is 40% (for lifetime gifts it is 20%) however for deaths on 

or after 6 April 2012 a reduced rate of 36% applies where 10% or more of the deceased’s net estate is left to 

charity. 

LIFE TIME NON-CASH GIFTS 

Gifts of property or shares can be made to the LMI and their value can be set against the donor’s liability for 

income tax. The proceeds from the sale by the LMI of other goods can be donated to the LMI under the Gift Aid 

scheme; details are available from the Administration Department. 

OTHER PAYMENTS 

There is a strictly enforced scale of benefits that the LMI can offer donors without impairing its right to receive 

the benefits of the gift aid scheme or its’ charitable status. Subscriptions and charges for attending social or 

technical meetings are subject to this scale. However these payments may be deductible under the individual’s 

personal tax regime, this should be discussed with his advisers. 

Mr J Penwill 

116

LMI Conference 

Centre 

An exceptional venue at exceptional value 

The LMI offers a relaxed and professional setting for 

meetings, away/training days, formal/informal dinner parties 

and receptions. 

• Magnificent Grade II* Listed venue 

• Centrally located in the Hope Street quarter and 

University precinct, opposite the Metropolitan Cathedral 

• Dedicated conference team to meet your needs 

• Lecture Theatre seating up to 120 

• Three seminar rooms seating 30-40 

• Meeting room seating 8 

• Videoconference facilities and audio visual equipment 

available in Lecture Theatre and Seminar Rooms 

• Dining Room seats 30 – extends to 90 

• Event catering for 120 

• Licensed bar 

• Exhibition and display areas 

• Fully accessible 

• Free WiFi throughout the building 

Please contact LMI Conference Office on 

0151 709 9125 ext 2 or email admin@lmi.org.uk 

A Meetings Industry Accredited venue

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