The physician’s tale Travels with the Medical Pilgrims 1928–2011 Foreword This is the third edition of accounts (Scribes’ Reports) of the Medical Pilgrims since the first volume was published in 1997 by RCP Publications. That first volume was collated by Clifford Hawkins. Sadly he died before finishing the task, which was completed by Alasdair Geddes and Robert Mahler. Subsequently, a further volume of eight Pilgrimages 1996–2003, edited by Robert Mahler was published in 2003 (see Editor’s note from that volume on page 159). Rather than producing a further update, Pilgrims agreed to a full compilation from 1928–2010 in a single volume which could then be made available on the internet and updated regularly. This contains 75 Scribe’s Reports (there were no meetings during the second World War and the first post war meeting was held at the London Hospital in 1948). The original purpose of the Medical Pilgrims was to visit centres of medical excellence and get to know leading continental physicians. Eight of the first ten Pilgrimages were to centres outside Great Britain and Ireland, seven to Continental Europe and one to America. Only three of the ten post war Pilgrimages were to Europe. However, although the pre-war pattern was temporarily re-established in the late 50s and 60s, the subsequent three decades saw 25 of 30 Pilgrimages within the UK and Ireland. From 2000, a more eclectic approach of earlier Pilgrimages has become established with an informal commitment to one in three Pilgrimages being undertaken outside the UK. The Medical Pilgrims are not an entity and there are no accounts to audit. An annual “Business Meeting” is held at the “Pilgrims’ Lodgings” (a hotel) before the start of each Pilgrimage. All Pilgrimages are self-funded and there are no officers apart from the Honorary Secretary, although for each Pilgrimage the Secretary identifies a Leader to chair proceedings, and a Scribe to ‘volunteer’ to produce a record – refusal is not an option! In 83 years there have been only six Secretaries: FJ Nattrass, R Bomford, J Butterfield, D Pyke, A Geddes and S Tomlinson. The longest serving Secretary was FJ Nattrass (25 years), which puts the current Secretary’s 15 years (so far!) in perspective. As Robert Mahler remarked, the Medical Pilgrims preferred rate of change is the status quo (see his Editor’s note from 2003, page 159). However, somewhat belatedly and long overdue some would argue, the first woman Pilgrim (Lesley Rees) was elected in 1993, Anne Tattersfield was the second woman to be elected and the first woman Pilgrim to attend a Pilgrimage in 1995. Partners and spouses joined Pilgrims for all Pilgrimages (not only for those overseas) in 2001 and digital photographs began to appear from about 2000 onwards. Now for the world wide web! Finally, no Pilgrim would argue that this is an historical record. It is simply a collection of informal accounts reflecting the development of medicine as influenced by the enormous advances in science and the political, social and cultural changes in the world around us in the past 83 years. Stephen Tomlinson Hon. Secretary, Medical Pilgrims 1995– The physician’s tale ii Acknowledgements Thanks to all the Scribes who “volunteered” to write the records of Pilgrimages, especially those during my time as Honorary Secretary. It was a pleasure to read them all, whatever the style, whether serious, witty, erudite or all three. This 2011 compilation of Scribes’ Reports would not have started without Clifford Hawkins, who was still alive in 1991 when I attended my first Pilgrimage in Dublin. He gave a “Pilgrims Paper”(a tradition after the Business Meeting) on photography and painting. He was a skilful painter and musician himself, but as Alex Paton said of him: “Perhaps his greatest gift was that he found the world and its way full of humour; meeting him invariably lifted the spirits”. Without Robert Mahler (formerly Professor of Medicine at the Welsh National School of Medicine, opera lover, and great-nephew of Mahler, the composer) and his involvement with the RCP there would have been no update in 2003; and without his introduction I would not have met Suzanne Fuzzey, then responsible for the design of the RCP journal Clinical Medicine, now Senior Production Controller in the RCP Publications Unit. She has worked incredibly hard to ensure a uniform format (or as uniform as possible given the enormous variation in style and content of the Scribe’s Reports) and done a considerable amount of editing to facilitate continuity from volume to volume. Moreover, as Robert Mahler reminded us in 2003, it was Suzanne who suggested inclusion of the shell, the ancient symbol by which Pilgrims were recognised and given food and shelter. I have seen such shells still carried on the Pilgrims’ routes to Santiago de Compostela, for example, in Conques in France! I would like also to thank Alasdair Geddes, my predecessor as Hon. Secretary and David London for advice and support while preparing the new volume, and John Walton for reading, correcting and amending early drafts of the manuscript. Finally, my personal thanks to Lisa Pearson, my PA/Secretary for all her hard work and enthusiastic support for this “project” and for all things to do with the Medical Pilgrims (like herding cats!), and for keeping me in order! Having had so much help and support in producing this final version of the third volume, nevertheless, like Robert Mahler for volume two in 2003: “I take full responsibility for any errors, mis-statements or infelicitous expressions”. It’s been a pleasure! Stephen Tomlinson The physician’s tale iii Pilgrimages 1928–1995 1 Introduction 6 Editor’s note 7 Paris 1928 9 Heidelberg 1929 10 Amsterdam 1930 11 Berlin 1931 13 London 1932 13 America 1933 14 Rome 1934 16 France and Switzerland 1935 17 London 1936 19 Paris 1937 21 Pilgrims Dinner to Hurst (1937) 21 Copenhagen and Stockholm 1938 23 The War Years (1939–1945) 24 London 1948 25 Manchester 1949 27 Dublin 1950 28 Birmingham 1951 30 Oxford 1952 32 Oslo 1953 35 Edinburgh 1954 36 Holland 1955 38 Newcastle upon Tyne 1956 41 Denmark 1957 46 St. Andrews 1958 48 Padua 1959 51 Marseilles and Montpellier 1960 54 Ireland 1961 57 Stockholm and Uppsala 1962 60 Switzerland 1963 63 London 1964 67 USSR 1965 73 Paris 1966 75 Eire 1967 76 Germany 1968 79 Holland 1969 81 Denmark 1970 83 Birmingham 1971 87 Vienna and Budapest 1972 90 Scotland 1973 The physician’s tale iv 93 Belgium 1974 95 Nottingham and Oxford 1975 96 Eire 1976 100 Cambridge 1977 103 London 1978: The 50th Anniversary 107 Newcastle 1979 110 China 1980 118 Bristol 1981 120 Norway 1982 123 Dundee 1983 124 Birmingham 1984 126 London and Leeds Castle 1985 129 Manchester and North Wales 1986 132 Glasgow 1987 135 Oxford 1988 138 Barcelona 1989 141 Edinburgh 1990 143 Dublin 1991 145 Cambridge 1992 149 Bristol 1993 152 Aberdeen 1994 155 Birmingham 1995 1996–2003 159 Editor’s note 161 Northern Ireland 1996 163 Nottingham 1997 167 Glasgow 1998 171 Dublin 1999 174 Münster 2000 179 Leicester 2001 183 St George’s Hospital Medical School 2002 187 The Gambia 2003 2004–2010 196 Cardiff 2004 201 Cambridge 2005 207 Sorrento 2006 213 Southampton 2007 220 Vietnam and Cambodia 2008 227 Brighton 2009 240 Birmingham 2010 246 Czech Republic 2011 Appendices 246 List of Medical Pilgrims The physician’s tale v 1928–1995 Introduction Founding of the Medical Pilgrims The Medical Pilgrims, founded in 1928, is a travelling club of physicians from various centres in Great Britain and Ireland. Each year the Club pays a visit to a medical centre, either abroad or in the British Isles. The name, as Professor Leslie Witts explained at the 50th Anniversary Dinner, was taken from the Canterbury Pilgrims. “They” he remarked, “went on pilgrimage ‘the holy blissful martyr for to seek’ and also to take a Spring holiday. And we likewise go in search of learning on the one hand, and of fellowship and good company on the other”. Raison d’être Consultant medicine in the early twentieth century was largely confined to certain centres – in England, for example, to London – and provincial physicians were isolated. A change took place in 1906 when William Osler suggested to some medical friends the foundation of an Association of Physicians of Great Britain and Ireland, based upon the model of the successful Association of American Physicians which he had helped to start twenty-one years earlier. The object of the Association was to be “The advancement of internal medicine and the promotion of friendship amongst physicians”.This ended the isolation of provincial members. The concept of the Medical Pilgrims originated at the 1927 meeting of the Association. Sir Arthur Hurst wrote that “Several physicians (WE Hume of Newcastle upon Tyne, FJ Nattrass, his successor in 1942 as professor of medicine at the University of Durham, and his old clinical assistant Will Johnson of Liverpool) decided to form a small travelling club of physicians. As they knew that I had been fortunate in having unusual opportunities of getting to know many of the leading continental clinicians, they invited me to join them. It was decided to call the club The Medical Pilgrims”.There were eleven other original members. The medical scene in 1928 Few English physicians travelled abroad in 1928. If they did, it was to visit centres in Europe, especially Vienna – then the Mecca of medical progress. The scientific approach had hardly begun; investigations were not subjected to statistical analysis as Bradford Hills’ pioneering Principles of Medical Statistics was not published until 1937.