Dr Brian Frost-Smith shares his memories after six decades as a doctor.
In 1950 medical students, on passing their finals and emerging as duly qualified medical practitioners, would be entitled to take up any suitable job. Many of my friends at that point entered general practice with no further training.
I completed six months in hospital before entering a locum practice on my own. I had complete control and could prescribe anything and the patient would receive it free. One pharmacist said at the time: “Anything you write on that EC10 prescription form, I must deliver”.
Most drugs were alkaloids – organic, plant-based compounds containing nitrogen – and there were very few synthetics. I had a patient with pernicious anaemia and I treated her with Anahaemin, an injectable extract of raw liver. Only a few years before, the treatment was raw liver which the patient had to eat!
There were no steroids, few antibiotics and the only diuretic was a mercury compound called mersalyl. We used arsenic to treat syphilis and calomel (another mercury compound) and phenobarbitone (an anti-epileptic drug) for a good night’s sleep on hospital admission!
Aneurin Bevan’s new NHS had just succeeded the “nine pence for four pence act”, introduced in 1911 by Liberal Chancellor of the Exchequer David Lloyd George – so-called as workers paid four pence a week in national insurance contributions, employers paid three pence and the state paid two pence. This was the forerunner of the modern welfare state and enabled workers to take paid sick leave for the first time.
Chemistry was emerging, with some resistance from older practitioners, as a diagnostic method enhancing the old inspection, palpation, percussion (tapping) and auscultation (listening) methods that were taught to me and other students. The cost of drugs was tiny and the one pound per year paid to dispensing GPs covered the cost of all medicines, except for drugs classified as ‘specials’. These included drugs such as insulin and antibiotics. The treatment of tuberculosis (TB) with streptomycin had just started but the powerful antibiotics para amino salicylicacidand isoniazid hydrazide had not yet arrived. When they did, in the mid 1950s, huge numbers of sanatoria (medical facilities for the care of patients with TB and other chronic illnesses) closed down.
My wife was a doctor on Block Two at Walton Hospital (a former workhouse in Liverpool) when we were both junior doctors there in 1950. Block Two was composed entirely of patients with TB. We both left at the end of our jobs but two years later I returned after my spell in the RAF. As soon as I entered the hospital grounds I saw that Block Two was no longer there – it had been demolished as a result of new drugs in just two years!
As GPs, we could not send blood samples for biochemical or haematology analysis – the patient had to attend personally at hospital for tests. Certain drugs produced life changing effects. The first that I remember was Butazolidin to relieve arthritic pain and proton pump inhibitors, like tagamet, which reduced the production of stomach acid and, in the case of benign gastric and duodenal ulcers, abolished the necessity for partial gastrectomy (removal of part of the stomach). Then we saw the introduction of anti-depressant drugs and phenothiazines to treat schizophrenia and psychotic disorders.
Chest X-rays were available in mobile units for the diagnosis of TB but nothing else.
Casualty departments were the forerunners of A&E and in those early days I would not dare to send a patient without prior notice and a letter. I would be expected to care for patients day or night if the treatments were accessible to me.
Many of my consultations were home visits and attendance at surgery was mostly without an appointment. Many country doctors could not afford a secretary and this role was carried out, in many cases, by the GP’s wife. Most practices were single handed at that time – partnerships and health centres came later and enabled tired family doctors to have time off. In my first house job at Walton Hospital, I was on duty 24/7 with one half day a week and every other weekend off duty, but that was sometimes cancelled!
Over the decades, surgery technology has advanced exponentially alongside the introduction of hugely expensive drugs demanded by patients and doctors despite some of them having a minimal effect on people’s longevity.
I am no economist, but all of these costly, innovative and life-saving treatments – many of which came into use in the first 10 to 15 years of the NHS – must surely lead a 92-year-old retired practitioner like me to consider the economics and to conclude that community care, efficient management and a degree of foresight are going to be more important than ever in the future.
After qualifying as a doctor in 1950, Dr Brian Frost-Smith became a surgical houseman before working as a locum GP in Wales. He joined the RAF as a national service medical officer then entered general practice, first in the Welsh countryside and later in Merseyside and Cumbria. His book, A Country Doctor: A Lifetime in General Practice, published by Hayloft, charts the radical changes he has seen first-hand during his six decades as a doctor.