I’m unsure of the exact point in my career that my fascination in listening to previously recorded, archived interviews became equally matched with my fascination in conducting new ones. Luckily my time as the oral history officer at the Royal College of Physicians [RCP] has given me the opportunity to indulge in both pursuits.
The college has an extensive archive of recordings dating back to the early 1960s. The bulk of these come from two main collecting periods. The first spanned the 1980s and 90s when Oxford Brookes University, in partnership with the RCP, conducted over 130 video interviews, leading to the formation of the Medical Sciences Video Archive [MSVA]. The second, ongoing project, Voices of Medicine has involved the collection of approximately 100 life story audio interviews. The recordings chart the breakthroughs, challenges and enormous scientific, ethical, and social changes experienced in the practice of medicine over the past century.
Among the earliest recordings is an interview with Sir Robert Platt, a former president of the college, in which he recalls how doctors treated pneumonia before the discovery of penicillin. This reminiscence takes on a whole new dimension in the light of the Covid pandemic in which physicians have, once again, been confronted with a respiratory disease against which they have few effective treatments. In the recordings that we have conducted recently with doctors who have been working on the Covid wards we can hear Platt’s experiences of helplessness eerily repeated in a way that shocks us in the time of modern medicine.
RP: Are we starting now?
Q1:Yes, they’re listening in next door, yes.
Q2: Well, Robert, from the point of view of history I was going to start right back, 50 years ago when you qualified, when medicine…
RP: 50 years, good God
Q2: Well, it’s 48 I think.
RP: Yes, 48 that’s right, 50 years ago I was a clinical student.
Q2: And you then decided to become a physician in spite of the fact that there was practically no means by which you could help your patients in those days, or did you, were you persuaded, as presumably your contemporaries were, that some of the methods you were using were in fact, useful? It’s such a very different position from now when a physician can do something for almost everybody?
RP: Yes, it’s an extraordinarily different position from now, and surprisingly enough this didn’t come into my consciousness very strongly you know, I mean every now and then of course one began to give thought to the fact of how little one really was able to do for one’s patients, but at the same time there always was something to do. One thought, in the young people with pneumonia who were such a tremendous worry, one thought one was doing something by guiding their nursing, by giving them four pillows, by deciding whether you should give morphia to relieve the pain and whether this was going to kill them in the night because it would depress their respiration and so on. All these were decisions of the greatest magnitude, you see.
Recording copyright Royal College of Physicians.
Now, what about a patient? Well the Radcliffe Infirmary like all hospitals had a septic ward and I went down there to find somebody who had a serious infection with a germ which could not be cured by other drugs but penicillin might cure, and there was a policeman there, a delightful man, who had been in having septicaemia with boils breaking out all over him, he’d lost one eye from the poison, he had boils all over him and he was in a desperate state, and we started penicillin and it was absolutely miraculous. The next day he said for the first time that he was feeling better, his temperature came down, and so it went on for four or five days, and then the supplies of penicillin were so scarce that I used to collect his urine in the evening each day and bicycle with it over to the Dunn Laboratory where Chain and Florey would be waiting to hear the latest clinical news, and I would give them this urine and they would extract the penicillin so that the patient could have on the third day the same penicillin he’d had on the first day. But in spite of this on the third or fourth day the penicillin ran out and it hadn’t completed curing his infection. The poor man then deteriorated and died about a week later.
Recording copyright: Oxford Brookes University
Interestingly one of Robert Platt’s interviewers is Charles Fletcher who was the first doctor to ever administer penicillin to a patient, an experience that he recounts in his own interview. This development would obviously have had dramatic implications for many of Platt’s pneumonia patients and changed the world of medicine forever. Doctors in the collections recall how the infection wards closed as antibiotic treatment became widespread, an experience repeated as further revolutionary drugs were developed emptying, for example, tuberculosis and rheumatology in-patient wards in their turn.
Fletcher, as you can hear in the above clip, was not well versed in the arts of oral history interviewing. I think of him as a terrible oral historian, but a terribly important doctor, who was also instrumental in the RCPs efforts to raise awareness of the dangers of smoking in the 1950s and 60s. You can hear more about in these events in this Witness History podcast which features audio clips from the MSVA collection.
In addition to ground-breaking changes in medical practice the collections can also tell us a great deal about the social changes that have occurred in the profession. Interviewees reflect on issues such as quotas for female medical students, the challenges faced by physicians coming to work in the NHS from overseas and the importance placed on personal connections in securing senior posts in the past. Sometimes the opinions stated are unexpected, even shocking for today’s listeners, as the clip below from Sheila Sherlock, a world famous hepatologist, demonstrates. Her views are repeated by several of her peers, including Margaret Turner Warwick, respiratory specialist and the first woman president of the RCP, whereas the generation following are much more willing to discuss gender discrimination and issues such as maternity leave and job share schemes. Interviewees also offer analysis of why things started to change.
Q: I imagine that your sex has never been a handicap to you in your medical career?
A: Not really. Feminists would like to say it has, you know, but I really don’t think so. I can think of a few things that I would like to have been that I wasn’t, I think, because of my sex.
Q: You ran for presidency of the college and you came close to election. Do you think that was, in any sense, still a discrimination?
A: [Pause] Probably.
Q: I think there is still a slight–,
A: Probably, but I wouldn’t be–, I’m not worried that I didn’t get because I think I had more interesting things to do. I think it’s a disgrace that a club like the Athenaeum doesn’t let women in, and my husband’s a member of the Athenaeum. He attended the meeting when they thought of ladies being admitted, and you should have seen those old fuddy-duddies getting up, including members of our profession, saying–,
Q: That’s what I think–
A: I mean, this sort of thing is ridiculous. But I think a lot of the trouble with women, is that they really don’t give their mind to it as much as they should and they perhaps don’t have such a good husband as I have.
Recording copyright Oxford Brookes University
The best bit of advice I ever had in those troubled teen years of mine was from my father, who said to me one day, ‘If you want to change the world you’ve got to get to the top but not lose your principles on the way’. And basically, absolutely right, he pointed out, you will not change anything by jumping up and down and protesting, you will change things by actually influencing change, and being in a position where you can pull levers to make change happen.
Recording copyright Royal College of Physicians
Looping back to Covid, one of the most haunting memories we have heard in recent interviews is that of a respiratory consultant in North East England recalling how she and a colleague tried to sooth the fears of an older patient when they came to her bedside wearing full PPE. Their patient had lived through World War Two and, thinking that the clinical staff were wearing gas masks, started to cry. The early sections of the interviews about the pandemic response are full of anxiety, fear and the terrible worry of looking after patients sick with a new disease about which so little was known. However, as the narratives progress interviewees speak about the RECOVERY Trial, new treatments and the vaccine roll out with gathering hope.
And we’d gone in to see this lady on the ward round and she was absolutely terrified. She didn’t have any of her family there and she saw us in all of this gear. And she thought she was in the Second World War as obviously she’d lived through that, so she started crying and she said, ‘Why have you all got gas masks on?’ And I was trying to explain to her, ‘They’re not gas masks, honey, they’re not gas masks, it’s just to protect us from the virus and from the germ.’ And then one of my colleagues said, ‘Oh, we’re in fancy dress!’ And she said, ‘You’re in fancy dress?’ And I went, ‘Yes we are, darling, we’re having a fancy dress party!’ And she said, ‘Oh that’s so lovely, that’s so exciting,’ and she calmed right down after that, and it felt like… a nice little glimmer of hope and then we went outside and we were crying for about ten minutes thinking this is awful, this is not how we deal with our patients, this is not the level of communication that we want. You want to be able to sit and hold the hands of these frightened people. I think that was really one of my worst memories of the situation, just how scared she was, but the best as well as it just brings out the kindness in your colleagues.
Recording copyright Royal College of Physicians
The final mention, therefore, has to go to Archibald Cochrane whose interview DVD I picked up somewhat at random from the RCP stack soon after I started the job. Listening to him talking of his life’s work, including how he set up his first ever clinically controlled trial in a prisoner of war camp in Crete during World War Two, gave me my first understanding of terms such as evidence-based medicine and epidemiology, which we have all become so familiar with over the past few months. Rather than being back with Robert Platt worrying about his pneumonia patients in the 1920s, suddenly, listening to Cochrane, we are thinking about all the work, and the experiments and developments in medicine over the past 100 years and how they have come together to give us hope and vital progress over the past 18 months.
My time at the RCP has been fascinating, and I owe a debt of thanks both to the Voices of Medicine volunteers and the generosity of the interviewees who shared their memories.