Number one hero

There are many definitions of a hero and mine includes someone I highly respect, whose opinions I trust, who is honest and true and whose mentorship has had a deep and lasting effect on my personal and professional development.

Over the past 40 years I have worked with three people who I regard as heroes. Interestingly, only one of these was a fellow General Practitioner and he is Dr Jamie Bahrami, the now retired Director of Postgraduate General Practice Education for Yorkshire. I worked with the second, Professor W R Keatinge, after my pre-registration house jobs. He was my Ph.D supervisor and we undertook research in the area of human temperature regulation from the Department of Physiology in The London Hospital Medical College, as it was then called. I will now turn to my third hero.
In 2000, one of our closest friends, Geoffrey Mair (who died in 2002) asked me “What were we both doing on September 23rd 1963?” I could not remember and so he reminded me. We went to our first lecture as fellow medical students at University College, London. Geof and I could remember some important points that were made in that lecture, which was pretty good after 40 years. The lecturer told us of the importance of the invention and development of the printing press for communicating scientific ideas. He also told us how Claude Bernard, a physiologist, in 1859 wrote “ la fixite du milium interieur c’est la condition de la vie libre”. (Free life depends upon the consistency of the internal environment). Maintaining a stable internal environment despite changes outside the body is now called homeostasis. Some of us were confused. The lecturer was an anatomy professor telling us about history and physiology!
The Professor of Anatomy was John Zachary “JZ” Young. I quickly realised that he was one of the leading biologists of that century and a very eminent scientist indeed. He was the first non-medical biologist to be appointed to that post. He was my first hero. That appointment was made in 1945 (the year of my birth) and I was not yet 18 when I attended that lecture. He was 56. His work in the 1920s on nerve fibre structure led to a Nobel Prize for Andrew Huxley and Alan Hodgkin. He also developed a method of re-joining peripheral nerves using a “glue”. He wrote many books and was the Reith lecturer in 1950. After the first 18 months pre-clinical work at University College, if one did fairly well in the first set of examinations (called 2nd MB), one could be invited to apply do an extra 18 months studying towards a B.Sc. in either Anatomy, Physiology, Biochemistry or Pharmacology. I decided to apply for the Anatomy B.Sc. course and was accepted. One of the attractions of that course was that during the summer holiday there was funding for us to go to Naples with JZ for 6 weeks and help with research.
You may think at this point that there could be no possible value in studying Anatomy in such depth to become a GP. You will read later how this experience had a huge effect on me as GP and a teacher of GPs.
12 of us spent 18 months working on our “Anatomy” degree. There is a trend these days to do part-time degrees whilst still at work and I think this is a great development. There is also a trend in the General Practice education world that, as one gets older and is awarded higher degrees, to drop a “mere B.Sc.” and only use the higher degrees. My B.Sc. was a most important qualification for me and I will never drop it. I am really proud of it even though it was a lower second class honours degree. My B.Sc. took me an extra 18 months of full time education!
The learning atmosphere in the department of Anatomy at University College was fabulous. There was every opportunity to question and explore. The course covered anthropology, comparative anatomy, embryology and histology.
JZ introduced us to the Oxford Tutorial system. The tutor sets you a task to write up and hand in an essay on a subject of his choice.This was handed in before the tutorial. The tutorial was one to one and I had JZ as my tutor for one term of the course. One of the tutorials involved me comparing two scientific papers. One was written by Solly Zuckerman and the other by Jacob Bronowski. Each of the papers were discussing the anatomy of an Australopithicine tooth that had been found. One author argued that this tooth was more like a human’s and the other more like an ape’s. I had to critically appraise these two papers and present my analysis to JZ. I was absolutely petrified at the prospect of a tutorial with such an eminent man on such an erudite subject. My fears were unnecessary. He treated me like an equal and like an adult. I found this absolutely fantastic and a great contrast with some of my hospital and general practice teachers. This is one of the qualities I have tried to develop when I teach and consult. I have tried to respect my students, GP Registrars, and other doctors I have helped, as equals. I hope I have also had a similar relationship with my patients however poor or deprived. This is how that B.Sc. course influenced me as a General Practitioner. I realise now that all the eminent people I have met in my life and whom I respect behave like this.
The summer arrived and 6 of us went to Naples for the fisrt half of the summer break and the other 6 for the second. We worked with a team scientists, who had arrived from all over the world, at the Stazione Zoologica. JZ had been going there for many years and was funded by the US Airforce. JZ had been working for several years on the memory system of the octopus. In the laboratory there were about 50 small tanks each connected to the nearby sea and were thus supplied with circulating natural salt water. Each tank contained one octopus and the lids were weighed down by bricks. This was because they were particularly adept at pushing the lids off, climbing out of the tank and slithering along the floor to the front door, then escaping outside.
A gang of experienced research workers from all over the world spent various lengths of time working there each summer.
Why was JZ was working on the memory system of the octopus. An octopus can only do two things – attack or retreat. They can see and feel. So, they were taught to recognise a shape or feel something rough. For example, with a shape, a triangle might be presented to the octopus and attached to the triangle there would be a small crab. The octopus attacked and ate the crab. Eventually the octopus would attack the shape without the crab being attached. JZ would then anaesthetise the octopus and remove a small part of the brain that he was studying. The octopus recovered in the tank and then it was presented with the shape again. If nothing happened the octopus’s memory system had been disturbed at a particular site in it’s brain.. If it attacked then the removed part of brain was probably not associated with memory. When JZ first started working at the Stazione there was a headline in one of the local papers which, translated, read “English Professor teaches octopuses to speak”. On one occasion a gang of us came back after a night of pasta and wine and fooled about trying on JZ’s lab coat. This was unique in that it was black. Usually laboratory scientists and hospital doctors wear white coats. I wonder why. Was it something to do with octopus ink or was this a bit of attention seeking? I took an octopus out of its tank and the tentacles of all eight legs sucked on to my forearm. It was with the greatest difficulty that I got it back in the tank. No sooner had I detached a few tentacles, one or two would re-attach themselves to my arm. It took two of us to get it off. There can’t be many GPs who have had such an experience with an octopus.
We worked Italian style with an early morning start. We had breakfast in a coffee bar and this consisted of a cake and Café con late. Lunch consisted of bread, mortadella and some fruit and this was taken at the beginning of a long siesta. The mortadella was ideal for the very hot summer days in Naples as it was fatty and there was no need for butter, which simply melted quickly. After lunch JZ would often take us to some place of interest such as Pompei or Herculanium. It amazed me that every afternoon for 6 weeks we could visit somewhere different in or around Naples. We often went swimming. These experiences gave me a life long love of Italy. We continued our work out of the heat of the sun from 4 to 8 pm and then went out on the town to eat at a tratoria and had plenty of wine and liqueurs such as grappa and ouso.
One tratoria I remember was called the “chicken run” because there were chickens running about which were used that evening for meals. Occasionally JZ would take us all out for a meal. He would drive his Austin 1800 with us all crammed inside and two trips had to be made to get us all to his favourite restaurant. There was a string quartet playing at one restaurant (a bit posher than the “chicken run”!) and when he walked in they stopped playing whatever they were playing and struck up JZ’s favourite tune. I forget what it was but I think this is fame indeed for a British scientist.
One night he asked me and my fellow student Dave Bromham to baby-sit for his daughter Kate while he and Ray went out with some of the senior researchers for a meal. They left us out all sorts of cold meats, cheese, bread and a huge bottle of chianti. When they all back at about midnight Dave and I were virtually unrousable (the chianti) but eventually heard the doorbell. Far from being in trouble, we were invited to have a nightcap with them.
Half way through the 6 weeks’ work JZ crammed some cash in our hands and Dave and I were given two days off to have a break. I felt that the whole 6 weeks was a “break” and we were not expecting this. We went to Palermo in Sicily by train and boat and slept on night on Palermo railway station to make things cheap. Dave became a consultant gynaecologist in Leeds and died several years ago at a relatively young age. Every summer, 5 of the students worked with the octopus memory experiments and one worked with squid giant axons. I was the one JZ asked to work on squid.
JZ won a scholarship from Oxford University in 1928 to study in Naples. He became fascinated by the behaviour and nervous system of octopuses and squid. When he returned to Oxford he studied the nerves of earthworms with John Eccles and Ragnar Granit. They generated nerve impulses along large diameter fibres of about 300 micrometers. JZ Young wrote a chapter in 1975 in “The Neurosciences: paths of discovery” and I particularly like one passage which discusses how scientists work.
“I did the dissection, Eccles the recording, whilst Granit sat in a deck chair. We were not quite sure of his function. Perhaps he was deciding what logical methods we were to use, though I doubt whether scientists really proceed in the way that philosophers of science seem to suppose. It is a banal truism that all scientific workers operate with some hypotheses, but this alone does not adequately describe the motivation or process of their activities. Eccles, Granit and I were certainly not doing the work on earthworms to try and disprove the hypothesis that nerve fibres conduct. We were groping our way, trying to find new material for study. Disparagers can say that this is not science, but we three seem to have been moderately successful scientists”.
JZ thought that others missed the discovery of the giant axons in squid because they were too large. It was in 1934 when he discovered giant axons of about 500 micrometers diameter in the mantle cavity of the squid and in 1936 stimulated the axon with a crystal of sodium citrate and recorded the discharge from the fibre.
There was a theoretical mathematical model developed by Hodgkin and Huxley that the conduction velocity of a nerve fibre (axon) is proportional to the square root of the diameter of that nerve. JZ was trying to prove that formula was true and each summer two of the 12 students in Naples measured conduction velocities of giant axons and also recorded the diameter, which varied.
Every morning a fisherman would bring in one or two freshly-cought squid and put them in a tank of sea water. I had to fish one of these out and “kill” it by cutting its head off. The tentacles remained attached to the head and the latter continued to move about on the floor while I got on with my dissection. Speed was of the essence. I had to dissect out a giant axon from the body using a scalpel and a microscope and do this under saline to keep it functional. This was a delicate operation and a minimum length of axon was required in order to complete the experiment. After dissecting out, each end of the axon had to have a length of cotton tied to it. It was then carried by me, in a dish of saline, along to the other end of the building where the measuring equipment was. The nerve was put in a special container so that an electrical impulse could be sent down it and picked up at the other end. The readings were made using an oscilloscope and the diameter of the nerve measured using another gadget. JZ showed me how to do all this on the first day and got a perfect reading. I got no reading at my first attempt. I got no reading at my second attempt. I could do my experiment only once in the morning and once in the evening as time had to be spent setting up and calibrating the instruments. Three weeks went by and I got no results. JZ said this was not a worry and that “it would come”. It did and I got readings twice a day for the rest of the stay. The results were plotted on a graph that had been started 6 years previously and it looked to me as though the relationship between diameter of axon and conduction velocity had been established. However, JZ wanted to do another couple or more years work on it. All this taught me about being patient when it comes to scientific research and not to expect an answer in weeks. It may take years to prove or disprove something. The other 5 mostly worked on “training” the octopusses to recognise shapes both visually or by feel.
JZ had a theory that there was a nerve connecting two parts of the octopus and he asked one of my fellow students, Brian, to work on visualising this nerve using a dye. Again, Brian spent day after day searching and eventually found it. This was my first experience of a scientific discovery and the excitement it generated.
JZ asked me to drive his car (an Austin 1800 Estate) back to England with some of my fellow students and some of the equipment. I liked driving and again he gave us what seemed like loads of cash to get us back home. I can’t remember where we stayed on the way up Europe but we arrived at the British customs in Dover at about 2 am. We were asked if we had anything to declare. I replied that we had an automatic octupus feeding device. I thought we would all have a laugh at this but the customs officer made us unload the whole car to get to this device which he examined carefully before allowing us to go on.
The B.Sc. Anatomy course was 18 months long and the trip to Naples was in the first summer holiday after the first term. There were three terms to go.
Most people assumed that a course on Anatomy involves simply studying the anatomy of modern man in more detail. The course covered anthropology, histology and comparative embryology, for example.
There were 12 of us on the course at University College and 30 in all in the University of London. To be offered a place on a B.Sc course, one had to get through an interview. One was only offered an interview if one had done well in the second MB examination, which was undertaken after 18 months.. As I mentioned above, there were other B.Sc courses offered. These were in Physiology, Biochemistry and Pharmacology. Of the 120 or so medical students that undertook the 2nd MB examination at University College about 25 of us went on to spend an extra 18 months undertaking one of these courses. It was a big decision whether to do this or not. The friends I had made would be going on to do their hospital training and would become doctors well over a year earlier than I. I talked it over with my parents who were supportive as usual and willing to fund my grant. I went back to my school in Wakefield and talked things over with the biology master Dr Bill Fletcher. He pointed out to me that 18 months was not a long time in a 40 year long medical career and advised me that I should not turn down opportunities that cropped up such as this one. This clinched it for me. I went for it. I have followed this advice all of my medical career which has been fascinating and enrichiched.
The 4 terms undertaking this B.Sc. was a journey on which we travelled from the creation of life to looking at the latest electron microscope pictures of cells. The course allowed time to reflect as well as exploring any avenue one wished by reading. One of us, Adrian, read both volumes of Marshall’s Physiology of Reproduction and he described to us in graphic detail such things as the weight of elephant testicles and how porcupines approached sexual intercourse. I spent some time reading about consciousness and what yawning was all about.
A lot of the course was undertaken at one’s own college or medical school but there were elements when all the Anatomy B.Sc. students from the University of London got together (30). This particularly happened when famous speakers had been invited to teach us. We had one session with Louis Leakey, the father of anthropolgy and expert in the finds at the Oduvai gorge in Tanzania. The main anthropology teacher was Dr John Napier. He came into the seminar room with two boxes. One contained 20 ashtrays which he distributed and the other a load of flints and tools. He smoked like a chimney as did a lot of us. He had worked with Leaky and I particularly remember a teaching experience he gave us on stone-age tools. He had recently spent a week at home where he and his wife only used stone-age tools for preparing food. It was extremely difficult. Just imagine what it would be like making a sandwhich! I meet two of my fellow anatomy B.Sc students at an annual reunion, Robin Harrod, Colin Teasdale and I generally agree that the anthropology we studied was the most interesting part of the course. Some of the time involved visiting the primate house at Regent’s Park zoo and observing the behaviour of the monkeys and apes. The Department of Anatomy at University College had a very good collection of models of skulls and bones of the ancestors of man. In the final examination I was presented with a dead pidgeon and had to dissect out the nerves in its arm pit (axilla) and describe how this complex of nerves (called the brachial plexus) differed anatomically from that of man. The main difference was that the nerve supplying the pectoral (chest) muscles of the pidgeon was 5 times the size of the nerve in man. Those muscles operate the wings and need to create a lot of power for flying. Thank goodness we somehow all knew that this was coming up the night before!! I think one of the lecturers told us in the pub. There was a prehistoric skull to identify in another part of the examination. The twist was if one labelled this as Autralopithecus or Homo Erectus or something, this was not good news. It was a model of the skull of the Pilkdown man which was a forgery that fooled the worlds anthropologists for many years. What a rotten thing to put in an exam!
Histology was a significant part of the course. We were taught how to make microscopically thin slices of tissue, put them on a slide, fix and stain them so as to show up differing aspects of the cells. The electron microscope was a fairly recent development and we were shown fabulous and beautiful pictures of structures in cells never see before because they were so small. I went back to the Department in 2001 and wondered up the stairs. On the walls there are still the framed colour photographs of electron micrographs.
JZ was a great influence on me. A couple of months ago i bought one of his books in a second hand bookshop in York. "The life of vertebrates" Published 1950 767 pages long. I have his book "A model of the brain" all about the octopusses. I hope to find theother text book "The life of mamals" somewhere -actually I have seen it on ebay. What a long blog this one is!!!