Oxford Medicine January 2017

Oxford Medicine THE NEWSLETTER OF THE OXFORD MEDICAL ALUMNI OXFORD MEDICINE . JANUARY 2017

Contents President’s Piece . . . . . . . . . . . . . . . . .2 Medical and health teaching and research at Oxford University has been ranked as the world's best . . . . . . . . . . . .2 People in the News

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Life as a female medical student at Oxford in the 1960s, Christine A. Lee

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Career Profile: Jason Arora . . . .7 Oxford — a medical student perspective, Liam Loftus . . . . .8 Roald Dahl's Marvellous Medicine, Tom Solomon . . . . .9 Penicillin and Norman Heatley book announcement . . . . . . . .9 Blue Plaque for Dorothy Hodgkin . . . . . . . . . . . . . . . . . . . . . .10 13 Norham Gardens , David Cranston . . . . . . . . . . . . . . . . . . . . .10 Florence Nightingale, Eric Sidebottom . . . . . . . . . . . . . . . .12 Medical School Prizes With Sadness

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OMA Events . . . . . . . . . . . . . . . . .15

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President’s Piece

Once again the Oxford Medical School has been given top ranking nationally and internationally and it is only right that the Head of the Medical Division, Professor Alastair Buchan, should tell you about that in detail (see below). All achievements build on what has gone before and our alumni, many of whom have gone on to become staff at the medical school, can bask somewhat in the reflected glory.

development, and are developing a mentoring scheme for clinical students using local alumni.

I hope that you will enjoy reading this issue, with its wide variety of different articles. If you have any comments, or have a story or a controversy that you would like to present to/raise with the thousands of alumni who receive Oxford Medicine, then do please contact us or send it in.

John Morris

John Bell Roger Bodley Alastair Buchan Martin Burton OMA held its AGM in September at the time of the University Alumni Fiona Caldicott weekend and shortly before Susan Jebb (Professor of Diet and Chris Conlon Population Health in the Department of Primary Health Care) Christine Fairchild delivered the 2016 Osler Lecture to a large and appreciative group of Charlotte Frise alumni. At the AGM Prof John Reid stepped down as honorary Derek Hockaday Treasurer and we thank him for all his efforts in that role. We were Derek Jewell delighted that Dr Roger Bodley was willing to take up that role despite spending part of the year in the antipodes. The new members Vacant Tim Lancaster of the Advisory Board appointed are listed at the end of this article Christine Lee and I look forward to working with them all.

Denise Lievesley At the AGM we looked forward rather than back and agreed a Rebecca Oram number of targets for the coming year. We want to increase still John Morris further the proportion of alumni attending the reunions and the Osler, John Reid Weatherall and Radcliffe lectures. We need to increase our Vacant subscription base, so if you value the reunion and lecture programme Judith Shakespeare and Oxford Medicine and don’t already subscribe, please fill in the Jeremy Taylor subscription form on page X in this issue! We want to increase our Jayne Todd international outreach and are looking to identify an ‘overseas Laura Watts member’ of OMAAB in N America and the Far East. We also plan to interact even more with the current clinical students: we participated Lynn Williamson in a musical celebration at Osler house linked with their plans for its Christopher Winearls

Regius Professor of Medicine OMA - Treasurer OU Medical Sciences Div.: Head & Dean of Medical School OMA member OUH Trust: Chair OMA Member OU Alumni Office - Director of Alumni Relations OMA member OMA member (ROM project) OMA member OU Development Office: Medical Sciences team OU Medical School: Director of Clinical Studies OMA member Principal: Green Templeton College Student rep: President of Osler House OMA - President OMA member OMA - Archivist OMA member OU Medical School: Director of Pre-Clinical Studies OMA: Head of Alumni Relations: OMA member OMA member OMA member

Medical and health teaching and research at Oxford University has been ranked as the world's best for the sixth year running in the Times Higher Education World University Rankings

Professor Alastair Buchan, Head of Medical Sciences Division September 2016 saw the arrival of the new cohort of students who will be graduating and joining the NHS in 2022. While we worry about the funding for students and the state of the NHS, in particular with the Junior Doctors contract dispute, this group will continue to receive world- beating training as shown by the exceptionally good news that not only has Oxford has been ranked the top university in the World University Rankings — the first time a UK institution has been awarded the accolade — but also the Medical Sciences Division has been given top ranking for Clinical, Pre-Clinical and Health for the 6th year running. (See www.timeshighereducation.com/news/world-university-rankings2016-2017-results-by-subject-announced. This is a fabulous result of which we should all be very proud.

There is other good news. We heard in mid-September that our Biomedical Research Centre has been re-funded for the third time, receiving £113 million from the NIHR, and was the only Biomedical Research Centre to see a 10% increase in funding.

This is, in large part, due to the leadership of Keith Channon. We are also very excited to announce that a second BRC has been awarded to Oxford Health for Mental Health led by John Geddes who is partnering, as Head of Psychiatry, with Kia Nobre the Head of Experimental Psychology and Irene Tracy, the new Head of Clinical Neurosciences. We are also about to launch the new Hans Krebs II or Biochemistry Phase II Building which will go a long way to support the integration of Cell Biology across South Parks Road.

A major publication on prostate cancer treatment by a team led by Freddie Hamdy of the Nuffield Department of Surgical Science appeared in two back-to-back papers in the New England Journal of Medicine. This compared the outcomes of active monitoring with radiotherapy and radical prostatectomy over 10 years after detection of elevated PSA. It revealed no significant difference in prostate-cancer-specific mortality (1%) across treatments, but surgery and radiotherapy were associated with a lower incidence of disease progression but a greater negative impact on sexual, urinary and bowel function and quality of life.

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In September Professor Robert McLaren, assisted by Dr Thomas Edwards, Nuffield Medical Fellow, performed the world’s first robotic eye surgery, using a remotely controlled robot to lift a membrane 10 micrometres thick from the retina at the back of the right eye of the Revd Dr William Beaver, 70, an Associate Priest at St Mary the Virgin, Iffley, Oxford. He is the first patient ever to undergo this experimental procedure. The Robotic Retinal Dissection Device (R2D2) trial is sponsored by the University of Oxford and funded by the NIHR Oxford Biomedical Research Centre with support from Oxford University Hospitals NHS Foundation Trust, which runs the hospital. Additional funding was provided by Zizoz, a Dutch charity for patients with choroideremia, a genetic form of blindness. The robot operates inside the eye through a single hole less than 1 mm in diameter and goes in and out of the eye through this same hole during various steps of the procedure, even though the eye may move. The device eliminates unwanted tremors in the surgeon’s hand through seven independent computer-controlled motors resulting in movements as precise as 1000th of a millimetre.

People

Congratulations to the following who were elected FMedSci

Graeme Black, Professor, Genetics and Ophthalmology, Deputy Director, Biomedical Research Centre, University of Manchester Christopher Butler, Professor of Primary Care, University of Oxford Georg Holländer, Hoffmann and Action Professor of Paediatrics, Head of Department, University of Oxford Sarah Lamb, Kadoorie Professor of Trauma Rehabilitation, Co-Director of the Oxford Clinical Trials Research Unit, University of Oxford Martin Maiden, Professor of Molecular Epidemiology, University of Oxford Timothy Maughan, Professor of Clinical Oncology, Deputy Director of the CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford Gilean McVean, Director, Big Data Institute, University of Oxford Paul Moss, Professor of Haematology, University of Birmingham Andrew Pollard, Professor of Paediatric Infection and Immunity and Honorary Consultant Paediatrician, University of Oxford Elizabeth Robertson, Professor of Developmental Biology, University of Oxford

2016 EAPM Life Time Awards 2016

The European Association of Psychosomatic Medicine Award in memory of Alison Creed for life time achievement in the field of Psychosomatic Medicine/ Consultation Liaison Psychiatry will be presented to Michael Sharpe, Oxford.

In 2015 Professor Sharpe received the Don R. Lipsitt Award for Achievement in Integrated and Collaborative Care from the Academy of Psychosomatic Medicine.

Finally, in September, Sir Peter Ratcliffe, who helped unravel a crucial biological process that underpins nearly all of life, was awarded one of the most prestigious prizes in science. Sir Peter shares the $250,000 (£188,000) Lasker basic medical research award with two US scientists: William Kaelin at the Dana-Farber Cancer Institute, Harvard Medical School in Boston, and Gregg Semenza at Johns Hopkins University in Maryland, for discovering how individual cells in the body sense and adapt to changes in the oxygen available to them. The discovery has already led to a raft of experimental anaemia drugs that trick the body into thinking it is at high altitude, causing it to produce more red blood cells. Other drugs that interfere with the process are expected to help combat cancer and heart disease. The Lasker award is one of the most reliable indicators of who will win a future Nobel Prize. More than 80 Lasker award winners have gone on to become Nobel laureates.

2016 Al-Sumait Prize for Health Professor of Tropical Medicine Kevin Marsh has won the Al-Sumait Prize for Health for his contributions to health in Africa. Professor Marsh is a principal investigator at the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya, as well as senior adviser to the African Academy of Sciences. His award recognises his sustained efforts to control and eradicate malaria, which impacts the health of tens of millions of African children.

The $1 million award honours individuals or institutions by recognising the studies, scientific projects, applied research and innovative initiatives that have a significant impact and lasting influence on advancing progress in economic and social development in Africa.

Professor Marsh's research on malaria spans more than three decades, from studying the immunology of malaria in the Gambia to his recent role as director of the KEMRI-Wellcome programme in Kenya from 1989 to 2014.

Al-Sumait awards are administered by the Kuwait Foundation for the Advancement of Sciences. This year's prizes will be presented during a ceremony at the Fourth Arab African Summit in Equatorial Guinea on 22 November.

2016 Feldberg Foundation Prize

Was awarded to Professor Patrik Rorsman FRS Oxford Centre for Diabetes,Endocrinology and Metabolism.

2016 Jacobæus Prize

The Novo Nordisk Foundation is awarding Mark McCarthy the 2016 Jacobæus Prize for uniquely contributing over many years to the research on the links between the human genome and the risk of developing type 2 diabetes. The Prize is accompanied by DKK 100,000.

Through high-quality basic research and excellent collaboration in

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international research consortia, researchers from throughout the world have mapped more than 100 DNA sequences present in the genes of people with an elevated risk of developing type 2 diabetes. Mark McCarthy has played an important role in this process as a basic researcher, as a leader of research groups and as a leading figure in large international consortia in which researchers share data and coordinate their work to obtain as much new knowledge as rapidly as possible.

McGill University Honorary degree

McGill University presented an honorary degree to Dr. Jonathan Meakins. Nuffield Professor of Surgery at Oxford, Emeritus upon his retirement in 2008, whereupon he returned to Montreal.

2016 AAPM Robert G. Addison Award Winner — R. Andrew Moore, DSc — For Evidence-Based Pain Mentoring provided

by Dr. Moore and his Oxford Colleagues to numerous Researchers, Clinicians, and Students

R Andrew Moore looks back on a distinguished career in biomedicine.

He was educated at Balliol College where he also did his DPhil. He subsequently trained in clinical biochemistry in Oxford and worked with the academic giants of the time including Nobel Laureate Hans Krebs.

Andrew Moore became, at the time, the second youngest top-grade clinical biochemist in the UK ever. His subsequent career involved stations in academia and industry. He currently is a Senior Research Fellow at the Pain Research Unit in Oxford.

Andrew Moore has published over 500 peer-reviewed papers, including about 100 Cochrane reviews, and has received many recognitions including a D.Sc. Oxford. His main interest is in the methods of pain trials, the effect of biases on trial outcomes, and the compilation and use of evidence. Andrew Moore was the founding editor of Bandolier, a newsletter on evidence-based medicine with readership across the world.

2016 American Thoracic Society Abstract Awards:

• Robert Hallifax, BM BCH, MSc for his Abstract Title: The Epidemiology of Pneumothorax in England (1968-2011) • Kirsty Hambleton, BMedSci, BM, BS, MRCP(UK) for her abstract Title: Defining Inflammatory Groups Within a COPD Cohort.

FENS-Kavli Network of Excellence

Dr. Linda Katona has been awarded the inaugural FENS-Kavli Network of Excellence PhD Thesis Prize.

2016 Taylor & Francis Commonwealth Scholar Best Journal Article Prize

The Commonwealth Scholarship Commission in the United Kingdom (CSC) and Taylor & Francis Group are delighted to announce that the winner of the 2016 Taylor & Francis Commonwealth Scholar Best Journal Article Prize is Dr Olivia Faull, for her article ‘Conditioned respiratory threat in the subdivisions of the human

periaqueductal gray’, published in eLife in February 2016.

Olivia is a 2012 Commonwealth Scholar from New Zealand, who undertook her DPhil in Clinical Neuroscience at Oxford. Her article and research focuses on human respiratory control and perceptions of breathlessness.

The Taylor & Francis Commonwealth Scholar Best Journal Article Prize is awarded to a Commonwealth Scholar who submits the most outstanding article published in a recognised peer-reviewed journal. This annual prize, first awarded in 2012, aims to encourage and reward the publication achievements of Commonwealth Scholars who are completing or have recently completed their doctoral studies.

Royal College of Surgeons of Edinburgh Oxford.

Medical student Daniel Klotz was awarded second prize by Britain’s oldest surgical Royal College at their 5th annual National Conference for Aspiring Surgeons, which called upon the best and brightest medical students and foundation doctors from around the UK, to present new ideas and share their passion on innovation, safety and quality in surgery, to help shape the future of healthcare.

2016 OUSU Student Led Teaching Awards Winners

Dr Sandra Campbell Department of Oncology/St John’s College

Jill O’Reilly Nuffield Department of Clinical Neurosciences Dr Proochista Ariana Nuffield Department of Medicine

200 Young South Africans 2016 Dr Tinashe Chandauka, a University of Cape Town alumnus who will be pursuing a DPhil in Surgical Sciences at Oxford, has been named in the 200 Young South Africans 2016 list. Dr Tinashe Chandauka, a Rhodes Scholar, who is pursuing a DPhil in the Nuffield Department of Surgical Sciences Surgical Sciences at Oxford, has been named in the 200 Young South Africans 2016 list. This year marks the 11th anniversary of this annual list, which features notable South Africans under the age of 35 who have made a mark for themselves in categories ranging from civil society to the environment. The top young South Africans were unveiled at a gala event on 23 June 2016, in which Dr Chandauka was listed in the health category. Under the supervision of Professor Peter McCulloch, his work will focus on surgical safety in theatre in subSaharan African, and the need for cultural adaptation of the World Health Organisation checklist and the teamwork training courses which have been widely used in Europe and the USA. He aims to gather and analyse vast amounts of data on surgical procedures in South Africa, Kenya and possibly Rwanda, to bring about improvements in surgery and its outcomes in developing countries.

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Department Of Pharmacology — Stutchbury Scholarship The winner of the 2016 Stutchbury Scholarship, for the highest-ranking MSc student undertaking the one-year MSc in Pharmacology, was Robert Macsics.

University of Oxford Recognition of Distinction 2016

The 2016 Recognition of Distinction Awards demonstrate the Medical Sciences Division’s commitment to excellence in research and teaching and reflect our world-renowned multidisciplinary approach to medical research.

Our congratulations to all our researchers who have been conferred the title of Professor, as well as to those conferred the title of Associate Professor and University Research Lecturer: Amar Rangan, Orthopaedic Surgery Anne Kiltie, Experimental Clinical Oncology Benoit Van den Eynde, Tumour Immunology Clare Mackay, Imaging Neuroscience Dmitry Filatov, Evolutionary Genetics Dominic Wilkinson, Medical Ethics Gary Collins, Medical Statistics Hemant Pandit, Orthopaedic Surgery James Wright, Orthopaedics Joel Tarning, Clinical Pharmacology

Jurgen Schneider, Medical Imaging Lisa White, Modelling and Epidemiology Lucy Dorrell, Immunology Mark Buckley, Behavioural and Cognitive Neuroscience Mark Woolrich, Computational Neuroscience Persephone Borrow, Viral Immunology Peter Simmonds, Virology Petros Ligoxygakis, Innate Immunology Radu Aricescu, Molecular Neuroscience Stephen Baker, Molecular Microbiology

News

• Anthony Harnden appointed to GMC Council. Professor Harnden is Professor of Primary Care in Oxford University’s Nuffield Department of Primary Care Health Sciences and a Governing Body Fellow of St Hugh’s College. The UK’s General Medical Council has appointed Professor Anthony Harnden as one of two new registrant members to its governing body from 1 January 2017.

• EnzBond launches to make fast, effective enzyme development a reality.

EnzBond, a new biotechnology company from Oxford University, has been formed to commercialise in-silico technology, which makes utilising enzymes in drug manufacturing both cost-effective and time-efficient.

• More global investors back Oxford ideas and Britain's technology future. Oxford University, on behalf of Oxford Sciences Innovation (OSI), today announces a substantial increase of capital raised worldwide to scale innovative ideas from the University of Oxford into world-class companies.

• New study finds antibodies that may be the cause of schizophrenia in some patients. For the first time specific antibodies have been found to be associated with the onset of schizophrenia in a study led

by Professor Belinda Lennox.

• Study highlights heart disease risk for pregnant women. The latest annual report into maternal deaths, produced by Oxford University researchers, highlights the risk of heart disease among pregnant women.

The latest Confidential Enquiry into Maternal Deaths from the national collaborative programme studying maternal and infant deaths, MBRRACE-UK, commissioned by the Healthcare Quality Improvement Partnership shows that in 2012-14, 8.5 women per 100,000* died during pregnancy or shortly after giving birth. The report, ‘Saving Lives, Improving Mothers’ Care’, highlights that two in every 100,000 died from heart disease, which is the leading cause of women dying in pregnancy or the early weeks after childbirth. There has been no significant change in the overall national maternal death rate since the last report.

• Three Oxford research centres among 14 to share £118M Wellcome funding. Three Wellcome centres in Oxford are among 14 to share in £118 million of Wellcome funding over the next five years. The Wellcome Centre for Human Genetics, the Wellcome Centre for Integrative Neuroimaging, and the Wellcome Centre for Ethics, Innovation, Globalisation and Medicine, are among the centres across the UK and South Africa to secure the funding for the next five years. All of the centres aim to advance our understanding of health and disease, and span fundamental and social sciences, humanities, clinical research and engineering. One of the seven renewed existing Centres, the Wellcome Centre for Human Genetics, has been based in Oxford for 22 years. The Wellcome Centre for Integrative Neuroimaging and the Wellcome Centre for Ethics, Innovation, Globalisation and Medicine are among the seven newly established centres.

• M40 Alliance forms to accelerate arthritis therapy.

A new partnership has been formed between the Universities of Oxford and Birmingham to speed up the development of novel treatments for arthritis, supported by a £7 million investment from the Kennedy Trust for Rheumatology Research.

• Scientists from two departments within University of Oxford Medical Sciences Division have been awarded research grants by the British Medical Association. Dr Jeremy Howick and Prof Paul Nicholas Aveyard from Nuffield Department of Primary Care Health Sciences were awarded the Dawkins & Strutt grant of almost £60,000 to support pioneering research into pain treatment. The HC Roscoe grant of £50,000 was awarded to Jenner Institute scientists from Nuffield Department of Medicine, Dr Lynda Coughlan and Prof Adrian Hill, who will use the funding to develop improved vaccines for influenza and other emerging infectious diseases.

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Life as a female medical student at Oxford in the 1960s

Christine A. Lee

Emeritus Professor of Haemophilia, University College London.

E-mail: Profcalee@gmail.com

Fifty years ago, in September 1966 — the year England last won the world cup at football — I began life as a clinical medical student at Oxford Medical School based at the old Radcliffe. There were 14 of us in the entry cohort, and I was one of three women in a heterogeneous group, including six from Cambridge, two from London and a Swedish student studying in Germany. I had graduated first class in animal physiology from Somerville College, and so I was well used to women being in a minority at Oxford. At that time, entry across the whole university was restricted to 10 women a year to read medicine for 1st BM BCh, approximately 10% of the annual intake.

The 4-week introductory course was a ‘rude’ shock, although it proved very successful in laying the foundations for my clinical medicine. I had spent the previous year in the esoteric pursuit of attempting to understand rudimentary molecular biology after the publication of Watson and Crick’s groundbreaking discoveries in the early 1960s. During the summer I had worked as a research technician in the haematology department at the University of Freiburg. Thus, to be confronted by the crudeness of a surgeon describing the niceties of a rectal examination, particularly to embarrass the female students, was, to say the least, uninspiring. Nevertheless, we were taught the protocol for taking a history and conducting a physical examination, which remained firmly imprinted throughout my medical career. I learned the seven characteristics for describing pain, and the list is still memorable 50 years later.

There were only three students allocated to our first surgical firm — vascular surgery under Mr Tibbs. We were expected to take the daily routine bloods from all the patients under the firm one week in three: an excellent training for acquiring venepuncture skills. As students we held retractors in theatre and, for four hours one Saturday morning I assisted Mr Tibbs in the resection of an accessory rib that had caused gangrene in several fingers of a patient who had come in on take. I think we were quite intimidated by the rituals of surgery and, as a woman; I was often taken as the scrub nurse or anaesthetic nurse and asked impossible tasks. Two years ago, with some surprise I read from a display at the Pegasus Bridge museum that Mr Tibbs was parachuted into Normandy at the start of the Allied invasion in World War II to lead the medical clearance of casualties. Mr Tibbs never mentioned these experiences, and in 1966, only 20 years from the end of the war, there must have been other senior doctors who kept their bravery and horrors hidden.

Our first medical firm was under North American Professor Paul Beeson who had recently taken up position of Nuffield Professor of Medicine. We soon learnt his two favourite topics: the adverse effects of alcohol, and hepatitis as a complication of blood transfusion. A Polish displaced persons camp situated near Oxford provided many admissions for the understanding of alcohol intoxication. Much later, researching literature for my MD, about hepatitis in haemophilia, I found Beeson’s 1943 paper in which he reported jaundice in seven patients who had received blood transfusion. I understood then how Beeson instilled in us the importance of clinical observation and careful history taking. One strength of our training was the rotation as students through a wealth of specialist centres based around Oxford.

We had to deliver at least 10 babies and to accrue these deliveries some of us were resident at Horton Maternity hospital in Banbury where the curries were legendary. Home deliveries were not unusual and the flying squad service provided blood to mitigate disasters. Professor Chassar-Moir taught us endlessly about X-ray pelvimetry: the link with childhood leukaemia ended this method of assessing pelvic disproportion. Chassar-Moir also recounted his many trips to Ethiopia to train surgeons in the management of fistulae causing incontinence in women. I now wonder how many of these women developed these complications as a result of female genital mutilation. As students we were able to act as locums (the reward being free meal tickets) and I filled-in on the postnatal ward for a week. Women were kept in bed postnatally and my main duty was to prescribe stilboestrol to prevent lactation: the link to DVT had not been recognized. I also examined the babies for congenital dislocation of the hip before discharge, and I still hope I did not miss any abnormality.

Professor Duthie taught orthopaedics at the Nuffield Orthopaedic Hospital, requiring daily attendance at 8am. Despite my enthusiasm, it was made very clear to me that women were not appropriate for this branch of the profession. This was my first encounter with haemophilia: a ward was full of haemophilic boys in traction and plaster. Treatment was in its infancy and their life expectancy was only 20 years. Oxford pioneered the management and surgery in these patients and in 1960 factor IX concentrate, developed in Oxford, was first used in a haemophilic child requiring an arm amputation for osteomyelitis.

Psychiatry was spent at the Littlemore where patients were not given a diagnosis, as a matter of principle.

Every morning there was a large assembly for patients and their health care providers, when anyone could say anything! The Warneford was rather more conventional and we observed intimate patient interviews through a one-way glass screen. The concept of patient consent did not exist.

I was awarded a Nuffield Scholarship that enabled an exchange between a student at the Oxford Medical School and Peshawar, North West Frontier.

Since women were in purdah in Peshwar I was able to spend three months at the Christian Medical School, Vellore, South India, with some clinical visits to hospitals in Madras. This experience was life changing, not least because I totally lost my idealism in the day-to-day reality of poverty and sickness. I learnt that only modest clinical improvements might be possible. I lived amongst student girls from all over India, and came to respect their immense dedication to their studies and to admire their waist-length hair that they used to build elaborate hairstyles.

Undoubtedly I was privileged to be a student at the Oxford Medical School even though at that time it was regarded as inferior to London. We were immersed in all aspects of medicine and obtained enormous experience. We were allowed full participation as part of a small medical community. Did I suffer discrimination? On the contrary, one stood out. However, as a woman, my expectations were certainly lower: I wanted to be a surgeon but recognized and accepted, like Mr Till my mentor that “surgery was not for women”.

The photograph shows Christine Lee examining a patient at Vellore, South India, as a student at the Christian Medical College.

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“Zooming out: from microscopy to macroscopy in medicine”

Dr. Jason Arora

(matriculated 2005, graduated 2011 from St. John’s College, Oxford)

Director, International Consortium for Health Outcomes Measurement (ICHOM) I remember first peering down a microscope in a Friday morning lab session back in 2005, thinking ‘Why am I looking at this?’ I hadn’t yet realised the beauty of understanding medicine from the bottom-up.

From the basic sciences to clinical medicine, we start small and gradually scale-up a deep understanding based on fundamentals. The majority of my fellow medical school graduates will agree with me when I say that this approach has served us well.

However, despite the obvious advantages of learning medicine in this way, we tend to stop at the boundaries of the human body. We generally don’t go on to explore how to approach medicine at scale — at the population level. Of course this depends on how we define medicine and differentiate it from ‘healthcare’, what our specific interests and motivations are, and how much more active learning we want to take on. Understanding the human body is difficult enough as it is and any learning of the bigger picture of healthcare tends to happen by passive absorption as we begin our work within the system.

But semantics and status quo aside, there is an important point to be made here — that there is significant benefit for clinicians to actively understand the bigger picture of medicine. Why? Because the system can have a much greater impact on patient health outcomes than the clinician. And if we, as doctors, are to fulfil our mission of improving the health of our fellow human beings, this understanding is key.

As I moved from lectures and labs to wards and clinics, this realisation slowly dawned on me. To maximise impact for my patients, I needed to extend my understanding of medicine beyond the human body.

Upstream factors were making it difficult for me to deliver consistently high quality outcomes for my patients, and — for me — this needed to be addressed directly. In the context of a global chronic disease surge that advanced economies are struggling to cope with, I wondered how the majority of the human population residing in low and middle income countries — around 80% — were going to manage. In order to improve health care as a whole, for all human beings, we need to change the way we approach it everywhere. To facilitate some dedicated time to explore potential solutions to this, I undertook a Masters in Public Health (MPH) at Harvard School of Public Health.

During my time at Harvard, I began to form an appreciation of two key variables — quality and cost. Whilst healthcare costs are rising everywhere, quality is not. There is a clear disconnect between the two, and herein lies the root of our sustainability problem in healthcare. I discovered Professor Michael Porter's work in value-based health care (VBHC) at Harvard Business School, which defines value in healthcare as patient-centred outcomes divided by the cost of delivering those outcomes. Professor Porter and his collaborators at the Boston Consulting Group and the Karolinska Institute had co-founded the notfor-profit VBHC catalyst organization, ICHOM (the International Consortium for Health Outcomes Measurement), in 2012, which I was to join only a year later.

ICHOM was just an ambitious startup run out of a quirky office in Harvard Square at the time. Its mission: to unlock the potential of valuebased healthcare across the world by defining globally-standardised sets of patient-centred outcomes around medical conditions which health care systems everywhere will measure. This will generate big data on the outcomes that matter most to patients, seeding an endless possibility of data-driven quality improvement opportunities in real-time and connecting health care systems across the world to benchmark, compare their data and learn from each other. This, in turn, will reduce costs by focussing health care systems on achieving — as a primary goal — the outcomes that matter most to patients. Anything else will be deemed waste, and therefore eliminated from the system.

As a Director at ICHOM, I now work globally with all stakeholders across healthcare — from clinicians and researchers to patient representatives, from hospitals and governments to medtech companies and patient charities — to help reshape the industry around value.

Having closely studied other healthcare systems and begun to understand what healthcare looks like from the perspective of different players, I’ve begun to appreciate just what healthcare really means. My journey has led me to develop a deep appreciation of the complexity of healthcare — a complexity that rivals that of the human body.

Many around the world see healthcare as a product, but I — like many British-trained physicians — see it as a human right that needs to be delivered at high quality, to all people. This is what makes it unique, and this is essentially why I’ve needed to broaden my understanding of medicine. I would encourage my fellow medics out there — whether medical students or practicing clinicians — that even if you believe your place is at the patient’s bedside — your art will be helped by learning something of sculpture. Understanding the bigger picture of healthcare will help you understand how, as a clinician, your role contributes to achieving the overall mission — of improving the health of our fellow human beings.

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Oxford — a medical student perspective

Liam Loftus

Osler House President 2015/16 At the age of 17 years old, I was confronted by a choice that would no doubt shape my future. I was committed to studying medicine, and was now faced with the rigorous admission process that comes before studying such a degree. The next decision that I needed to make was where do I study? Do I stay close to home, within my comfort zone, and study at a local university such as Liverpool or Manchester, or do I take a risk, broaden my horizons, and take a step into the almost complete unknown that is studying at Oxford? For some, applying to leading institutions such as Oxford is strongly encouraged, if not expected. For others like myself, studying at Oxford can be seen as an unachievable pipedream, and even then, one which is clouded by stereotype and preconception.

When such decisions arise, my instinct is to turn to my family for advice.

However, my incredibly supportive parents had no personal experience of studying at university, never mind at Oxford. This was true for pretty much all of my extended family, and their thoughts on both university and Oxford were based on hearsay, rather than first-hand experience.

The opportunities that studying at Oxford presents are universally recognised. I would be taught by the people who quite literally wrote the textbooks on the subject that I love, and would work in the same locations as so many influential figures in medicine have done so before me. I could dine in the spectacular halls, and marvel at the breathtaking architecture on my morning walk to lectures. Though this was far removed from what I was used to when I was growing up in a small town called Widnes, the opportunity did excite me.

With such well-recognised benefits, one may ask why one hears of incredibly talented people being put off the idea of applying to Oxford.

Coming from a background where stereotypes of Oxford may be unfavourable, it’s fair to say that I did have my doubts, many which were reinforced by how Oxford is portrayed in some of the press. A whole range of question filled my head. How would I make friends with the people that the media suggests that Oxford is filled with; people of great wealth, who are from a vastly different background to myself?

Would all my friends now be royalty, or future Prime Ministers or bankers, and would I be looked down upon because I’m from ‘The North’ and I was not privately educated? Even putting this aside, how would I even have chance to make any friends if every waking hour should be dedicated to my studies, as some suggest that it should be?

It would have been so easy for me to choose the ‘safe option,’ and to remain close to home. On reflection, I believe that there are a few key reasons why I chose the path that I did. This was not something that I could have done without the full support of my parents, and true to form, it has been ever-present. Though they were unable to provide first-hand information about what life is like at either university, I was incredibly fortunate that my school (The Blue Coat School, Liverpool), were able to plug this gap, offering a great deal of advice and support, as soon as it became clear that I may be capable of studying at Oxford. In addition, I was very grateful to have been reached by one of the many access programs that the University of Oxford runs. I will always remember attending an event at Goodison Park, at which I was able to hear more about life at Oxford, and meet current students who dispelled many of the myths and stereotypes that surround this university.

Day one arrived, and saying goodbye to a (very!) teary mum and dad while being dropped off to start a new life three hours from home was never going to be easy. However, the anxiety began to subside just a

few hours into my ‘new Oxford life.’

I met people who, like myself, were not only passionate about their subject and excited by the journey that lay ahead, but also similar to me in so many other ways. Instead of the ‘Oxford stereotype’ that I thought would greet me, I soon saw Oxford as the vibrant, eclectic, and inclusive place that the majority of the media simply has no interest in portraying. Though the intensity of the Oxford experience may not be to everybody’s taste, I would argue that almost everybody in my position would find that their pre-existing views are strongly challenged, all while relishing the unique opportunities that such a place has to offer, and meeting incredible people along every step of the way.

Though I may not have had any family that had been to Oxford, or even live in an area where many go to University, I cannot say for definite that I would have come to the same decision had it not have been for the support of my family and school. It is unfortunately the case that there are many people who are not as fortunate as I was, and have no access to the support that I did. Year upon year, countless A Level students will have the potential to complete a degree at Oxford, but many will be discouraged by their preconceptions about studying here.

The aims of the access programmes that I was very grateful to be reached by are to abolish this inequality. They provide the advice and information necessary to give all those who have the academic potential the same opportunity, regardless of their background.

I am also extremely proud to belong to my college, Lady Margaret Hall, which in its own words, has a “passion for scholarship, equality and fairness.” Their recent introduction of a foundation program exemplifies their commitment to this objective. Open to students whose background may have presented them with obstacles in the past (such as those from disadvantaged socio-economic backgrounds, and those from areas with low participation in higher education), the course will support them both academically and personally, in order to enable them to reach their full potential. The fact that there will be zero cost to the student, with Lady Margaret Hall paying for both tuition and accommodation costs, as well as providing a living allowance, really does make it available to all those who would benefit from it the most.

I believe that innovations such as these demonstrate the commitment of those at Oxford to widening access. It is a progressive step that will have a real, lasting impact, both on those who are part of the program, and on the idea that if you have the potential, your circumstances should not be a barrier to studying here.

My Oxford journey has been incredible, and I have no doubt that it has developed me as a person in ways that would not have been possible elsewhere. The opportunity to achieve my academic potential, all while having such an enjoyable time and making friends for life, is one that I am so very glad that I did not pass up on. I am very optimistic that as access programs continue to develop, barriers will be broken down even further, and more and more of those who are capable will grasp this fantastic opportunity with both hands. As long as the University of Oxford continues to put inclusivity and equality at the centre of its mission statement, I believe that the even more diverse and welcoming community that it creates will be one that we will be even more proud to be a part of.

OXFORD MEDICINE . JANUARY 2017 / 9

BOOKS Roald Dahl's Marvellous Medicine

by Tom Solomon

Most people know Roald Dahl as a famous writer of children's books and adult short stories, but few are aware of his fascination with medicine. Right from his earliest days to the end of his life, Dahl was intrigued by what doctors do, and why they do it. During his lifetime, he and his family suffered some terrible medical tragedies: Dahl nearly died when his fighter plane went down in World War II; his son had severe brain injury in an accident; and his daughter died of measles infection of the brain. But he also had some medical triumphs: he dragged himself back to health after the plane crash, despite a skull fracture, back injuries, and blindness; he was responsible for inventing a medical device (the Wade-Dahl-Till valve) to treat his son's hydrocephalus (water on the brain), and he taught his first wife Patricia to talk again after a devastating stroke. His medical interactions clearly influenced some of his writing — for example the explosive potions in George's Marvellous Medicine. And sometimes his writing impacted on events in his life — for example the research on neuroanatomy he did for his short story William and Mary later helped him design the valve for treating hydrocephalus. In this unique book, Professor Tom Solomon, who worked with Sir David Weatherall to look after Dahl towards the end of his life, examines Dahl's fascination with medicine. Taking examples from Dahl's life, and illustrated with excerpts from his writing, the book uses Dahl's medical interactions as a starting point to explore some extraordinary areas of medical science. Solomon is an award-winning science communicator, and he effortlessly explains the medical concepts underpinning the stories, in language that everyone can understand. The book is also peppered with anecdotes from Dahl's late night hospital discussions with Solomon, which give new insights into this remarkable man's thinking as his life came to an end.

Penicillin and the Legacy of Norman Heatley

by David Cranston and Eric Sidebottom with illustrations by Valerie Petts

This is the real (and surprising story) behind the greatest medical achievement of the 20th century.

“I am amazed that it has taken so long to tell the story of Norman Heatley, the scientist whose talents made the development of penicillin, the world’s first antibiotic, possible He was truly ‘the right man in the right place at the right time’. He deserves to be remembered, and this book will help ensure that the true story of the birth of antibiotics is not forgotten. The authors are to be congratulated on giving us this sensitive and sympathetic record of the life of ‘the unsung hero of penicillin’, Norman Heatley.”

Professor Matthew Freeman, Sir William Dunn School of Pathology “It is remarkable that while his colleagues were receiving the world’s acclaim for the development of penicillin, the crucial contribution of Norman Heatley was largely forgotten. What is equally remarkable is that, in the subsequent years he never expressed even a hint of disappointment or envy at his exclusion. Norman’s modesty was not regarded as weakness by those who knew him but as a life-long feature of his personality which led to trust and friendship. It is a rare quality in the competitive arena in which many scientists spend their professional lives struggling for recognition.

Sir James Gowans, Fellow of the Royal Society.

David Cranston is currently Consultant Urological Surgeon in the Oxford University Hospitals NSH Foundation Trust, Associte Professor of Surgery in the Nuffield Department of Surgical Science, and a Fellow of Green Templeton College, Oxford.

Eric Sidebottom held a University Lectureship in Experimental Pathology and was Nuffield Research Fellow and Medical Tutor at Lincoln College. Recently he has been a freelance Education and Research consultant studying and writing about the History of Oxford Medicine and the role of Disease in World History.

Valerie Petts first started training as a lab technician in Professor Howard Florey’s department in Oxford and has now been painting full-time since about 1990. She has had numerous exhibitions in England and has also exhibited in Tokyo and Cape Town and has illustrated many books.

10 / OXFORD MEDICINE . JANUARY 2017

Blue Plaques Board honours the only British woman to be awarded a Nobel Prize for science, Dorothy Hodgkin The Oxfordshire Blue Plaques Board has decided to honour the only British woman to be awarded a Nobel Prize for science, Dorothy Hodgkin, Nobel Laureate in Chemistry with penicillin with a plaque at her house in Woodstock Road, where she lived from 1957 to 1968 with her husband Thomas, their three children and her sister, Joan, and her five children.

Professor Hodgkin, who is remembered as a great scientist and a warm, gentle and supportive person, attended Somerville College to read chemistry in 1928. The undergraduate course at that time did not include X-ray crystallography – a tool used for identifying the atomic and molecular structure of a crystal – but she had the opportunity to do her fourth year research. She began her life’s work on the structures of medically important chemicals such as antibiotics, vitamins and proteins and in 1934 she became a research fellow at Somerville, later, a lifelong fellow and tutor.

The mother-of-three was at first given a somewhat makeshift laboratory of her own in the University Museum of Natural History, but by 1945 she had determined through X-ray diffraction techniques the structure of penicillin, by 1955 that of Vitamin B12 and by 1969 the structure of insulin. In 1947 she was elected a Fellow of the Royal Society and in 1964 was awarded the Nobel Prize in Chemistry. This honour was followed in 1965 by her appointment to the Order of Merit.

By now, a figure of international standing, she gave her support to causes close to her heart and in 1975 she became President of the Pugwash Conferences on Science and World Affairs campaigning against nuclear weapons. In 1993, the year before her death, though frail and confined to a wheelchair, she made the journey to Beijing to attend the International Congress of Crystallography.

The plaque was unveiled at 94 Woodstock Road by leading crystallographer Professor Elspeth Garman.

13 NORHAM GARDENS

David Cranston Associate Professor of Surgery, Nuffield Department of Surgical Sciences Governing Body Fellow of Green Templeton College Oxford Situated in the centre of Oxford next to the University Parks, 13 Norham Gardens is known to the medical community throughout the world as the Oxford home of William and Grace Osler. They arrived in Oxford in 1905 and bought the house in 1906. Built in the 19th Century for the Public Orator on land once owned by Henry VIII’s physician, William and Grace lived there for the remainder of their lives. The house became known as the ‘Open Arms’ renowned for its hospitality for which the Oslers were famed.

After the sad death of their son Revere at Ypres in 1917, the house was left to Christchurch for future Regius Professors of Medicine and through Richard Doll and the generosity of the McGovern Foundation, Green College (now Green Templeton) acquired it.

While the majority of Osler’s extensive library was left to McGill University, 13 Norham Gardens has a number of his books and letters and items of furniture, including the famous portraits of Linacre, Harvey and Sydenham, that Osler first saw in Henry Acland’s library and which Grace Osler asked Sir Henry if he would arrange to get a copy for William as a birthday present.

Several letters of great interest are in the collection including a copy of the letter Balfour wrote inviting Osler, on behalf of the King, to the Regius chair in Oxford. In spite of the fact that he often said his ideal of life would be to live within an hour of the British Museum and to have ‘The Times’ on his breakfast table, and commenting years before after a visiting the city ‘I have lost my heart to Oxford’, he had difficulty in coming to a decision when he was officially offered the post, and so it was that he wrote to his wife from London expressing uncertainty. She was still in Canada and she received his letter one Sunday morning, read it, went straight away to the telegraph office and cabled: ‘Do not procrastinate accept at once.'

Another original letter in Osler’s own hand speaks of a forth-coming trip to Canada in 1906 for his mother’s 100th birthday. She died a few months later but on her birthday she recounted how, as a young child of nine, she walked from Hampstead to Bushy Park to carry the news of the victory at the Battle of Waterloo in 1815. She had lived during the reign of five monarchs; she had six living children, 26 grandchildren, and 21 great-grandchildren.

OXFORD MEDICINE . JANUARY 2017 / 11

Before his departure for Oxford Osler finished the revision for the 6th edition of his textbook, and on 19th May 1905 they sailed from New York on ‘The Cedric', arriving in Oxford on Saturday evening of May 27th where they took up rented lodgings in 7 Norham Gardens, fully furnished and owned by Mrs Muller. Her husband, Professor Max Muller, was a Sanskrit specialist and one of the founders of the western academic field of Indian studies and comparative religion who had died five years previously. Osler was totally exhausted, and it was six weeks before he felt himself again.

No transition could have been greater, from a noisy Baltimore and the hurly-burly of the preceding month to a quiet Oxford suburb where they were kept awake by the wood pigeons cooing on the chimney. From a sweltering Maryland to an English springtime, which that year was so cold that they promptly built a fire in the dining room that greatly shocked the warmly-dressed Oxonians who first dropped in on them.

Three of their early visitors were his recent colleagues from Baltimore, Welch, Halsted and Kelly, the founding fathers of Johns Hopkins Hospital. They all travelled to London to John Singer Sargent’s studio for the first sitting of the now famous portrait of the four of them. Sargent was an American artist who was considered to be the leading portrait painter of his generation, and he had settled in London. Welch had asked Sargent if he might wear his Yale robe and the painter acquiesced, but when Osler spoke of wearing his red Oxford robe Sargent refused, saying

"No, I can’t paint you in that: I know all about that red — they gave me a degree down there and I’ve got one of those robes. I’ve left it on the roof in the rain and I’ve buried it in the garden. It’s no use, the red is as red as ever, the stuff is too good, it won’t fade. Now if you can get a Dublin degree the red robes are made of different stuff and if you wash them they come down to a beautiful pink!"

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For many years Professor Terence Ryan has looked after the library at 13 Norham Gardens and recently Professor Max Blythe and I have had the pleasure of joining him. Although the library is primarily a celebration of Osler’s life and work it is also home to various other medical collections including Sir Richard Doll and his work linking lung cancer to smoking.

It also has the story of penicillin and the role of the Oxford Team in its production with one of the original ‘penicillin bedpans’ on display.

The doctors of today would do well to know more of Osler. In the current practice of medicine it is all too easy to look at computers, charts and scans and ignore the patient. Osler never forgot the patient and always said “it is more important to know about the patient who has the disease than the disease that has the patient”. Perhaps Osler had no greater accolade that his reputation among the clinical students who said that “if you wanted to see the chief at his best, watch him as he passes the bedside of some poor old soul with a chronic and hopeless malady as they always get his best”. All doctors would do well to remember that one day we too will be in the bed rather than standing at the end of it.

12 / OXFORD MEDICINE . JANUARY 2017

Florence Nightingale: a most remarkable life

Eric Sidebottom

Learning about the life of Florence Nightingale has been a great pleasure for me. She was undoubtedly the second most important woman of the Victorian era in Britain. Much has been written about her life. Lynn McDonald is the foremost authority and the editor of her 16 volume Collected Works and the source of much of what follows in this short article.

Although most people remember her essentially as the founder of the nursing profession-“the lady with the lamp” in the Crimean war, her impact was much wider and she was perhaps the most important social reformer of the 19th C. Part of the problem in coming to lasting conclusions about her is the sheer scale of the materials involved. Her papers are scattered through more than 200 archives around the world. The enormous collection at the British Library - the second largest personal archive after Gladstone's - is just the tip of the iceberg. At least 14,000 letters are known to survive, along with 147 printed publications, and hundreds of private notes and memoranda. The weight of material combined with Nightingale's long life – (few people realise that she lived almost nine years longer than Queen Victoria!)- make her a difficult person to pin down to a definite point of view. She remains, above all, a creature of paradox: a woman whose work and standing supported the idea of women's rights, but who disliked the women's suffrage movement, and found it almost impossible to cooperate with other women; She spent much of the decades after her return from the Crimea, confined to her bed as a chronic invalid (she is now thought to have

"Nightingale receiving the Wounded at Scutari", a portrait by Jerry Barrett

suffered from, Brucellosis, Relapsing Fever, a bacterial infection picked up in the short time (three weeks) she was actually in Crimea. Despite the recurrent bouts of fever she nevertheless worked with an almost demonic energy in the areas of reform she was interested in; She knew Queen Victoria personally and persuaded her to initiate two Royal Commissions, the first on the medical services of the armed forces (which had been abysmal in the Crimean war), the second on the administration of Britain’s colonial interests in India. Another paradox about her was that although she was a woman who claimed to dislike the celebrity about her name, she nevertheless manipulated her fame to masterly effect for her own ends.

But let us first consider Florence’s origins and the influences which shaped her. Her parents were wealthy and very well connected. Her father, the son of a banker, changed his surname from Shore to Nightingale so that he could inherit a large fortune and estates from ‘mad Uncle Peter’, who had made the fortune in mining lead. Her mother, Frances Smith, was a society lady with 4 sisters and 5 brothers. Florence’s maternal grandfather was an MP for almost 50 years.

She was the second child, named after the city in which she was born. Her elder sister, Parthenope was born in Naples, both during grand European tours undertaken by the family. When not travelling the family had a summer home, Lea-Hurst, near Matlock in Derbyshire; a winter home, Embley Park, in Hampshire but the ‘Season’ was often spent in London.

Florence and her sister were taught by private governesses but an interesting extract from her childhood diary reveals much about her early years.

OXFORD MEDICINE . JANUARY 2017 / 13

I had a sickly childhood, the climate of England did not suit me, after that of Italy (Florence) where I was born. I could never like the play of other children. But the happiest time of my life was during a year's illness, which I had when I was 6 years old. I never learnt to write till I was 11 or 12, owing to a weakness in my hands. And I was shy to misery. At 7 years of age we had a governess, who brought me up most severely. She was just and well intentioned, but she did not understand children and she used to shut me up for 6 weeks at a time.

My sister, on the contrary, she spoilt.

When I was 10, my mother would have no more governesses and my father took us himself in hand. He taught me Latin and Greek and Mathematics and whatever he knew himself. I had the most enormous desire of acquiring. For 7 years of my life I thought of little else but cultivating my intellect.

I am intrigued by her comment about not being able to write until she was 11 or 12. I have a private theory that the weakness in her hands might have been caused by a peripheral neuritis due to heavy metal poisoning by lead or mercury. Remember, the family wealth arose from lead mining and not only was there a lead mine close to Lea-Hurst, their home in Derbyshire but there was also a hat factory nearby. Such factories were renowned for their use of mercury. Could one of these have been the origin of “Mad” Uncle Peter’s nickname?

It is clear that her father, a graduate of Trinity College, Cambridge, inspired her with his teaching, especially of mathematics. It is no coincidence that Florence’s masterly use of statistics, following her collection of data about battle injuries, acquired infections, and deaths during the Crimean war became famous and celebrated, leading to her election as the first female member of the Statistical Society in 1858.

A turning point in her life occurred on Feb 5th 1837 when she was 16.

According to her records it was on that day that she received a call from God to his service. But it was not clear to Florence just what the nature of that service should be. It took her until 1845 to decide that the call was for ‘nursing’ and she tried to persuade her parents to let her go to Salisbury to train. They refused since, at that time, nursing was not considered a profession at all, certainly not for young ladies of fine breeding! Eventually her persistence was rewarded. She travelled around Europe with Charles & Selina Bracegirdle who had rescued her from despair and during that time she spent 3 months at Kaiserwerth am Rhein where her interest in nursing was rekindled. She also met Sidney and Mary Herbert who became of key importance in her life. He was a leading member of the government and in Aug 1853 he invited her to take charge of “The establishment for Gentlewomen during illness“ in Harley St. She accepted this invitation and then in Oct 1854 Herbert officially invited her to lead a party of 38 nurses to Crimea.

They arrived in Scutari on 5th November 1854, the day the Battle of Inkermann was fought in the Crimea. Wounded soldiers were still arriving in Scutari from the previous battle of Balaclava which had been fought on October 25th. Conditions in the so-called hospital were dreadful. Moreover it was 500 kms from the battlefields in Crimea and the crossing of the Black Sea was slow and hazardous for injured soldiers. Scutari was actually a military barracks built over an open sewer. The bacteria responsible for cholera and dysentery were often present on the wet floor. It was probably more dangerous in the ‘hospital’ than on the battlefields. The ‘hospital’ was atrociously underequipped with medical supplies, bedding and food. Fortunately Nightingale had used some of the £9,000 raised for her by readers of The Times to acquire such supplies that she had anticipated might be needed. Nightingale was so appalled by the conditions and particularly by the fact that Dr John Hall, the senior medical officer, and the senior

administrators in the War Office knew about the problems but had done nothing to solve or alleviate them, that she recorded all the shortcomings and these eventually were reported in her 840 page published report presented to the Secretary of State for War in 1858, (by which time a Royal Commission had been established).

The fighting in Crimea stopped when the Russians essentially surrendered and evacuated Sevastapol on Sept 11th 1855 but injured and sick soldiers continued to be transported to Scutari. Indeed when Nightingale realised how inadequate the medical provision for treating injured soldiers was, she had appealed to the Government, via the Times, for a solution to the dreadful conditions at Scutari and they had commissioned Isambard Kingdom Brunel to design a prefabricated Hospital. This had been designed, built, transported and erected by Oct 1865 and had treated 1300 patients when it closed in July1866. 50 patients died here, a death rate one tenth of that in Scutari!

Nightingale finally left Scutari in July 1856 and arrived home in Derbyshire in August. During September she visited Queen Victoria in Balmoral and the Royal Commission into the Medical Services supporting the War office had been agreed.

It is arguable that the British Army owes far more to Nightingale than nursing in this country does. True, as the standard-bearer of nursing, she played a decisive role in transforming nursing into a profession for single women of impeccable moral standards; but her actual strictures on hospital care were part of a much broader attempt to formulate a policy on public health through the adoption of better sanitation. Her famous little book on nursing, “Notes on Nursing” was published in 1859 and The School of Nursing at St Thomas’s Hospital was established the following year. It is another of the very surprising things about Florence’s life that it is thought that she only visited St Thomas’s hospital once in her life! In the introduction to her book she explains - “I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient”.

Her sister Parthenope, with whom Florence had a difficult and ambivalent relationship over many years, once wrote that Florence was 'a shocking nurse'. She 'has little or none of what is called charity or philanthropy, she is ambitious - very, and would like... to regenerate the world... I wish she could be brought to see that it is the intellectual part that interests her, not the manual.'

We should remember that when Nightingale left Crimea she was just 36; when she founded her School of Nursing at St Thomas’s Hospital she was 40. Most of her life was still in front of her. And I believe that it was during this later part of her life, when she was often bed-bound, and house-bound most of the time, that she achieved her greatest successes; persuading those in power to improve the lives of the sick, the poor and the disadvantaged.

A good example of the realization of her vision began in 1865, in the Liverpool Workhouse Infirmary, with the appointment of 8 nurses and a superintendent, Agnes Jones, who had trained at the Nightingale School at St Thomas’ Hospital. It was funded by Christian philanthropist William Rathbone. This was a major step in transforming workhouse infirmaries into real hospitals.

Indeed in conclusion I would go so far as to say that Florence Nightingale was one of the originators of ‘evidence based medicine’ and if her visions could have been fully realised we would have had a National Health Service many decades before 1948!

14 / OXFORD MEDICINE . JANUARY 2017

2016 Oxford Medical School prize winners: THE CLINICAL SCHOOL YEAR 4 GENERAL PRACTICE ESSAY PRIZE Awarded to: •Zain Abbas Syed, Christ Church College • Grace Barnes, Somerville College Runners up: •Ronan Llyr, Green Templeton College • Sarah Richardson, Corpus Christi College • Aaron Hundle, New College PETER TIZARD PRIZE IN PAEDIATRICS 2015/16 For best performance in Year 5 Paediatrics •Claire Peet, Magdalen College • Proxime accessit - Yi Yi Chua, Green Templeton College ROGER BANNISTER PRIZE IN NEUROLOGY 2016 For outstanding performance in the Year 5 Neurology •Harsh Samarendra, Green Templeton College • Proxime accessit - Thomas Aquilina, Balliol College MEAKINS MCCLARAN MEDAL 2016 Prize awarded for the outstanding overall performance of a student graduating with the degrees of BM, BCh (Oxon).

• Nicholas Black, Merton College BRIAN JOHNSON ESSAY IN PATHOLOGY PRIZE 2016 •First Prize: Amine Awad, St Anne’s College.

• Second Prize: Craig Mounsey, Magdalen College.

GEOFFREY HILL SPRAY PRIZE IN CLINICAL BIOCHEMISTRY 2016 • Phillip Oddie, Green Templeton College.

R.B. DUTHIE PRIZE IN ORTHOPAEDIC SURGERY 2015/16 AND 2014/15 For best performance in Year 5 Orthopaedics: Joint winners 2015/16: • Jawaad Farrukh, Green Templeton College • Jennifer Southern, Green Templeton College Winner 2014/15: • James Kimpton, Green Templeton College

SIR JOHN STALLWORTHY PRIZE 2015/16 For Best Clinical Performance, Year 5 Obstetrics & Gynaecology • Henry Hughes, Magdalen College MATILDA TAMBYRAJA PRIZE 2015/16 For Best Written Performance, Year 5 Obstetrics & Gynaecology • Jamie Arberry, Green Templeton College CARDIOLOGY ESSAY PRIZE 2016 • Brett Kennedy, Worcester College JOHN POTTER ESSAY PRIZE 2016 For an essay on a clinical neurosurgical, neurological or neuropathological topic • Emeka Okonji, Brasenose College UNIVERSITY OF IOWA EXCHANGE SCHOLARSHIP FOR 2017 •Katherine Birse, Lincoln College • Gabriel Trueblood, St Peter’s College MARTIN WRONKER PRIZE FOR PRELIMINARY EXAMINATION IN MEDICINE •Part I: William Sargent, Somerville • Part II: George Wallis, Keble OSCE PRIZE FOR PRELIMINARY EXAMINATION IN MEDICINE •Part I: William Pettersson-Yeo, Magdalen • Part II: Eleanor Grant, Somerville HOBSON MANN LOVEL SCHOLARSHIPS •Jamie Arberry, Green Templeton • Dominic Ballard, Green Templeton • Harriet Brown, Green Templeton • Bethany Kingston, Corpus Christi • Emily McFiggans, Green Templeton • Claire Peet, Magdalen • Mila Roode, Keble • Yi Yi Chua, Green Templeton

With sadness…

Ranald Phi lip Clay t on Handf ie ld -Jone s, Retired general practitioner Haddenham, Buckinghamshire b 1923; matric. New College 1941, q 1946, d 14 October 2016 Edw ard Walte r Le slie Fle t che r (Wat t ie ) Consultant radiologist Oxford, b 1934; q Emmanuel College, Cambridge/St Thomas’ Hospital, London; MRCS Eng, MA Camb, MB, DMRD Eng, FRCR, d.

17 September 2016 from aortic valve disease, atrial fibrillation, and Parkinson’s disease.

Me rcy He at le y, consultant psychiatrist —b. 1921, m. Somerville 1939, q 1947, d. 5th September 2016 aged 94 Je f fe r y Adr ian Pr ie stl y Marsto n, vascular surgeon, b 1927; q 1951, died 7th April 2016. Pioneering vascular surgeon and prolific writer.

Rosalind M ask e ll, microbiologist, b. 1928, m. Somerville 1947, q.

1953, d. 7th September 2016 aged 88

Willi am Pi ct on, b.1909, m. Merton 1927 d. 9th September 2016 aged 107.

Bhe e shm a Rajagap olan, General Physician, b. 1942, m. Balliol 1961, q. 1968, d. 26 August 2016 aged 74.

Anthony Ry l e, matric. University College 1945, q 1949; DObst RCOG, DM Oxf, FRCPsych, d 29 September 2016.

Jose ph Col in S m it h, Consultant Urologist, b. 2nd September 1931, q London 1954, d. October 2016 aged 85.

M ichae l S w e e t-Escot t , General practitioner and general practitioner trainer Skipton b. 1922; m. Christ Church 1948, q 1951, d. 4 August 2016.

Phi lip R Wal ke r, m. Brasenose 1942, d. October 2016 Ge o f f re y Donald Wil so n, General practitioner, b. 1919; m.

Pembroke 1946, q 1952, d 15 December 2013. One of the first people to be anaesthetised by the “Oxford vaporiser,” invented at the Radcliffe Infirmary in Oxford by Robert Mackintosh.

OXFORD MEDICINE . JANUARY 2017 / 15

EVENTS & REUNIONS IN 2017 2017 WEATHERALL LECTURE 1ST APRIL 2017

The 2017 Weatherall Lecture will be given by Professor Tom Solomon Prof Tom Solomon BA BM BCh MRCP DCH DTMH PhD FRCP, is Director of the Institute of Infection and Global Health; Head of the Brain Infections Group; Professor of Neurological Science; Honorary Consultant Neurologist, Walton Centre NHS Foundation Trust and Royal Liverpool University Hospital.

Tom studied medicine at Wadham College, before undertaking a PhD on central nervous system infections in Vietnam, with a Wellcome Trust Advanced Training Fellowship. He then became a Clinical Lecturer in Neurology, Medical Microbiology and Tropical Medicine at the University of Liverpool, and was awarded a Wellcome Trust Career Development Fellowship. This included two years as a visiting scientist at the University of Texas Medical Branch, Galveston, Texas. Tom was made a Senior Lecturer in Neurology in Liverpool in 2005, and awarded a Medical Research Council Senior Clinical Fellowship the same year, becoming Chair of Neurological Science in 2007, and Head of the newly formed Institute of Infection and Global Health in 2010.

Professor Solomon is head the Brain Infections Group, which, with more than £9 million in funding in recent years, and works to reduce the burden of neurological disease in the UK and globally.

JUNE 2017 — REUNION FOR THOSE QUALIFYING IN 2007

The 10th anniversary reunion for all who attended Oxford Clinical Medical School from 2004, qualifying BM BCh in 2007 — join us for a special reunion marking 10 years since you became a doctor. (This reunion includes those starting the Graduate Entry Course in 2003.)

Your guests, including children, are most welcome. We would be delighted if you could join us from midday on Saturday 10 June 2017 at Osler House. A buffet lunch will be served from approximately 1pm and afternoon tea will follow from 3.00pm. Tickets will be available from March 2017.

Children under 12 are free — there will be child friendly activities, and face painting.

MARCH 2017 — REUNION FOR THOSE QUALIFYING IN 1997

To mark the 20th anniversary of your qualification as a doctor in 1997, the Dean of the Oxford Medical School and the Officers of Oxford Medical Alumni invite you to a special reunion on Saturday 25th March 2017.

The reunion will take place at the newly refurbished, and very lovely, Osler House. This will be an informal occasion and there will be lots of time to chat and reminisce, supported by good food and wine, a speech or two and a toast. The Osler bar will be open until very late with music to dance to from the years when you were students.

BOOKING IS OPEN w ww.medsci.ox.ac.uk/get-inv olv ed/alumni/events-reunions and follow the link

SEPTEMBER 2017 — REUNION FOR THOSE QUALIFYING IN 1987

The 30th anniversary reunion for those qualifying in 1987 will take place on Saturday 14 October 2017 at St Hugh's College. More information will be available soon.

2017 — REUNION FOR THOSE QUALIFYING IN 1977

The 40th anniversary reunion for those qualifying in 1977 will take place on Saturday 28 October 2017 at Green Templeton College. More information will be available soon.

SEPTEMBER 2017 — REUNION FOR THOSE QUALIFYING IN 1967

The 50th anniversary reunion for those qualifying in 1967 will take place on Saturday 14 October 2017 at Green Templeton College. This 50th Anniversary Reunion is for those who started their clinical courses in: October of 1964, March or October of 1965, and March or October of 1966.More information will be available soon.

16 / OXFORD MEDICINE . JANUARY 2017

EVENTS & REUNIONS IN 2018 Contacting OMA

Oxford Medical Alumni, University of Oxford, Dept of Physiology, Anatomy and Genetics, Le Gros Clark Building, South Parks Road, Oxford OX1 3QS +44 (0)1865 282346 oma@medsci.ox.ac.uk

Front cover pictures, clockwise from top: by Ginny AE Matthews; by Rob Judges; Rob Judges; Rob Judges; Photo by Alex Kamweru; Photo by John Cairns Photography

REUNION FOR THOSE QUALIFYING IN 2008

The 10th anniversary reunion for those qualifying in 2008 will take place in June 2018.

REUNION FOR THOSE QUALIFYING IN 1998

The 20th anniversary reunion for those qualifying in 1998 will take place in March 2018.

REUNION FOR THOSE QUALIFYING IN 1988

The 30th anniversary reunion for those qualifying in 1988 will take place in October 2018

REUNION FOR THOSE QUALIFYING IN 1978

The 40th anniversary reunion for those qualifying in 1978. More information will be available soon.

REUNION FOR THOSE QUALIFYING IN 1968

The 50th anniversary reunion for those qualifying in 1968. More information will be available soon.

Please note that information and opinions expressed in this publication are those of the contributors, and do not necessarily represent those of the editorial team, OMA, the Medical Sciences Division or the University of Oxford, or of any of its constituent Colleges. Reference to specific commercial products or services should not be taken to imply endorsement or recommendation of such products or services by the University of Oxford or of any of its constituent Colleges. The University of Oxford and its constituent Colleges assumes no legal liability or responsibility for the accuracy, completeness, or usefulness of any information presented.

Oxford Medicine is produced by the Medical Informatics Unit, NDCLS, University of Oxford. Telephone +44 (0)1865 222746.

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