Personal views of the NHS--warts and all.

Abstract

training experience than her general house jobs. When the midwives got into trouble she set off on her bicycle with emergency bag and lamp-many of the houses had no electricity-and applied the forceps or whatever was necessary. Both of them commonly had to act as anaesthetist and obstetrician in a routine that sounds deceptively simple. Don two pairs of gloves, go to the head end and give a light chloroform anaesthetic, rush to the other to do a forceps delivery. Most breeches were delivered vaginally in those days. Innovations preceded the NHS In Oxford we were in a unique position though, for in 1938, £2m was given to create the Nuffield department of obstetrics, together with the corresponding departments of medicine, surgery, and anaesthetics. Before taking up my post as first assistant to the new department I spent three months in Vienna studying under Professor Fraenkel. At this time, in marked contrast to England and America, colposcopy was a routine procedure in the teaching hospitals in Vienna, Leipzig, and Berlin, and indeed in much of Europe, and after the war we imported a colposcope and started a colposcopy service. Gradually we took over the gynaecology from the general surgeons and built up our department. We also took over responsibility for the maternity home and built up outpatient clinics in all the outlying hospitals in the Oxford region, with a back up consultancy service for general practitioner obstetricians working in cottage hospitals as well. I was on call all the time, and it was rare to have an unbroken night. But such was the spirit in the hospital that no one resented the hours they put in. One of the innovations with the most impact was the weekly departmental meetings we started to discuss difficult cases and clinical, research, and training policies. Registrars from as far afield as London, Bristol, and Birmingham came for, amazingly enough, at this time such meetings were actively discouraged because they were "not conducive to good departmental discipline." We also, in 1938 on the advice of Professor Chassar Moir, set up a flying squad for it was not uncommon for women with serious obstetric complications to be dead on arrival by the time the ambulance had reached hospital from villages 30-40 miles away.