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General PractitionerBorn in Manchester in 1922.
Overview: : Dr. Joe Needoff was a GP in an old-established Black Country practice from 1951 to 1989. He had a few, mainly elderly, patients with diabetes, but issued very few prescriptions for insulin and never saw a young person with diabetes. At first he had no nurse to help him, so did urine tests himself and, when he needed a chaperone, he called on his wife or another patient. The waiting-room was often crowded, as there was no appointment system. He saw no increase in diabetes throughout his career and had no diabetic clinic: ‘there was no necessity for it.`
There is also an interview with another Black Country GP, from one generation later, Dr. Richard Gee.
for starters: I was brought up in
which is now part of Greater Manchester. My parents: my father was a lady‘s tailor, and owned, eventually, a
factory producing ladies garments, but also started a chain of retail shops,
and, in the end, had six or seven shops scattered around
Manchester. I went to the local council school -
elementary school, as it was called then - starting in the infants, at the age
of five, and going on to senior elementary school from the age of nine till… no,
from the age of
Tell me about
your medical training.
training, at that time, was six years, starting in 1940 to 1946. It was divided into a pre-clinical course,
for the first two and a half to three years - lectures only, we never saw a
patient - and at the end of three years, then we started clinical
training. It was meant to be half
clinical training in the afternoons or in the morning, and alternatively in the
morning or in the afternoon, when we weren‘t doing clinical training, we were
(2) Clinical training was divided into the
various subjects we had to undergo We
spent some months doing medical training, some months doing surgical training,
some months doing midwifery training. And,
at that time, midwifery training was very unusual, and rather hazardous at
times, because you had to go out on what we called the district; in other words,
we had to attend confinements at home. Now, our training school, at that time - and during the whole of the
course - was Manchester Royal Infirmary, a very well-known and very respected
hospital; the main hospital, the main teaching... well, the only teaching
Manchester. Going on the district meant that we had to
have a bicycle. We had to attend
patients who lived in the slums of Hulme, which is a desperately poor part of
Manchester - poverty was
extreme - and, at that time, we also had the odd air raid to consider, so it
was quite exciting, at times. Nevertheless, we all managed. The
main subject of our clinical training were ward rounds, which were led by the
local consultants. The consultants, at
that time, were called honoraries, and they were called honoraries because they
didn‘t… they weren‘t paid for their job; they weren‘t paid for the time they
attended and gave us ward rounds. The
wards, at that time, as I remember, were - if I might call them - Nightingale
wards; in other words, they were long wards with rows of beds on either
sides. The odd curtain divided one
patient from the other. There were
certainly no mixed wards; that would have been horrifying for sister or matron,
at that time. The idea was never even
contemplated, as far as I can remember. Hospital infection: well, if there was a case of a hospital infection in
a patient, he was isolated. Sometimes, I
remember, the whole ward might well have been closed, to combat the
infection. Certainly, as far as I
remember, we‘d never heard of MRSA, or any of the other horrible bugs that seem
to be about at the moment. Any case of
hospital infection was dealt with there and then, and strictly.
(3) Can I just clarify the question of these
consultants not being paid?
consultants had thriving - for the main part - had thriving private
practices. They gave their expertise to
the hospitals, I think, without payment. I‘m not absolutely certain, but that‘s why they were called honoraries,
so I presume they weren‘t getting payment. Hospitals, at that time, were not funded by the National Health, because
the National Health Service didn‘t come until later. They were funded by voluntary
contributions. We, as students, once a
year, used to have a rag day, in which we collected money from the population,
as far as we had a procession, and we all wielded our money boxes, shaking them
vigorously, and attracted contributions from various patients. But I don‘t know how the hospitals managed,
but they did. We never had a shortage of
bandages, or… We made do with bandages,
sometimes; we had to… and I sometimes saw the nurses washing and scrubbing
bandages, so that they could be used again. And I must say that the hospital was kept very, very... the standard of
hygiene, in the hospital, was very good. Nurses, if you went into the sluice room, where the... I never saw dirty
bed pans. They were always kept
spotlessly clean by the nurses, or whoever. I hear horrible stories, at the moment, of the desperate facilities, and
the desperate way in which sluice rooms are kept now, and the way toilets are
dirty, and not kept tidy and not kept clean. And this amazes me and distresses me, because it shouldn‘t happen.
training, what did you learn about diabetes?
Not very much. We learned the basics, but nothing in very
great detail. I think we had an honorary
physician who specialises in the treatment of diabetes, as he mainly
concentrated on adults and old age. I
can‘t remember ever seeing a child with diabetes in my whole medical
training. If I can explain, diabetes was
mentioned perhaps one or two lectures at the most, but the main part of our
medical training were the main things: medicine, surgery, orthopaedics,
midwifery, bacteriology, pharmacology, and I think that sums it up.
Can you remember
what impression you gained of diabetes from your training?
impressions of diabetes is that it was a disease mainly of the elderly. I‘m trying to remember, but I think in the
British Medical Journal, some time in the mid forties, there was a large
article classifying diabetes into Type 1 and Type 2. I‘m not absolutely certain about that, but I
seem to think there might well have been this article, and that was the
beginning of the division between treating children with diabetes... recognises
children have diabetes as well as older people.
So, that came… that
recognition perhaps came while you were training?
Yes, it came in
the mid forties. There was this large
article in the British Medical Journal, as far as I remember.
(4) What did you do after you completed your
I did six months
as a house surgeon to the Professor of Surgery at Manchester Royal Infirmary,
and then did my two years National Service. I didn‘t encounter any patients, then, with diabetes. They were mostly fit, young men.
What did you do
And then, after
National Service, I took a locum in a place called
no doubt you‘ve heard of
Blackpool. I stayed there for three months, enjoyed it
very much. It was a very small practice,
run by an elderly doctor who‘d had a heart attack, and he was off work, at that
time, for three months. Six weeks in
bed, and then gradual convalescence; quite different to the treatment of heart
attacks, I may say, at this time. I then
took a locum, for eighteen months, in
and helped out a GP there who‘d taken over from his father. And it was an old, established practice, next
to a cotton mill. And I still, to this
day, wake up in the morning, and still hear the clatter of clogs as the workers
made their way to the cotton mill. At
that time, there was a fair amount of dust at the cotton mills, as you may
imagine, which led to a lot of respiratory diseases, which have only, in the
last twenty or thirty years, been recognised as life-threatening.
encounter any diabetes as a locum?
As a locum, no. No, I can‘t remember. After my eighteen months in
I kept applying for GP practices as an assistant, in various parts of the
country. I went to a mining district in
Yorkshire, and I went to another one, in various other
places, one in
Preston. And eventually landed up down here in the
Black Country, and was offered a position as an
assistant, leading to partnership in six months, if things turned out to be all
right. I joined a very old established
practice, started by a Dr Baker, in about 1896. He retired, I think, at the beginning of the Great War, about 1914. And then a Dr Rigby came to the practice, and
he stayed till about 1920 or ‘21. He was
not a very well man, I understand - I am told. And then, when he retired, or died - I don‘t know which - he was... the
practice was then taken over by Dr Millington. And Dr Millington stayed from 1920 or ‘21 till 195... he was there till
‘57, ‘58. I joined him in ‘51, as an assistant,
for six months. We had a very amicable
arrangement between us. I took to him,
he took to me. He was, at that time,
about sixty, or late fifties, and he stayed till he was sixty seven or so, and
then he retired and went to live down south.
(5) Can you describe the practice to me, when you
arrived in 1951?
I arrived in
March 1951, and became an assistant. The
way I got the practice was rather strange, because it so happened that when I
was telling Dr Millington - with whom I joined - my previous experience, and
that I‘d just finished National Service, I mentioned where I was in National
Service. And it so happened that I had a
friend or a colleague or an acquaintance, who was also in the same unit as I was
in National Service, and he happened to be the son of Dr Millington‘s
wife. And so, I was offered the post, not
because of my medical qualifications, because I knew his son-in-law! I stayed, and started in the practice, which
then had a total of nearly five thousand patients. And stayed with Dr
Millington, and we worked the practice up,
between us, and in the end we had about six thousand two hundred, or six
thousand three hundred patients between the two of us. We managed our surgeries without an
appointment system. Patients queued, patients
had to wait. They didn‘t mind waiting,
because they knew that if they wanted to see the doctor, they could see the
doctor the same morning or the same evening, and there was no problem, except
they would have to wait in the waiting room. We had Saturday morning surgeries, and, when I started, we also had
Saturday afternoon surgeries, but we decided to scrap those, because we saw
very few patients in Saturday afternoons. Saturday morning surgeries were quite crowded. We did alternate nights on duty, and we were
often called out in the middle of the night, say once, sometimes twice a week,
sometimes more than once a night. The
most famous time was in a snow storm, when I was called out no less than three
times in one night, and also had a puncture the same evening! But we had to start work at the same time in
the morning. We didn‘t have a morning
off, we just battled through; somehow, we managed. I know the standard of medical expertise, at
that time, was not as strict, or was not as... the standard of drugs, then, was not as well provided, as we have
now. For example, when we treated blood
pressure, we didn‘t have the amount of drugs we have now. We didn‘t have the beta-blockers, and the
like. All we had was a mixture of what
we called red medicine, which was a mixture of potassium bromide and valerian (rarely), or potassium bromide and strychnine (in fact, potassium bromide and nux.vom.),
which we handed out for the treatment of blood pressure, and also we used Phenobarbitone,
which was a long-standing drug. Certainly we didn‘t have, as I say, any of these beta-blockers, and the
like, that we have now, where we can treat patients with blood pressure quite
(6) You mentioned being called out in the middle
of the night. Can you talk about how
much visiting you did?
We did a lot of
visits, in those days. Between us, we
did... let me think now... in the winter, especially when there was a ‘flu
epidemic, but even in a normal winter, between us we would do twenty or thirty
visits. I remember one day - and my wife
can corroborate this - the telephone rang, and we had sixty visits.
In one day?
In one day. That has just happened once. But thirty or forty in the winter, when we
were very busy, nothing unusual.
Were you ever
called out for a diabetic hypo or coma?
No, I don‘t
think we were. My experience of diabetes,
in general practice, was mainly to deal with the elderly. We had one or two elderly patients who used
to come up with their specimens of urine once every two weeks, or once every
month. And we used to test the urine the
old-fashioned method, by boiling the specimen up with reagents, and watch the
Can you remember
what the reagent was?
I think it was
either Benedict‘s or Fowler‘s; I‘m not sure.
Can you describe
the process, as you remember it?
Yes. We‘d take a sample of urine; not a... we were
told not to take a morning specimen. That
seemed to be the... we were told to take a specimen one hour after their main
meal. Bring it to the surgery. Then we had a test-tube, and we poured a
little into a test-tube, add the reagent to it, boil the mixture up in this
test-tube - on a little gas flame, which we had in the surgery - and watched
the colour change. If it remained green
or so, okay. If it remained, and went to
orange or deep orange, then we knew we had a bit of a problem, and we had to
perhaps raise their insulin a little bit, or tell them to... "what have
you been eating these days? Well, stop
This is you
doing the testing yourself?
We did the testing
ourselves. We didn‘t, at that time, have
a nurse. There was a district nurse,
which dealt with our patients, as well as other doctors‘ practices‘ patients,
but we didn‘t have a full-time nurse, or even a part-time nurse, until fairly
well on. After Dr Millington retired, I
then took a partner, who came from
- an Irish chap - who
stayed with me for thirty years or so. And, in our first years, we decided we should have a) a part-time
secretary - never had one before - and b) a part-time nurse. This we did, and they were a great help.
(7) So, tell me about your memories of patients
We had very few
patients with diabetes, and, as I say, mainly elderly. Some were on oral hypoglycaemics, and some
were on insulin. And there was a Mr Meredith
- I remember his name, now - he was one of the first people in
given this new treatment of insulin, introduced by Banting and Best, I
think. And that was interesting, as far
as I remember.
What sort of
state was he in? This would be...
He was a very
good... he was very well. He was very
well-stabilised. An old
Black Country person, lots of
Country stories, and no problem.
patients did you have with diabetes?
Had an old lady,
who always used to come up with her little bottle, and it was invariably showed
a rather dark orange or red colour when I boiled it up. But she managed for years and years and
years. Eventually she must have passed
away at a very advanced age, but the diabetes didn‘t seem to bother her.
What did you
recommend to your patients with diabetes?
have a diet, they cut out sugars. I
managed to scrounge a few diabetic slips from the local hospital, and gave them
out to them, and told them to lead as normal a life as possible. And they accepted this quite well.
Any memories of
younger people with diabetes?
As far as I
remember, no. I never saw a young person
with diabetes during the whole of my time as a GP. Diabetes, at that time... we didn‘t have a
special diabetic clinic. We didn‘t need one,
given so the number of patients. But
diabetes, that was treated mainly in the hospitals.
Can you remember
what contact you‘d have had with the hospitals about the patients‘ diabetes?
no. No, we didn‘t have any contact with
them. They just went to the hospital,
and were kept under hospital supervision during most of their time. They came to us for replenishment of their
drugs, but that was all. And we saw very
few. I can‘t remember issuing more than
half a dozen prescriptions for insulin, at that time.
oral tablets. Would you have had those
right from the beginning, in 1951?
We didn‘t have oral
tablets right from 1951, those came in later. 1951, the main treatment - the only treatment - was diet and
insulin. I never saw any big increase… I
never saw any increase, as far as I remember, in diabetes during the whole of
my general practice, from 1951 to 1989. We certainly didn‘t have a diabetic clinic, because we simply didn‘t
need one; there was no necessity for it.
(8) It would be interesting to know what kinds of
people you were seeing, and what their lifestyle was.
In the first
years of my general practice in the
in a place called Coseley, which was a little area of... it‘s a little urban
district council, taken over, in latter days, by Dudley, and part of it by
Wolverhampton, and part of it by Sandwell - the Tipton part, that is. In my early days, the main...
people, lots of them were miners, and lots of them worked in the metal
refineries (in fact, metal foundries). We called them metal bashers - they worked in
the strip mills. Some of them worked in
the chemical factories roundabouts, and their wives, also, when they looked
after their young families, then they went out to work and did part-time work,
some of them. Some of them stayed at
home. Most of them never went far from
Coseley, which was perhaps twelve or thirteen miles from
Birmingham, but they went to
Wolverhampton, mostly, because that was nearer. But a trip to
Birmingham was a trip to foreign parts, as
far as I remember - in the early days - in the 1950s.
Do you know what
sort of diet they had?
mostly, was a lot of carbohydrates, a lot of potatoes. Meat, yes, they had… some of them... the odd
one kept pigs in the back garden. They
always had a mixed diet, as far as I remember. I never saw any case of malnutrition, never ever.
(9) So, if they weren‘t getting diabetes, what
were they getting?
When I first
started, we had - most unusual for me, because I‘d never seen it before - we
had diphtheria. We had six or seven
cases a year, for the first three or four years, of diphtheria. And my partner always used to tell me, when
he went into a room, he knew a patient was suffering from diphtheria before he
even looked down their throat, because he could smell it, which was very
strange, very interesting. Diphtheria
went out after about four or five years. We had a very good local isolation hospital called Moxley, which used to
take them in without any qualms whatsoever, and treated them, and they all got
better. I‘d never seen a case of
diphtheria before that, ever. I
certainly saw about twenty or thirty in my time. If you speak to a general practitioner now,
he wouldn‘t know what you were talking about, he would never have encountered
diphtheria, because it‘s all gone, it‘s all passed away, it‘s all been
treated. Scarlet fever, yes, saw a lot
of scarlet fever as well. And those we
shipped over to the isolation hospital in Moxley, again, with no problem. German measles, yes, we saw a lot of German
measles, which we treated at home, because, at that time, it was a very mild
disease - still is, of course. Sometimes
it was difficult to diagnose German measles from scarlet fever (intended to say measles), but it posed
no problem, really. German measles… Measles itself, yes, we saw an awful lot of
measles. Of course, in that time, we had
to - well, we still do, of course - have to notify them, on a special form, to
the local medical officer of health. As
soon as we saw a case of infectious disease, such as diphtheria, scarlet fever
or measles, we had to write down on a special form, and send it off to the
local medical officer for statistical purposes. Chicken-pox, yes, we saw a fair amount of chicken-pox in children, with
no complications. As far as
complications from the other three, which I mentioned, I don‘t think I saw
one. I perhaps saw one with middle ear
disease after measles, but that‘s about all. Certainly never saw any with ocular complications or other complications
after measles. Miners, yes, we had a
fair amount of miners working in a large coal-pit at Baggeridge - Baggeridge
colliery - which is situated in a place called Sedgley, and which had a very
long tunnel, reaching from Sedgley to - underneath the ground - to
Wolverhampton, which was a distance of about four miles. Miners, then, suffered from bronchitis, after
various years in the mines, but they battled through. They were the salt of the earth, and they
managed it quite well.
The miners did
eventually not only suffer from bronchitis, but suffered from lung disease as
well, for which, now… for which, then, they got a pension. Not very much, but still, it helped out.
from the other occupations?
went to see… I did also a job - I didn‘t
mention this - but I did a job as factory doctor, which meant visiting the
factories - the local factories - within an area of about three or four
miles. And this is where I got my
knowledge of the local factories, and how the works was carried out, and the
conditions under which people worked. I
went to one factory which was... went to two factories which involved using
lead. And the work people there had to be
examined, once every month, to see whether they had traces of lead
poisoning. It was a very rough and ready
examination. We looked at their teeth,
to see whether they had what we called a blue line between their teeth and
their gums, which was an indication that they were suffering from lead
poisoning. And, of course, if this was
the case, we shipped them off to hospital. We took blood tests every month to see what the level of lead in their blood
was, and this gave us some indication as well. I also visited a factory which was involved with the use of chrome. And the chrome workers, if they were
affected, developed an ulcer in their nose. So, every month, we had to visit these work people and have a look in
their nose to see whether there was any ulceration present, to give us some
idea of whether they had any problem with the use of chrome. And I also had to look at their hands, to see
if there was any ulcers on the back of their fingers, which was another
indication of chrome poisoning.
Were there quite
high incidences of lead poisoning and chrome poisoning?
Not at all,
no. It was quite uncommon to see any
incidence of lead or chrome poisoning. But nevertheless, it was there, and had to be treated.
(11) So, let‘s then return to the few patients you
had with diabetes. Can you remember what
you did to help them?
Yes. The few patients with diabetes, we treated
with, as I say, diet and insulin, and regular - three-weekly or monthly - urine
tests. Later on, in the 1950s, or was it
early sixties, we... there was the introduction of what we called the strip
tests. And these were a great boon to
us, because we could tell, at one glance, without having to boil the urine up,
whether there was any sugar present in the urine or not, by simply dipping a
little strip of paper into the specimen which they brought, and watch the
colour change on the strip. This was
very useful and very time... saved a lot of time. I don‘t think the patients themselves had
strip-test bottles, but we certainly did. The sucrose strips not only tested for sugar in the urine, but also
tested for albumin - that‘s protein - to give us a significance whether there
was any trouble with the kidneys or not. And also tested for blood, too. If I came across ketones on the strip, I would, of course, naturally
send them to hospital, because this was a very… indication of the severity of
Did you come
across any diabetic complications?
Very few. Occasional eye complications, yes. Complications with arteries, in fact, very
rarely. And gangrene, no; never came
across a case of gangrene due to diabetes.
Did you test
Not really, no;
never tested a person‘s eyes. Had a look
quickly to see if there was any evidence of cataract, but that was about
all. If a patient developed or
complained of eye problems, we used to refer them first either to the local
optician, or to the eye hospital for further evaluation of the condition.
(12) And for historical interest, could you
describe what the practice looked like?
Yes. The practice was an old Victorian villa. It was built in the mid eighteen
hundreds. It consisted of a living
quarter, and then, at the back, there was a servants‘ quarter, with a separate
entrance and a separate staircase. At
the back, also, was the waiting room and the doctor‘s surgery. Behind the waiting room, there was the
stables. And at the far end of the back
garden, as it were, there was another coach house, which consisted of a large
stable underneath, and, on top, a large room. This was in the early days, when I first joined the practice. And it had remained like that for some years,
I‘m sure. The doctor‘s room was a large
airy room, with a wash basin and a couch - an examination couch. And there was a very narrow off-room, in
which the dispensary was kept. This was
in the days pre-National Health Service, when the doctor used to dispense his
own medicine. He also had a dispenser
assistant, at that time, but I never met him or her. There were also a few bottles of ready-made
mixture, which were doled out to the odd private patient. But in our practice, after the introduction
of the National Health Service, we had very few private patients. Less than five, I remember.
By the time you
began, the National Health Service had been in existence for three years, from
1948. So, were the private patients
continued after that?
did. They were very loyal. I do remember some patients used to tell me,
in the distressed times of the mid 1920s, Dr Millington never sent out a bill
to any of his patients for twelve months, and he was revered for that.
How did he
I don‘t know; with
difficulty, I expect.
the couch in the doctor‘s room, but there was no nurse to provide chaperoning?
No, there was no
nurse to provide the chaperone, so when I had a lady patient who had to be
examined, I used to go out into the waiting room and ask someone to come in and
chaperone me (but this only happened
yes. Never had any problem.
(13) To see the patients with TB was very
distressing, because, in the early 1950s, there was no treatment, apart from
bed rest and fresh air. And they used to
linger and linger, and then die. Not
many; occasionally we used to manage to get them into the local sanatorium, but
that was always full, and it was always a long waiting list. It was distressing to me, sometimes, to see a
young girl lying there, dying of TB, and knowing there was nothing one can
do. And this young girl, I remember especially,
she was really... had a positive attitude. She knew how desperately poorly she was, but she was always cheerful to
the last. I also had patients… a young
patient of about thirteen or fourteen, I attended to, who had severe heart
problems. Nowadays, that would have been
a surgical problem. Then, of course,
there was no treatment, and she died. The mother took it all very well. But they‘re a bit distressing, really.
mentioned all the visiting you did. What
were their homes like?
Their homes were
usually, for the most part - of course, when the doctor was coming, everything
was changed - but, for the most part, well kept. Yes, except in the lower part of Coseley,
Village, where there was a lot of
back-to-back houses, and a common courtyard with one privy, or two
privies. And this was eventually cleared
away. I managed to get a seat on the
local town council, and did my little bit to help clear the slums away. But it was a problem.
(14) What improvements took place in your
practice, during the time you were there?
Millington retired, I took on a young doctor from
. And between us, we divided the large doctor‘s
consulting room into two, which eased the waiting time for patients. Eventually - after fifteen, sixteen or
seventeen years, I can‘t remember which - my wife got a little bit fed up of
the practice, being in the practice house, sometimes coming downstairs and
seeing the odd patient in the kitchen! And we eventually were evicted, and a small surgery was built around the
corner. This was state-of-the-art, at
that time. It had three consulting
rooms, nurse‘s room, and a nice waiting room. And eventually, after twenty years or so, a new - shall I say
state-of-the-art, again - practice building was built with aid from the
National Health funding. And this was
quite super, and cost an awful lot of money.
You say three
consulting rooms. Were there then three
There were then
three doctors, yes. The practice had
grown to six thousand five hundred patients, and, by the time I left, a third
doctor was appointed.
And can I
clarify: you said that by dividing your original room into two, that shortened
the waiting list, so what happened before that? Did two doctors work together in the same room, or?
Yes, with two
doctors, we used to alternate surgeries: morning, afternoon, evening.
And also, I
hadn‘t realised that you lived on top of the practice. Can you talk about how much your wife was
My wife was
involved an awful lot, by answering the telephone. And going out on social visits was also a
problem, because we always had to have a telephone at hand. And, not uncommonly, we used to decline
invitations, because we knew the practice was busy, we might be called
out. And this was a problem.
So, your wife
was perhaps a kind of an unpaid secretary?
Wife was unpaid
secretary, unpaid chaperone, when there were no female patients in the waiting
room, and unpaid adviser on the telephone. Doctor‘s wife - she must know something!
So now, after a
pause - and your wife has corroborated that she was unpaid secretary, chaperone
and so on - you wanted to correct something about your third partner.
I must correct
something about my third partner. We
took a third partner on much younger than I had indicated just recently. He was a young, newly qualified doctor - a
Black Country man, who came from
Bromwich - and he joined us in the mid sixties.
patients whose memories I‘ve recorded, there are several whose GP - local
doctor - failed to diagnose their childhood diabetes. Would you like to comment on that?
certainly. I had no occasion, as far as
I remember, to diagnose or even consider a child that was brought to me was
suffering from diabetes. If I had, I‘m
sure I could have remembered, but I can‘t.