Andrew Wilson’s An Essay on the Autumnal Dysentery, 1777 – October 2017

For many of us, autumn is synonymous with falling leaves, darker nights, and wrapping up in warmer clothes. It’s a time when the clocks go back, and we can enjoy the last of the sunny days before winter sets in. However, in the Eighteenth Century, autumn was also synonymous with something altogether less pleasant: ‘autumnal dysentery’.

Dysentery was common in Newcastle and wider Tyneside during the Eighteenth Century, but reached epidemic levels during the autumns of 1758 and 1759. There were also significant outbreaks in 1783 and 1785.

Andrew Wilson (1718-1792) was a Scottish physician and medical writer, who studied medicine at the University of Edinburgh and graduated in 1749. He set up a practice in Newcastle a short time after and stayed in the city until 1775 or 1776, when he moved to London.

Wilson was in Newcastle during the 1758 outbreak, and ‘the conceptions that I then formed of the nature and genius of the Autumnal Bloody Flux, and of the true indications of cure to be adhered to in it’ (pp.1-2), he put into his Essay. The Essay was first published in 1760. The second edition that we have in Special Collections was published in 1777. Considering Wilson’s Edinburgh connections, it is unsurprising that he dedicated the tract to Dr John Rutherford, Professor of Medicine at Edinburgh, ‘my respected Master, my Patron, and my Friend’.

Title page from ‘An Essay on the Autumnal Dysentery’ (Medical Collection, Med Coll 616.935 WIL)

Wilson went into considerable detail discussing the causes, symptoms, and treatment of patients with dysentery. He offered a fairly gory description of the symptoms, which may not be suitable for those of squeamish dispositions…:

‘This disease is called the Bloody Flux, because more or less blood is generally, tho’ not always, mixed with the slimy fetid stools which are discharged during the course of it. The bloody discharge may be attributed to different causes, according to the degree, malignancy and continuance of the disease; such as, the vehemence of the inflammation, stretching the vessels opening into the cavity of the intestines, and straining red blood thro’ them, which does not naturally pass that length undissolved; the acrimony of the humours which are discharged into these guts during the inflammation, fretting and corroding the blood vessels…’ (pp2.3)

Page 2 from ‘An Essay on the Autumnal Dysentery’ describing the symptoms of the disease

Page 4 from ‘An Essay on the Autumnal Dysentry’ describing the time of year that dysentery spread

Wilson also mentioned how ‘This disease, like all epidemics, is… more frequent in cities and towns than in the country; among the feeble than among the strong…’ He also claimed that dysentery was ‘more frequent among the poor and labourers, than among the wealthy, and those who live better and pay more attention to their health’. As for the reason for this, he suggested that ‘indigence, but much more especially negligence in the article of cooling after heats by labour, exercise etc., exposes the lower class of people prodigiously to this and many other diseases’. (p.28)

Page 31 from ‘An Essay on the Autumnal Dysentry’ describing the signs of danger when treating patients

The second edition of the Essay, there is also the hint of medical controversy. In the ‘Introductory Discourse’ (which was new to the second edition), Wilson mentioned some of the recent publications on dysentery since his work was first published. Of particular interest to Wilson was a study by the Swiss physician Johann Georg Ritter von Zimmermann, titled A Treatise on the Dysentery. Zimmerman had been made Physician in Ordinary in Hanover to George III in 1768.

First iii of the ‘Introductory Discourse’

Zimmermann’s book was of such interest to Wilson because, in the course of reading it, he ‘discovered that he had made use of my Essay, and totally supressed his knowledge of it, while he was very profuse in his references to every other latter English writer on the subject’. Wilson argued that he ‘would be sorry to mention this circumstance upon presumptive evidence only, but he has extracted a pretty long case verbatim from my Essay, which was to be found nowhere else…’ Wilson found this ‘a very strange way… of extracting from a writer upon the very subject he was treating of, while he was, almost in every page, citing other authors who had written in English as I had done…’ However, drawing back from a full accusation of plagiarism (perhaps because of Zimmerman’s relationship with George III), Wilson left the question open, and stated: ‘I make no remarks upon it’. (p.V)

Title page from Zimmerman’s ‘A Treatise on the Dysentery’ (Medical Collection, Med Coll 616.935 ZIM)

Newcastle University’s Special Collections have both Wilson’s and Zimmerman’s books here in Special Collections. Reading them and deciding whether there has been any wrongdoing might be a nice way to spend a dark autumn day, but only if you’ve got the stomach for it.

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Item references

Andrew Wilson, An Essay on the Autumnal Dysentery (1777) (Medical Collection, Med Coll 616.935 WIL)

Johann Georg Ritter von Zimmermann, A Treatise on the Dysentery: with a description of the epidemic dysentery that happened in Switzerland in the year 1765 (1771) (Medical Collection, Med Coll 616.935 ZIM).

Cataloguing the Collector: The life and career of Frederick Charles Pybus

Exhibition now open to the public March – August 2017.
Level 1, Philip Robinson Library, Newcastle University. 

The text and images below are from the exhibition, ‘Cataloguing the Collector: The life and career of Frederick Charles Pybus’. Items within this exhibition are taken from the Frederick Charles Pybus Archive.  


Exhibition talk: ‘The Life of the Collector: Frederick Charles Pybus

 

ALL WELCOME

Date: 29th March 2017
Time: 5.30-7pm
Location: Room 152, Level 1 of the Philip Robinson Library

A talk on the exhibition will be given by our archivist Alex Healey hosted by the Friends of the University Library.

 


Frederick Charles Pybus is arguably best known for his collection of historic medical books, held here in the library. However, items from his personal archive reflect his medical career and personal interests, demonstrating that collecting was only one aspect of his personality.

Pybus the Surgeon

fp-1-3-9-1

Surgery team including Pybus ready for theatre in the Fine Arts department at Armstrong College, 1st Northern General Hospital, c. 1915 (Professor Frederick Pybus Archive, FP/1/3/9)

 

 

 

 

 

 

 

 

 

 

At the start of the 20th century, medical developments relating to antiseptics and anaesthesia allowed surgeons to perform more elaborate and lengthy procedures on their patients.

Frederick Charles Pybus entered the profession, registering as a medical student in 1901 and graduating in 1906. He was to remain associated with the medical profession for over 50 years, until his retirement in 1961.

Pybus not only witnessed the development of surgery in this period, but himself conceived and undertook experimental processes on his patients, contributing directly to the development and improvement of surgical procedures, including tonsillectomies and the removal of cysts.

With the exception of a brief stint in London after his graduation, Pybus’ career both as a student and a practitioner was spent working in medical institutions here in Newcastle, including the Royal Victoria Infirmary, the Fleming Hospital for Sick Children and the Newcastle General Hospital.


Pybus the Veteran

The Royal Army Medical Corps (RAMC) were responsible for the wellbeing of all military personnel during the First World War. As well as serving overseas, members of the RAMC worked on the home front. Suitable buildings were requisitioned as hospitals to accommodate the huge number of wounded soldiers returning from the trenches.

Pybus received his papers placing him on reserve duty in 1910. When war arrived four years later, he helped requisition Newcastle University’s Armstrong College for use as the 1st Northern General Hospital.

Over 1000 operations were performed by Pybus at the 1st Northern, at least some of which were performed in what had been the Fine Arts department. Many surgeries were attempts to correct the damage caused by gun-shot wounds and it was during this period that the field of plastic surgery was developed.

Image included in patient notes for removal of a bullet from Private J. Shrubb of the Inneskilling Fusiliers, Sept 1914 (Professor Frederick Pybus Archive, FP/1/3/3)

Image included in patient notes for removal of a bullet from Private J. Shrubb of the Inneskilling Fusiliers, Sept 1914 (Professor Frederick Pybus Archive, FP/1/3/3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Pybus and Children’s Medicine

After the First World War Pybus was appointed Assistant Surgeon at the Fleming Memorial Hospital for Sick Children, located at what is now Princess Mary Court in Jesmond.

The early 20th century was a period of change for children’s hospitals, in which their status was shifting from being seen as the last resort of impoverished families, to places in which modern medical techniques, tailored to the needs of children, were delivered by skilled practitioners.

During this period, Pybus’ publications and research interests became focussed on the treatment of children. This culminated in the publication of his book The Surgical Diseases of Children: A Handbook for students and practitioners in 1922. The book was published in England and North America, and was received favourably by the medical press.

The Surgical Diseases of Children: a handbook for students and practitioners, 1922 (Pybus J.I.11)

The Surgical Diseases of Children: a handbook for students and practitioners, 1922 (Pybus J.I.11)

Pybus and Cancer Research

At the start of the 20th century improved understandings of the causes of cancer caused this long known illness to become a focus of public debate. The understanding that environmental factors could directly cause cancer made the illness a social issue as well as a medical one.

As a result of this, research into the identification of carcinogens became increasingly popular as the 20th century progressed. Having spent some time at cancer specialist hospitals early in his career, Pybus established a Cancer Research Institute in Newcastle in 1925.

The Institute used animal testing to research bone tumours and was one of the first to suggest that atmospheric pollution could be a major contributing cause.


Pybus the Collector

Arguably, Pybus’ most well-known legacy is the Pybus Collection of historic and rare medical texts. He became interested in such books after an encounter with a ‘really handsome book’ at the first meeting of the Association of Surgeons in the early 1920s. He later recalled that this encounter with the ‘magnificent’ plates of a Vesalius folio ‘wetted his appetite with a vengeance’.

Frontispiece from 'De humani corporis fabric' (Fabric of the Human Body) by Andreas Vesalius (Pyb.N.v.10)

Frontispiece from ‘De humani corporis fabric‘ (Fabric of the Human Body) by Andreas Vesalius (Professor Frederick Pybus Collection, Pyb.N.v.10)

Despite offers from book dealers and American universities to purchase parts of the collection, Pybus donated it in its entirety to Newcastle University Library in 1965, where a dedicated reading room was established in the old library. The collection is now held by Special Collections here in the Philip Robinson Library, and is included on the library catalogue.


Pybus the Person

Photograph of Professor Pybus, c. 1913

Photograph of Professor Pybus, c. 1913 (Frederick Charles Pybus Archive)

Much of Pybus’ life was taken up with his medical career and hobby of collecting medical texts. His archive demonstrates that these were the dominating aspects of his life. Nevertheless, there is evidence of other interests.

Other items in the archive hint at Pybus’ other interests. These include involvement with lecture societies, membership of Masonic organisations and an attempt to resurrect the historic Company of Barber Surgeons and Tallow Chandlers of Newcastle upon Tyne.


Other Resources

Interested in Pybus’ book collection. Find out more about the Professor Frederick Pybus Collection.

More about Pybus our blog:

Pybus during the First World War

IMG_1743

Operating Theatre, Fine Art Dept., 1st floor., 1st Northern General Hospital, Armstrong College, 1915 – 16 (Pybus in the centre with a mask on)

Pybus was informed of his mobilisation in 1909, he became a Captain in the Royal Army Medical Corps, Territorial Force. Initially he had very little to do in his role as Captain, he spent time in York Military Hospital and camped at the Royal Station Hotel, during this stay he described visiting the hospital to understand the organisation and also lots of form filling.

In 1913 Pybus was persuaded by a colleague to become a Registrar at the RVI which meant he had to be coached in military law, organisation and equipment, he passed this and became a field officer; meaning his authority changed to training the unit based at the RVI. For Pybus, this mainly meant leading marches. This all changed in 1914 and on the 4th of August he received the mobilisation papers to take authority of Armstrong College and establish the First Northern General Hospital. Pybus surveyed the college deciding which rooms would be turned in to wards, bathrooms and sanitary accommodation. He renamed the main building block A and two newer buildings B and C. Block C first floor was designated ordinary rank and lower floor for officers.

IMG_1742

The notebook details patients name, ward, regiment, number, date of surgery, type of surgery, surgeon (Pybus), anaesthetic used, anaesthetist, result and remarks. 1364 operations are listed.

This was organised within 48 hours and set up with Infirmary staff so if any wounded soldiers arrived they could be provided for immediately. It was sometime after the initial set-up that the first wounded were brought to Newcastle, these consisted of Belgian soldiers and officers.

IMG_1744

Section of the Operating Theatre C notebook

The Hospital gradually expanded from 520 beds to 2166 in 1917. Huts were built in the grounds of Armstrong College and extra wards built on the North side of main infirmary corridor. Further places were offered as convalescent or auxiliary hospitals these were mainly Country houses on estates such as Howick Hall owned by Earl and Countess Grey. The most northern of these homes was Haggerston Castle just south of Berwick-upon-Tweed and the most southern was Crathorne Hall in Yarm. These were all visited weekly by surgeons and physicians including Pybus, his work also meant that he was on boards which decided what to do with soldiers after injury.

Pybus eventually transferred from registrar to surgeon due to shortages, he was briefly posted in Alexandria, but on his returned continued as surgeon at Armstrong College where he performed at least 1346 operations.

Pybus’ Cancer Research

A brief introduction to Pybus’ research interests

Pybus had a wide ranging interest in cancer and published many cases and research papers in the medical journals concerning all aspects of his research. What comes through in his papers is that his main research focus was on lung cancer and carcinogens found in the air pollution, particularly benzopyrene in soot from burning materials and diesel fumes. Pybus did discuss lung cancer and tobacco smoking but felt that air pollution should be considered a bigger threat. He primarily used statistical evidence and cases he had seen to understand lung cancer and its association with air pollution.  He worked in his own research institute for 30 years and retired from active research in 1955; going on to campaign for cleaner air in the UK due to his findings.

1-3-49 cut

1-3-49 [boxlist number]

Pybus’ interest in cancer first began as a schoolboy, but became fully realised when he saw his first tumour as a veterinary pupil in about 1899. He saw a human cancer for the first time in 1903 after deciding to switch from veterinary school to medical school. He made this decision due to his distaste of the treatment of animals; such as lack of anaesthetic while surgery was performed. Pybus worked primarily as a surgeon, but in 1925 was able to set up his own Cancer Research Institute.

During this time Pybus was supported by the Imperial Cancer Research Fund, this fund was set up in 1902 and was aimed at finding new approaches to cancer and its treatment. In the 1920’s a new funding party was set up, namely the British Empire Cancer Campaign who also went on to fund Pybus’ Newcastle based Research Institute.

During his active research period Pybus used similar techniques to other researchers, including a “Tar-Painting” method which was first used in 1915 by Katsusaburo Yamagiwa and Koichi Ichikawa at Tokyo University to induce cancer in animals – the tar acted as a carcinogen. Using this method in 1924 Pybus produced neoplasms in mice.

3-1-29 [boxlist number]

3-1-29 [boxlist number]

Not only did Pybus explore various carcinogens he also researched and published an article in the British Medical Journal on hereditary bone tumours in mice. This follows a strong research theme within oncology which, since the discovery of DNA, has led to the ability to actively pinpoint inherited defective genes which can lead to cancer, such as a mutated BRCA1 and BRCA2 gene which link to breast cancer.

3-1-22 [boxlist number]

3-1-22 [boxlist number]

 

The Pybus Papers

Pybus c. 1913

Pybus c. 1913

Professor Frederick Charles Pybus (1883 – 1975) was a surgeon and alumni of our College of Medicine, graduating  in 1905. He joined the 1st Northern General Hospital shortly after its formation and was serving as its Registrar in 1914. As a Major in the Royal Army Medical Corps, except for a brief posting at the 17th General Hospital in Egypt, he served as a surgeon at Armstrong College throughout the war. Up until 1919, he carried out at least 1,364 operations on wounded servicemen.

WW1 MRC

WW1 MRC

Professor Pybus went on to have a distinguished career as a surgeon in the Royal Victoria Infirmary from 1920 until his retirement in 1944, becoming Professor of Surgery in the College of Medicine in 1941. Amongst his claims to fame was inventing a drink to sustain patients before operations, which was later developed and sold by a local chemist to Beechams, becoming Lucozade.

Lucozade

Lucozade

His lifelong concerns included cancer research, developed during his 50 year surgical career from 1924 and pursued through his own cancer research laboratory. He was amongst the first to make the link to atmospheric pollution as a major contributing cause of cancer and his work directly informed the Clean Air Act 1956.

For some 40 years Professor Pybus also built up a collection of international importance on the history of medicine, including books, engravings, letters, portraits, busts and bleeding bowls. In 1965, he donated the collection to the Library, where it remains a valuable source of information for medical historians. Meanwhile, his papers, also held in Special Collections, offer a unique insight into a renaissance man of medicine.

pybus-professor-frederick-collection

 

Letter to Sir Liam Donaldson from Prime Minister Gordon Brown on his retirement from the role of Chief Medical Officer – May 2013

Not all of the materials held in Special Collections are old, and that is particularly true of archives. A good example of unique but fairly recent material can be found in the Sir Liam Donaldson Collection.

As well as being the present Newcastle University Chancellor, Sir Liam Donaldson was the 15th Chief Medical Officer for England from 1998 to 2010, an historic role dating back to 1858 as a means of affecting sanitary reforms in the wake of the early cholera epidemics. Their remit developed into being the Government’s top medical advisor on all elements of health policy as well as representing their profession and the public health at the very highest level as the Nation’s doctor.

In this letter, written on 17th December 2009,the then Prime Minister Gordon Brown, expresses his sadness at Sir Liam’s decision to step down as Chief Medical Officer and touches on some of the landmark campaigns made possible through his leadership.

He thanks him first for remaining in post to help respond to the H1N1 “Swine Flu” influenza epidemic. Sir Liam had intended to step down in November 2009 but delayed his decision because of the expertise he could bring in responding to such a crisis. Sir Liam had warned as early as 2004 that such new strains of influenza were inevitable and put in place contingencies such as writing infectious disease strategies, establishing the Health Protection Agency to monitor and respond to such outbreaks and major public awareness campaigns. These steps helped to considerably minimise the impact of the severity of this disease in the UK.

The Prime Minister goes on to recognise Sir Liam’s input into NHS reform, with his personal campaigns enacting a quality and patient safety ethos in the organisation; something Sir Liam continued to do on a Global scale as founding Chair of the World Alliance for Patient Safety at the World Health Organization from 2004 onwards.

Gordon Brown finishes by touching on Sir Liam’s efforts to increase the take up of organ donation and his most celebrated achievement in leading on the smoking ban in public places on 1st July 2007: a public health milestone. He tirelessly targeted such modern, self-made epidemics in his influential annual reports which led to action through policy and legislation. Similar efforts based on his concerns over the consumption of alcohol and calls for minimum pricing in 2009 were not greeted as favourably, but speak for the independence of the role of Chief Medical Officer, acting for the greater good rather than political gain.
The full catalogue for the Donaldson (Sir Liam)Archive is hosted on the Archives Hub. It includes archival material on this significant public health reformer’s many campaigns as Chief Medical Officer, his early roots in the North East, and on-going attempts to tackle the world’s most devastating health issues.

The archive has also been selectively digitised and these images can be searched and browsed via CollectionsCaptured.

You can also view an online version of the complementary exhibition, Root and Branch: Public health under the Nation’s doctors, on the Special Collections web pages

Root and Branch: Public health under the Nation’s doctors

Poster for the exhibition depicting a tree in the middle and images of Chief Medical Officers around the bottom edge, with Sir Liam Donaldson pictured in the middle

From the streets of Sunderland to the steps of Whitehall: Origins of the role of chief medical officer

The outbreak of cholera in Sunderland in 1831 brought about the catalyst for the UK Government to begin thinking seriously about the health of the nation.

Image of a political cartoon, depicting a cholera patient siting on the words 'starvation' with a table next to him with the words'Board of Health' with a vial saying 'Emetic' and 'The dose to be repeated' and a box of 'Blue Pills'
Collections relative to the Cholera at Gateshead, in the County of Durham, 1831
(Rare Books, RB616.932 BEL)

Public health champions with local connections (including one of the first and most famous alumni of Newcastle University) brought scientific approaches to preventing disease and raising awareness of the hazardous conditions the majority of the population lived in. It was these breakthroughs that led to the first Public Health Act of 1848 and the first Chief Medical Officer to advise the Government on Public Health issues in 1855.

King Cholera enters England via Sunderland

Prior to 1829, “Cholera Morbus” epidemics had been isolated to India and Asia, killing hundreds of thousands, including British soldiers posted abroad.

It is now known to be a bacterial disease caused by contaminated food and water supplies. Because of its major ports and trade centres, as well as poor sanitation and living conditions, it was the North East that first experienced Cholera in this country, which went on to kill an estimated 55,000 nationwide.

Notice entitled 'Spirit Drinkers Beware!!!', issued by the Gateshead Board of Health, in response to the outbreak of cholera, warning people that drinking spirits has been linked to the cause of the disease
Notice entitled ‘Spirit Drinkers Beware!!!’, issued by the Gateshead Board of Health, in response to the outbreak of cholera, warning people that drinking spirits has been linked to the cause of the disease. from Collections relative to the cholera at Gateshead, in the county of Durham, 1831 (Rare Books, RB616.932 BEL)

The first victim died on 23 October 1831 in Sunderland and it quickly reached Gateshead and beyond. Because of a lack of local or even central disease control, the causes of cholera were largely misunderstood even with the establishment of Local Boards of Health in badly affected areas and its spread was not properly addressed. The reign of “King Cholera”, became a call to action for the Government and medical profession to work together in order to protect the health of the population.

Cleaning up towards a public health act

Through the culmination of the pioneering Report on the Sanitary Condition of the Labouring Population of Great Britain in 1842 by philanthropist and civil servant Sir Edwin Chadwick (1800-1890) and a fresh outbreak of cholera in 1848, claiming 52,000 lives, poor sanitation in England became the focus of the Government’s efforts to curb disease epidemics. These were sound assumptions; sewerage, water supplies and housing were largely inadequate and “nuisances” such as refuse and animal waste in the streets, made the lives of the general population hazardous and short. The average life expectancy was 40 in the 1850s and as low as 26 in some urban areas.

Chadwick himself was instrumental in the passing of the first Public Health Act in 1848; a major milestone. Its aims were to improve sanitation through the creation of a General Board of Health and provision for Local Boards of Health to oversee reforms. These could be imposed by the General Board if death rates in an area exceeded twenty-three in a thousand. Although these institutions were largely overworked and underfunded and had little remit beyond sanitation, they succeeded in bringing the true plight of the working people of England to the attention of the policy makers.

Chadwick himself was instrumental in the passing of the first Public Health Act in 1848; a major milestone. Its aims were to improve sanitation through the creation of a General Board of Health and provision for Local Boards of Health to oversee reforms. These could be imposed by the General Board if death rates in an area exceeded twenty-three in a thousand. Although these institutions were largely overworked and underfunded and had little remit beyond sanitation, they succeeded in bringing the true plight of the working people of England to the attention of the policy makers.

A first class answer to cholera

The roots of the cholera epidemic can be traced back to the North East, but so can the solution to its cause and prevention.

Portrait of Dr John Snow
Portrait of Dr. John Snow (1813-1858), British physician.

When the first School of Medicine and Surgery opened in Newcastle in 1832, which the University as we know it emerged from, one of the eight students was a John Snow (1813-1858), an apprentice to a surgeon in Benton. He attended to the poor during the cholera epidemic, witnessing the disease first hand; an experience that was to define his medical legacy.

Front cover of 'On the Mode of Communication of Cholera'
On the Mode of Communication of Cholera, by John Snow, 1849 [Medical Collection, Med. Coll. 616.932 CHO(11)]

In 1849, Snow published the groundbreaking work On the Mode and Communication of Cholera theorizing that it was in fact a waterborne infection. He built on this through statistical experiments which proved that an 1854 cholera outbreak in Broad Street, London was caused by contamination of the water pump. Snow’s scientific research techniques into evidence, patterns and prevention identify him as one of the fathers of Epidemiology; the cornerstone of Public Health medicine.

Branching out: evolution of the Chief Medical Officer

The value demonstrated by Sir John Simon in the role has made the post of Chief Medical Officer an enduring one to date, but also one of the most difficult and misunderstood. For over 150 years, those charged with protecting the Nation’s Health have overseen multiple health crises, scientific medical breakthroughs, the birth of the NHS, and a more parental attitude towards the population’s well-being.

Photograph of  Sir Liam with former Chief Medical Officers of England - (left to right) Sir Kenneth Calman (14th CMO), Sir Donald Acheson (13th CMO), Sir Henry Yellowlees (12th CMO) and Sir Liam Donaldson (15th CMO). 2004
Photograph of Sir Liam with former Chief Medical Officers of England – (left to right) Sir Kenneth Calman (14th CMO), Sir Donald Acheson (13th CMO), Sir Henry Yellowlees (12th CMO) and Sir Liam Donaldson (15th CMO). 2004 [Donaldson (Sir Liam) Archive, LD/3/9/8]

Through these challenges, they spoke as the head of the medical profession, chief independent advisors to the Government on all medical matters, but, above all, the Chief Medical Officers had to act in the interests of the public’s health.

Such a balance required strong personalities with both the medical expertise and diplomacy required to push through reforms for the greater good. 13 of these are profiled on this diagram of Chief medical Officers on 1876-1998.

Healthy roots, local soil

Sir Liam Donaldson was born in Middlesbrough in 1949 into a medical family. His father Raymond “Paddy” Donaldson (1920-2005) was himself a Public Health champion and a local Medical Officer for Health in Rotherham and later Teesside. Like the first Chief Medical Officer, Sir Liam initially opted for a career in surgery, gaining a Masters degree from the University of Birmingham in Anatomy.

Photograph of Sir Liam as a pupil at Rotherham Grammar, 1963
Photograph of Sir Liam as a pupil at Rotherham Grammar, 1963
[Donaldson (Sir Liam) Archive, LD/5/5/1].

After 2 years as a Surgical Registrar and teaching and research posts in the Midlands, gaining his Doctorate in 1982, Sir Liam changed his speciality to Public Health so his work could impact on populations rather than just individuals. He honed his skills and understanding of the discipline as a General Practitioner, but continued to be a force in academic medicine, including becoming Professor of Applied Epidemiology at Newcastle University in 1989.

A Chief Medical Officer in the making

It was in the North East that Sir Liam was able to gain the vital experience in Public Health Management that would ready him for the top job as Chief Medical Officer. 

Photograph of Sir Liam Donaldson from Northern Regional Director of Public Health's Report for 1992
Sir Liam Donaldson from Northern Regional Director of Public Health’s Report for 1992
[Donalson (Sir Liam) Archive, LD/1/2/3]

In 1986 he became Regional Medical Officer to the Northern Regional Health Authority, progressing to become Regional General Manager and Director of Public Health. He continued in these roles when the Northern and Yorkshire Regional Health Authorities merged in 1994, becoming responsible for the health needs of some 7 million people.

During this period, he responded to high profile local crises which received national media coverage, such as the Cleveland Child Abuse scandal. Sir Liam formative years also gave him the opportunity to develop the health agendas that would define his career. 

Card received by Sir Liam from the Northern and Yorkshire Regional Office on his Appointment as Chief Medical Officer
Card received by Sir Liam from the Northern and Yorkshire Regional Office on his Appointment as Chief Medical Officer – Cartoon depicts Sir Liam, a lifelong Newcastle United supporter, as a player. Sir Liam’s appointment as Chief Medical Officer coincided with the club’s appointment of Ruud Gullit as manager. Sir Liam is also shown to be carrying John Snow’s Broad Street Pump to signify his Public Health credentials.
c. 1998,
[Donaldson (Sir Liam) Archive, LD/5/3/9]

A firm believer in the importance of high clinical performance, he is credited with the invention of Clinical Governance as a means of constant improvement in health care standards. He also successfully reduced waiting lists and created strategies for improving the health care and quality of life for local people.

Sir Liam’s initiatives during his 12 years in the North led to him to become the leading candidate to be Chief Medical Officer for England when Sir Kenneth Calman stepped down in 1998.

Letter from Sir George Godber (11th CMO), congratulating Sir Liam on his appointment as Chief Medical Officer and offering some insights into the role. 10 Jul 1998
Letter from Sir George Godber (11th CMO), congratulating Sir Liam on his appointment as Chief Medical Officer and offering some insights into the role. 10 Jul 1998
[Donaldson (Sir Liam) Archive, LD/5/3/4]
Letter from Sir Donald Acheson (13th CMO) congratulating Sir Liam on his appointment as Chief Medical Officer and offering some insights into the role. 19 Nov 1998
Letter from Sir Donald Acheson (13th CMO) congratulating Sir Liam on his appointment as Chief Medical Officer and offering some insights into the role. 19 Nov 1998
[Donaldson (Sir Liam) Archive, LD/5/3/8]

Without fear or fervour: the 15th Chief Medical Officer for England

Sir Liam’s time at the Department of Health was one of major reactive and proactive reform shaped by his vision of improving the health of the population.

Photograph of Sir Liam Donaldson in his office, c.1998
Sir Liam Donaldson in his office, c.1998
[Donaldson (Sir Liam) Archive, LD/3/9/9]

Among his many achievements were the ban on smoking in public placesregulated stem-cell research, improvements to infectious disease control, and new systems to prioritise patient safety in the UK.

Acting as the bridge between Government and medical practitioners, he responded to high profile criticism of his profession through better safeguards. His trailblazing annual reports and significant campaigns meant he was also able to further his own health agendas for action on poor lifestyle choices, high quality health care and patient centred medicine.

The fire fighter: responding to crises

UK legislation regulating the removal, storage, use and disposal of human bodies, organs and tissues based on recommendations by Sir Liam. Gained Royal Assent and became law on 15 November 2004.
UK legislation regulating the removal, storage, use and disposal of human bodies, organs and tissues based on recommendations by Sir Liam. Gained Royal Assent and became law on 15 November 2004.
(London: HMSO, 2004),
[Donaldon (Sir Liam) Archive, LD/3/3/8/35]

When a public inquiry in 1999 revealed that a large number of hospitals, notably Alder Hey Children’s Hospital and Bristol Royal Infirmary, had retained patient’s organs and tissues without family consent, Sir Liam was charged with leading the Government response. He commissioned a census to determine the scale of the problem and made significant recommendations for reform. These led to the Human Tissue Act 2004 to ensure the wishes of the deceased and their relatives came first.

Special Report by Sir Liam in response to the 2001 inquiry into the murders of Dr Harold Shipman. Makes recommendations for greater regulation of the medical profession, which led to amendments being made to the Health and Social Care Act 2008 to achieve this.
Special Report by Sir Liam in response to the 2001 inquiry into the murders of Dr Harold Shipman. Makes recommendations for greater regulation of the medical profession, which led to amendments being made to the Health and Social Care Act 2008 to achieve this.

Donaldson, L. Good Doctors, Safer Patients: Proposals to Strengthen the System to Assure and Improve the Performance of Doctors and to Protect the Safety of Patients
(London: Department of Health, 2006)
[Donaldson (Sir Liam) Archive, LD/3/3/16/20]

A parallel crisis which similarly damaged public confidence in the medical profession was the murders carried out by Dr Harold Shipman. Sir Liam first established, through an audit of Shipman’s clinical practice, that he was likely to have been responsible for between 200 and 300 deaths. His response was to target how doctors were regulated and continually assessed. His recommendations formed the basis for changes to the General Medical Council and complaints procedures.

As early as 2004, Sir Liam had predicted the inevitability of a new strain of influenza becoming pandemic.

Cartoon depicting Sir Liam's Appearance on Breakfast with Frost to discuss the potential SARS epidemic
Cartoon depicting Sir Liam’s Appearance on Breakfast with Frost to discuss the potential SARS epidemic. © Health Service Journal, May 2003
[Donaldson (Sir Liam) Archive, LD/3/3/11/20]

His work established the Health Protection Agency to lead responses to such outbreaks and those caused by bioterrorism. His extensive preparations and awareness campaigns proved well founded when in 2009 the H1N1 ‘Swine Flu’ virus became pandemic. Sir Liam put his plans to step down as Chief Medical Officer on hold to coordinate the response and was commended for his key role in lessening the potential impact.

The communicator: on the sate of the nation’s health

Annual Reports had been used to highlight the nation’s health issues since Sir Johns Simon’s first in 1858. Sir Liam aimed to write more accessible reports for a wide audience targeting the most serious problems with clear action points. These 9 influential reports led to considerable media coverage and both policy and legislative change.

Three of Sir Liam's influential reports subtitled On the State of the Nation's Health covering prevalent health issues aimed at a wide audience. Repeated themes were calls for action on tobacco control, alcohol abuse, and obesity. Also includes a letter from MP Hilary Benn congratulating Sir Liam on his 2008 Annual Report.
Three of Sir Liam’s influential reports subtitled On the State of the Nation’s Health covering prevalent health issues aimed at a wide audience. Repeated themes were calls for action on tobacco control, alcohol abuse, and obesity. Also includes a letter from MP Hilary Benn congratulating Sir Liam on his 2008 Annual Report.
Donaldson, L. (London: Department of Health, 2003, 2007, 2009),
[Donaldson (Sir Liam) Archive, LD/3/2/2/2; LD/3/2/6/3; LD/3/2/8/2]

Sir Liam’s repeated call for smoke-free public places and workplaces led to legislation being passed on 1 July 2007 with this outcome for England; a true public health landmark. By 2009, all cigarette products were also required to carry explicit health warnings.

He also continually drew attention to the damaging effects of poor lifestyle choices, such as obesity. He promoted the need for regular physical activity, which led to major policy changes and awareness campaigns on diet and well-being.

Similarly, Sir Liam produced guidance on the consumption of alcohol by children and young people in 2009 based on scientific research in an effort to change the way families view and use alcohol. His call for minimum pricing on alcohol was rejected by the Government in the same year; a move they were heavily criticised for. The fact it remains a policy agenda is testament to the value of Sir Liam’s tireless campaigning for the good of the Nation’s Health.

The Reformer: New Branches

Photograph of Sir Liam in Incident Room, c. 1999
Photograph of Sir Liam in Incident Room, c. 1999 [Donaldson (Sir Liam) Archive, LD/3/9/12]

As Chief Medical Officer, Sir Liam wasted little in time in developing his concept of Clinical Governance; this means of measuring and continually improving on the performance of medical practioners and excellence in health care. His publications paved the way for the establishment of National Clinical Assessment Authority to monitor competency and, through statutory reforms, the NHS was required fot the first time to continuously improve the quality of their services.

The Secretary of State for Health and Darlington MP thanks Sir Liam for his part in devising the plan.
The Secretary of State for Health and Darlington MP thanks Sir Liam for his part in devising the plan.
27 Jul 2000
[Donaldson (Sir Liam) Archive, LD/3/3/9/4]

At the heart of this like much of Sir Liam’s work, was the safety of patients where poor standards meant unnecessary risks. He identified the deficiencies in reporting, investigation and learning from mistakes as key to the problem. In 2002, the National Patient Safety Agency was created to collect data and encourage such reporting in order to prevent accidents happening again. Through reforms, the UK became a world leader in patient safety.

Under Sir Lian’s leadership, the scientific community also benefitted when he reviewed and made recommendations for less restrictive stem cell research. After consultation, he concluded that the potential to develop new tissues for a wide range of diseases and disorder through theraputic cloning was warranted. This laid the foundations for amendments to the Human Fertilisation and Emryology Act 1990, making regullated stem cell research legal and the UK to again become a world leader in this field.

International recognition of Sir Liam's work in the field of patient safety. He donated the prize of $10,000 to establish an essay competition at Oxford University.
International recognition of Sir Liam’s work in the field of patient safety. He donated the prize of $10,000 to establish an essay competition at Oxford University.
23 Oct 2006
[Donaldson (Sir Liam) Archive, LD/5/1/5/1]

Advancing health: an enduring legacy

Circular photograph of Sir Liam Donaldson from Advancing Health, 14 March 2010
Sir Liam Donaldson from Advancing Health, 14 March 2010 [Donaldson (Sir Liam) Archive, LD/3/3/20/2]

Sir Liam retired from the post of Chief Medical Officer after 13 years in May 2010. He left England a world leader in patient safetyinfectious disease control, and stem cell research and empowered the public to be more aware of the health risks they could help prevent. Like many of his predecessors, he acted without fear or political fervour and is recognised as one of the great Chief Medical Officers.

Letter to Sir Liam from Prime Minister Gordon Brown on his Retirement as Chief Medical Officer  - The Prime Minister thanks Sir Liam for his various health campaigns and for postponing his retirement to help in the response to the “Swine Flu” epidemic. 17 Dec 2009
Letter to Sir Liam from Prime Minister Gordon Brown on his Retirement as Chief Medical Officer – The Prime Minister thanks Sir Liam for his various health campaigns and for postponing his retirement to help in the response to the “Swine Flu” epidemic. 17 Dec 2009 [Donaldson (Sir Liam) Archive, LD/3/7/20]
Letter to Sir Liam from MP Alan Johnson on his Retirement as Chief Medical Officer -  The Home Secretary and former Secretary of State for Health pays tribute to Sir Liam's work, especially responding to the “Swine Flu” epidemic, and comments on the impor-tance of Chief Medical Officers being politically independent.
11 May 2010
Letter to Sir Liam from MP Alan Johnson on his Retirement as Chief Medical Officer – The Home Secretary and former Secretary of State for Health pays tribute to Sir Liam’s work, especially responding to the “Swine Flu” epidemic, and comments on the impor-tance of Chief Medical Officers being politically independent.
11 May 2010
[Donaldson (Sir Liam) Archive, LD/5/3/12]

Beyond Borders

Sir Liam with WHO Director-General Margaret Chan and Bill Gates - (Right to left) Sir Liam with WHO Director-General Margaret Chan and Bill Gates at meeting on polio eradication, 17 May 2011,
Sir Liam with WHO Director-General Margaret Chan and Bill Gates – (Right to left) Sir Liam with WHO Director-General Margaret Chan and Bill Gates at meeting on polio eradication, 17 May 2011,
© The Global Polio Eradication Initiative

Sir Liam’s Public Health campaigns were not just a national call to action but a global one. The World Health Organization recognised the innovative work done in the UK on patient safety during Sir Liam’s time as Chief Medical Officer. He proposed a World Alliance for Patient Safety in 2003 to adopt global standards and support member states in this field. This was establishment a year later and, as a champion of patient safety, Sir Liam was chair from the inception.

World Alliance for Patient Safety Forward Programme 2005 -  Launch document for the World Health Organization's World Alliance for Patient Safety, which Sir Liam chaired from its inception on 27 October 2004. Aimed to bring together health policy-makers across the globe to reduce adverse events resulting from unsafe health care.
World Alliance for Patient Safety Forward Programme 2005 – Launch document for the World Health Organization’s World Alliance for Patient Safety, which Sir Liam chaired from its inception on 27 October 2004. Aimed to bring together health policy-makers across the globe to reduce adverse events resulting from unsafe health care [Donaldson (Sir Liam) Archive, LD/4/1/1]

Among the far reaching programmes developed here were collaborative networks for reporting and learning from mistakes in health care and the Global Patient Safety Challenge which generated commitment from governments covering 78% of the world’s population to reduce harm to patients.

Continuing this work, in July 2011 Sir Liam was named the World Health Organization’s Envoy for Patient Safety. His current role is to mobilise political support to address patient safety at international levels and propose strategic actions for collaboration.

The Public Responds: Awards and Recognition

Invitation for Investiture at Buckingham Palace and Photograph of Sir Liam with his Knighthood - Sir Liam's wife Brenda, Lady Donaldson's invitation regarding his Knighthood. Photograph shows Sir Liam with his wife Brenda, father “Paddy”, and mother June after receiving his Knighthood. c. Apr 2002
Invitation for Investiture at Buckingham Palace and Photograph of Sir Liam with his Knighthood – Sir Liam’s wife Brenda, Lady Donaldson’s invitation regarding his Knighthood. Photograph shows Sir Liam with his wife Brenda, father “Paddy”, and mother June after receiving his Knighthood. c. Apr 2002
[Donaldson (Sir Liam) Archive, LD/5/1/4/9, LD/5/1/5/2)

Sir Liam set up the Public Health Awards in 2009 to acknowledge those who had made a strong impact in the field. Among many other honours, recognition of his own significant impact came when Sir Liam received a Knighthood in 2002 with his wife Brenda and parents “Paddy” and June in attendance.

Sir Liam at his inauguration as Chancellor of Newcastle University, 7 December 2009
Sir Liam at his inauguration as Chancellor of Newcastle University, 7 December 2009

It was of great privilege that Sir Liam accepted the invitation to become Chancellor of Newcastle University in 2009; recognition of his local roots and international achievements. He commented:

“Nothing could give me greater pride than taking up the post of Chancellor in such a great city and in a university fit for the challenges of the 21st Century.“

Sir Liam Donaldson, 2009
Photograph of Sir Liam at his Inauguration as Chancellor of Newcastle University - Sir Liam awarded former Newcastle United footballer and one of his own personal heroes Alan Shearer an Honorary Doctorate of Civil Law (Hon DCL) at the same ceremony.
07 Dec 2009
Photograph of Sir Liam at his Inauguration as Chancellor of Newcastle University – Sir Liam awarded former Newcastle United footballer and one of his own personal heroes Alan Shearer an Honorary Doctorate of Civil Law (Hon DCL) at the same ceremony.
07 Dec 2009
[Donaldson (Sir Liam) Archive, LD/5/1/7/1]

In his first act as Chancellor, Sir Liam showed recognition to some of his personal heroes with honorary degrees, including surgeon Lord Ara Darzi, who he worked closely with on National Health Service reforms, and Newcastle United footballing icon Alan Shearer.

Photograph of Sir Liam at his Inauguration as Chancellor of Newcastle University, 7 December 2009
Photograph of Sir Liam at his Inauguration as Chancellor of Newcastle University, 7 December 2009