Chicago, Illinois, United States
Liverpool Royal Infirmary
In the winter of 1962-1963 I spent a few months working as locum registrar in several hospitals in Liverpool. It was a cosmopolitan city inhabited by people of many origins but predominantly by the descendants of those who had escaped the horrors of the Irish potato famine, who characteristically dined on a local beef or lamb stew (or scouse), and would tell you in a distinct brogue that they were scousers and were proud of it.
Once a leading trading and financial center famous for its ports and shipyards, Liverpool had seen better days. That year it was quite cold most of the time; pipes would freeze, trains would not go, and the political scene was troubled: De Gaulle had spurned England’s application to join the Common Market; and Mr. Profumo’s love peccadillo had brought down the government of Harold McMillan. But the people were friendly. I learned that one went up to London and not down to it; and an excursion by boat across the Mersey and back was free because tickets were sold only on the Cheshire side.
The environments of Liverpool were picturesque and seemingly affluent, but the poor in the city more often lived in look-alike houses strewn along endless roads lit in the fog by dim yellow lamps. Unemployment was high, poverty often extreme, exemplified by the plight of the family whose toilet and bathtub had collapsed through the floor into the apartment below, leaving it without these usually indispensable utilities for the remainder of the winter.
Medical care took place in the famous Royal Infirmary and in other less famous hospitals, some huge with up to 1400 beds and wards numbered from A to Z, staffed on weekends by a lone intern who would move from ward to ward, “write up” the new admissions, then move on and sign off at the end of his shift, leaving an equally lone junior registrar to deal with problems that nowadays would challenge the collective resources of a modern intensive care unit.
Academically Liverpool boasted an illustrious medical tradition. It had the first school of tropical medicine in the world, and that is where many of the mysteries of malaria had been solved. Before the war young men had made their name writing about the sedimentation rate. Later it was genetics. The great Lord Cohen of Birkenhead had dominated the medical community, remembered as a godlike figure of clinical wisdom and acumen, embodying what was understood to be the best practices of the day. Treat what was treatable, he would advocate, treat the still undiagnosed mass as a treatable amebic abscess rather than as a generally incurable colon cancer. Other medical luminaries in Liverpool were Cyril Clarke, later knighted and president of the Royal College of Physicians; David Weatherall of a younger generation and later Regius Professor of Medicine at Oxford. And then there was Dr. Eric Baker-Bates, the subject of these reminiscences.
Generally referred to as BB, he lived on Rodney Street with his housekeeper. Eccentric and usually manic, he was always on the move, writing handouts for his students at the crack of dawn, and waking his intern at ungodly hours to discuss the plan of the day. He also saw patients at St. Helen’s, where the nuns idolized him. At Christmas, he would become depressed, disappear several weeks for treatment, then return in the New Year in his usual manic state. On rounds he was theatrical, such as when he asked the head nurse to put a thermometer in a woman’s mouth in order to avert the anticipated flood of complaints. Of obese patients he said they were digging their graves with their teeth. He was an experienced clinician, and before seeing him in his consulting office patients had to fill in a questionnaire written as if taking a history, starting with when were you last in good health, then what brings you here, what was the first thing you noticed wrong, then a detailed symptoms analysis, more clinically useful than modern electronic record systems.
I remember being awakened early one Sunday morning and told we were going into North Wales, of which Liverpool was then the virtual capital. He came in a large Jaguar, put on his driving slippers, offered coffee from a thermos flask, and sped away. We reached a small collection of houses scattered in the snow and entered one of them. I was told to wait in a tiny living room while he went to see the patient. Re-emerging after some time he said I should also examine the patient. I felt the cirrhotic liver, observed the red liver palms, and dutifully confirmed his diagnosis. He then named his honorarium, perhaps twenty-five or fifty pounds, and said to also give the “lad” five pounds.
I recently discovered on the Internet an item for “Liverpool graduates of a certain vintage who may still remember this great man” at http://drsoupdragon.blogspot.com/2013/01/baker-bates-isma.html. I also found in my files several of the handouts he used to write for his students. Though clearly old-fashioned and reflecting the medical though of half-a century ago, they contain immutable truths of which we need to be reminded from time to time.
George Dunea, MD, Editor-in-Chief