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Enduring memories: a paediatric gastroenterologist remembers—a tale of London and Sydney
  1. J M Fell

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    J Walker-Smith. The Memoir Club, 2003. £17.50 (hardback), pp 299. ISBN 1841040525

    John Walker-Smith describes himself as an inveterate collector, and in this autobiography he has drawn together his personal collection of memories, anecdotes, and most importantly people; some 400 are indexed. They are, as one would expect, mostly friends and acquaintances acquired during a distinguished career, although there is the occasional adversary or rival. For the younger reader many of the descriptions of life as a young doctor will be strikingly familiar even if separated by 30 or 40 years, while the image of early morning tea brought to one’s room by a domestic, and communal roast dinner carved by the resident medical officer are truly from another era.

    The first half of the book describes a childhood in Sydney, following his father into medicine. His subsequent training followed a path that required a flexibility which with our current system would be almost unthinkable. Having been a junior doctor in Sydney the author came to London to work as a houseman at the Hammersmith and Brompton hospitals. He then returned to Australia, before moving again to Zurich for further training. After this he spent five further years in Sydney before finally moving again to London to become a consultant/senior lecturer in child health at St Bartholomew’s and Queen Elizabeth Hospital for Children (QEHC), London. Along the way he undertook his MD. This was based on an analysis of the dissecting microscope appearance of the small intestine in children at postmortem examination who had died from both gastroenterological and non-gastroenterological causes. The fact that he could analyse 116 child autopsies over a period of 22 months, reflects the changing face of child health in the developed world, where diseases such as infantile gastroenteritis were frequently fatal not so many years ago, before effective oral or intravenous rehydration regimes had been developed.

    Subsequent chapters deal with issues which for many readers will be all too familiar. In the London context there is the permanent revolution of both hospital and medical school merger and restructuring which for Walker-Smith was particularly difficult: Barts merged with the Royal London and QEHC closed. Then, more recently, in the last few years before retirement spent at the Royal Free, there was the controversy around the MMR vaccine and autism. It is interesting to read his perspective as someone at the very centre of events. For although he does not believe that “professional and research matters should normally be discussed in the public media”, but “should be discussed in scientific and medical media and at the relevant meetings”, the controversy has been the most widely reported medical media story in the UK for many years.

    The final, and probably the most significant of the themes running through the book is that of the development of paediatric gastroenterology as a separate discipline within paediatrics but in an international context. There have been the technical advances from small bowel biopsy with Crosby capsule to fibreoptic endoscopy, the clinical advances in the management of intestinal failure and transplantation, and the laboratory advances in the microbiology of infections diarrhoea, and understanding of the mechanisms of mucosal inflammation. For those of us in the field this process continues. Although there have been some advances with, for example, the development of identifiable sub-specialist training schemes, many of the tensions documented in the book—specialist versus general paediatrics, academic versus clinical paediatrics, and clinical versus non-clinical research—still persist.