Henry James EastesBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2234 (Published 01 June 2009) Cite this as: BMJ 2009;338:b2234
- Peter Brunyate
Henry James Eastes died in December 2008 having given 70 years of his life to his patients and the community of Marshfield, the rural village where he spent all his professional life. This alone is not remarkable as many before him and since have done the same. However, he was archetypal of the general practitioner of his era who inherited the traditions of the past but lived through and developed the enormous changes in medicine that have taken general practice to the position it is in today.
Henry and his wife, Zeta, also a doctor, arrived in Marshfield in December 1939. The incumbent doctor had died and his widow was happy to sell the practice to the Eastes. The price included a house and dispensary that had been a doctor’s residence for the previous 80 years.
Consultations took place in the dispensary, a narrow corridor of a room with room for only two hard chairs for the patients to sit on while the doctor stood. Through a thin wall was the waiting room, which led out into the street. There was no facility for examining patients lying down. If one wished to do that they were sent home and visited later. Medicines for collection were left out in the waiting room, which was open 24 hours a day. Surgery hours were morning and evening with a let up on Saturday evenings and Sundays. However, the doctor was permanently on call (especially during the five years of the second world war) and holidays were rare. Telephones were not common as it was not a wealthy community so the doctor would be fetched by someone calling at the house to ring the bell or, at night, blow down the speaking tube which terminated in the doctor’s bedroom. They are still there today.
The range of medicines was extremely limited. Henry brought with him University College Hospital’s vade mecum, from which he made up 12 stock bottles of tonic, antacid, bromide, etc. There were some barbiturates. He made his own pink aspirin tablets, pink because he reckoned that patients would already have tried white ones. The very first sulphonamides were becoming available but a stock bottle of M and B 693 represented a third of the total capital value of the drug stock.
So in these uninspiring conditions the Eastes set to work to try to use some of the training they had had. Maternity was one of the areas to which they first applied their knowledge. Most deliveries were done at home under the eye of the village “midwife,” an experienced but not necessarily formally trained woman. The doctor was called only in an emergency. At one of Henry’s first attendances the nurse noticed that he used a face mask and enquired its purpose. She went home and made herself one. Henry initiated antenatal clinics, and when a local community maternity home opened he made good use of it. However, one can never predict everything. The woman in the maternity home who bled enough to need 34 pints of blood and an emergency hysterectomy owes her life to Henry’s skill and perseverance. It gave him a few grey hairs, but mother and child are both alive and well today.
Visiting was an important part of the working day. There were the eagerly awaited regular visits to housebound patients, when the normally restless Henry would sit quietly and listen, occasionally in later years “resting his eyes,” as he put it. Many of the newer drugs such as diuretics and penicillin were initially available only as injections. Thus patients with heart failure would require a daily visit. To Henry’s memorial service came a woman whose father had been saved by his visits to inject penicillin four times daily in the winter of 1947, digging himself through the snow in both directions. Asthma had a very limited range of therapeutic options and calming and reassuring a child in the night was an important part of the doctor’s armamentarium even if it did take an hour or two.
Practical procedures were undertaken on a wide front. A collection of 150-200 instruments came with the practice. These covered delicate procedures such as myringotomy for acute otitis media, nasal polypectomy, and of course tonsillectomy. Drainage procedures using trochar and cannula would be applied to chest and abdomen alike. A full set of 12 different shapes of pliers for pulling teeth were to be found. Lower down fixed catheters for urethral obstruction and a range of obstetric instruments from forceps to destructive tools were available. This was heroic medicine, and we should be grateful that it is not required today. Finally, there was a postmortem set, which was regularly used by Henry and Zeta in the room adjoining the village cemetery where they conducted their own postmortem examinations.
It is difficult to single out the most important changes that occurred over the next 35 years. When Salk vaccine was first available around 1957 Henry ensured that every child in the practice received a dose before it became time expired, visiting them at home if necessary. At this distance it is difficult to appreciate the impact of antibiotics when bacterial infections could be lethal. Puerperal fever from postnatal infection was greatly feared and yet a few sulphonamide tablets could make the difference between life and death. This didn’t stop a neighbouring doctor whom Henry was doing some work for from chiding the young Eastes for his extravagance: “For at threepence a pill he would bankrupt doctor and patient alike.”
Antidepressants, judiciously used in association with a sympathetic ear, made an immense difference to many people. Henry encouraged those with recurrent depression to seek help early in an episode as he at last had something which would stem the slide into the misery they knew so well.
Alongside the revolution in medical practice, other changes were occurring. The advent of the NHS at last provided stability for the incomes of less wealthy practices. As late as 1980 a patient I was visiting for pneumonia said to me, “Of course we would never have had you in the old days doctor. A visit was half a crown, and we couldn’t afford that.” The 1966 new contract was enthusiastically welcomed. By this time Henry was involved in medical politics, driving the 40 miles to Gloucester once a month for local medical committee meetings. He was elected to the General Medical Services Committee and also sat on the Medical Practices Committee. The latter required weekly visits to London. He would tear around the practice in a large Citroen trying to ensure that everything was done before he caught his train. One local wag said, “They will never catch the doctor for speeding, only for low flying.”
Education was another area Henry became involved in. Initially there was no postgraduate education of any kind. After the war a Sunday morning teaching round with a consultant was established for general practitioners at Bath Hospital. In time this grew into the postgraduate centre, which was established and financed by local doctors. Students were beginning to come out to practices in the 1950s. Dr Jane Richards had her first experience of general practice with Henry during an idyllic two weeks in 1956. She subsequently returned as a locum and then as an assistant before moving to her own practice in Exeter. They remained firm friends.
Henry finally retired in 1982. The practice now had surgeries in four villages with a general practitioner in each. New premises had been opened in Marshfield in 1976 greatly aided by Henry’s enthusiasm for the future. The practice covered 100 square miles of south Cotswold countryside and the patient numbers were four times greater than when he took over.
Men like Henry Eastes were the backbone of medical care in this country. They had the foresight to embrace change as it occurred at a pace that had never been seen before. Yet in the upheaval they maintained and developed excellent standards of medicine without ever losing sight of the patient at the core of their practice. Before 1940 personal concern and care was almost all that the general practitioner had to offer. Now the therapeutic options are legion but are we in danger of forgetting the central position of holistic care in our enthusiasm for new technologies. Henry’s most important legacy to the practice was the ethos he gave and passed on best expressed in his parting words to Jane Richards when he was off on holiday: “Whatever you do, Jane, be kind to my patients.”
Zeta predeceased him in 1999 (BMJ 2000;320:1149, www.bmj.com/cgi/content/full/320/7242/1149#resp1). He leaves a son, two daughters, and several grandchildren.
Cite this as: BMJ 2009;338:b2234
Former general practitioner Marshfield, Gloucestershire (b 1912; q University College Hospital, London, 1937; FRCGP), d 17 December 2008.
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