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HAROLD JORDAN MALKIN

1898-1978


President of the Nottingham Medico-Chirurgical Society

1959 - 1960


Harold Jordan Malkin  26, The Ropewalk, Nottingham. C.B.E., F.R.C.S. (Edinburgh) 1925, M.R.C.S. (England) L.R.C.P. (London) 1923. M.D. London, 1926; M.B., B.S., 1924. F.R.C.O.G., 1938 (University College Hospital, London) Surgeon, Nottingham Womens Hospital Gynaecology and Obstetric Surgeon, City Hospital and Firs Maternity Hospital, Nottingham. Gynaecology Surgeon, Newark Hospital; Consultant Obstetrician Surgeon, Victoria Hospital, Mansfield, Nott's. Obstetric Specialist, Nottinghamshire County Council. Exam Centre, Midwifery Board. Association Exam London, M.B., B.S. Member of the Council of the Royal College of Obstetrics and Gynaecologists. Fellow of the Royal Society of Medicine and Nursing of England Obstetric Society. Late:- House Surgeon and House Physician, Royal North Hospital. House Surgeon, Obstetric House Surgeon, Obstetric Registrar and Associated to Obstetric Unit, University College Hospital, London.


Medical Directory 1948.


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Harold Jordan Malkin came to Nottingham in 1928, and was connected with the Old Samaritans' Hospital before it was changed to the Nottingham Women's Hospital. From 1937 he was on the staff of the Nottingham City Hospital, and before that in 1932 the Newark Hospital. Also from that same year, 1932 to 1945 he was linked with Mansfield General Hospital.


In 1956, Mr. Malkin was chosen to be a member of the Government committee set up to inquire into the country's maternity services, a committee that was led by Lord Cranbrook. During his long career with hospitals the many changes he was able to influence were advances in after-care.


Among his many duties Mr. Malkin held the position of president in the North of England Obstetric Society, and the obstetric section of the Royal Society of Medicine.


For the years 1959 - 1960, he was elected President of the Nottingham Medico-Chirurgical Society. Also at that time he was vice-president of the Council of the Royal College of  Obstetrics and Gynaecologists.


In 1963 he retired from the National Health Service but retained his position as chairman of the Obstetric Committee of the Nottingham City and County Health Executive until his retirement in 1969.


Harold Jordan Malkin finally passed away in December 1978, aged 80. In a memorial service held in January 1979 a tribute was paid to him. It was said; "Selfless dedication of his outstanding gifts in teaching and administration. Younger people, it was said, had been ready to respond to the inspiration of his example and the encouragement of his counsel."


Nottingham Local History Library


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“Obituary”


British Medical Journal,

6th January, 1979.


Mr. Harold Jordan Malkin, formerly consultant obstetrician and gynaecologist at Nottingham died on the 13th December, 1978; he was aged 80. He was survived by his wife Joyce and two daughters.


Harold Jordan Malkin was born on 27th April 1898 and educated at Epworth College and at University College and Hospital. During the first world war his studies were interrupted by service in the Royal Field Artillery. After qualifying in 1923 he held house appointments at University College Hospital and at the Royal Northern Hospital. He took the  Fellowship of the Royal College of Surgeons, Edinburgh in 1925 and proceeded MD in 1926. Two years later he became consultant obstetrician and gynaecologist at Nottingham and held the appointment until 1967. From then until 1975 he was director of postgraduate studies at the Royal College of Obstetricians and Gynaecologists, of which he had been a fellow since 1938.


Harold Malkin will be remembered in many places as the kindest and most considerate of friends, as a great obstetrician, a leader in the councils of his specialty, and a broadminded and tolerant seeker after the best outcome for us all and not merely for his own profession. He, and Miss Glen Bott established his specialty in Nottingham at a time when it seemed firmly under the dominance of the surgeons yet contrived to avoid the strife that so often attended such a development. He built up a centre that could compare with any, despite the limitations of hospital resources. He will be remembered for that achievement in the city to which he gave a life’s work far into the future. He taught many who were to look back on their time with him with gratitude and affection for the one who led by unmatched example. He was to play a large part in the establishment of the new medical school, even though he had ceased by then to be an active teacher. His devotion to Nottingham did not prevent him from playing a major part in the college of which he was to be vice-president, and in which he was to hold many offices. His last long service to the college as director of postgraduate education came at a time when that side of medical education most needed his talents of persuasion and patience. Harold was an original member of the Joint Consultants Committee at a time when that body played a crucial part in the inception of the National Health Service, a part too seldom recognised at the present time. His role in the N.H.S. was always constructive and fair and locally of the greatest importance. He was not merely active at the national level, but visited Africa, the Middle East, and the Far East on behalf of his college. He was one of the original group of regional assessors who made the confidential investigation into maternal deaths the outstanding success it became, and he served in that capacity for 20 years. This was a life of service to medicine at every level seldom equalled and never surpassed; but Harold’s memory will be cherished by all who had the privilege of his friendship or of his professional help being the man he was, even more than the great doctor he also was.


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PRESIDENTIAL ADDRESS


by


H. J. MALKIN, Esq.

M.D., F.R.C.S. (Ed.), F.R.C.O.G.


‘THE HEALING ART’

(AN HISTORICAL SURVEY)


Delivered Wednesday, 14th October, 1959.


Ladies and Gentlemen,


That you have made me President of our Society this year is an honour of which I am deeply appreciative and, apart from this evening, I look forward to a programme that I hope will appeal to you. That this is an old and well-known society was brought home to me by the fact that there was no refusal by any invited speaker.


It is, I am afraid, on this occasion of the first meeting that you have to listen to a talk by myself instead of an address, I am proposing  to make reference to some personalities who have a bearing on medicine.


In Ariege, in France. there is painted on the wall of a cave, a picture of a very early member of our profession, dressed in animal skins and made to look extremely ferocious. Even today, in the 20th century there are witch doctors who wear quills through their noses to produce the same effect. This fearsome appearance is presumably intended to strike awe into the heart of the patient and doubtless to make up to a large extent for lack of scientific knowledge. Perhaps the black coats and striped trousers used by past, and sometimes present-day, doctors are a symbol of the same idea!


The progress of medicine was roughly in three stages - the Pre-Dark Ages (up to A.D. 200), the Dark Ages (A.D. 200 to 1500), and the Renaissance to the present day (A.D. 1500 onwards).


In the Pre-Dark Ages, the first physician was Imhotep in 2000 B.C., who built the first Pyramid. He is often associated with Aesculapius, who, at the siege of Troy, was so successful in treating the wounded that he was deified. He was said to be the son of Apollo, and born on Mount Olympus, but his medical successes upset Pluto, who complained that Hell was becoming depopulated, and Jupiter, upholding the complaint, killed the offender with a thunderbolt. Hygeia (whose name is familiar today) was the daughter of Aesculapius. He had started the Aesculapian cult for healing, and 300 temples were built in his name and used as hospitals; their sign was the serpent, the touch of whose tongue healed. This is now included in the badges of many organisations, including the Royal College of Obstetricians and Gynaecologists, where it can be seen twined around his staff.


In Greece, at Delphi, the palace of the Oracle, is the Temple of Apollo, and inside one may see the actual spot where the Pythia or Pythoness (a girl or women selected by the priests as the mouthpiece of the Oracle) sat over a crevice which excuded intoxicating fumes. These fumes sent her into a trance during which she made her utterances. These were translated by the priests, who were very much the wise men of the day, and the translations were so carefully worded that the hearers were satisfied and the priests uncommitted! Kings, statesmen and great leaders, besides more ordinary folk, came from far and wide to hear wisdom, and gain advice, both medical and otherwise, from the voice of the Oracle. One such visitor was Croesus, who came especially to ask whether it would be wise to involve himself in a certain war. The Oracle replied that “in the case of such a war, a great nation shall fall.” Croesus went off quiet happy with this verdict. There was a war - a great nation did fall - but it was that of Croesus, and the Oracle had spoken truly!


Also in Greece, at the temple of Epidaurius, a great deal of healing was done, and I am reminded here of the story of Clio. She was a young woman, who having had no children, went to the Temple to ask that this might be remedied. She duly became pregnant, and grew larger and larger, until, after nearly five years had gone by, and she had not yet come into labour, she returned to the Temple to ask why this was so. She was told hat her wish had been to become pregnant, and this was granted, but she had never mentioned anything about being delivered. However, she was them permitted to come into labour and was delivered a son aged about four-and-a-half years, who took her by the hand and led her home!


Even in those days statistics were of some importance, and in order to keep figures of patient survival satisfactory, all the sick who were unlikely to recover were turned out into the hills to die. (On the island of Delos neither births nor deaths were allowed, and all women nearing confinement, and all aged and sick approaching death, were sent away). The Temple at Epidaurus has been destroyed, but the Greek Theatre, with its round orchestra or stage and perfect acoustics, still remains. It seats about 15,000 people at the Festival each year, and from a seat at the top one can distinctly hear the slightest noise - such as someone breathing - down in the orchestra.


The first medical school was at Cos, and there, about 400 years before the birth of Christ, we find Hippocrates - the Father of Medicine. He has been described, and I think very aptly, as a close member, a humane scholar and the first sound clinician. He recognised the difference between acute and chronic illness, and it was he who said “To know is one thing - to believe one knows, another.” The Oath which bears his name is, in fact, the background of a good deal of our medical ethics of today.


Another great man to whom I must refer was as interested in healing bodies as in saving souls. Some sixty years after the birth of Christ, Paul of Tarsus, moving from place to place, preached to the people and told them that he knew the name of the Unknown God many of them had been worshipping. In Athens, near the Acropolis, and in view of the ancient Parthenon and the Temple of the Wingless Victory, one can see the spot from which he preached. He preached in Corinth, too. When a prisoner on the way to Rome, and travelling in the same ship as St. Luke, he was shipwrecked and landed on what was afterwards known as St. Paul’s Island, where he and St. Luke gained a great reputation for healing, owing to their success in treating the Govenor of the island, who was suffering from enteric fever. Eventually, after continuing the journey through the Straits of Messina and passing between Scylla and Charybdis, Paul reached Rome for his trial. Later, when condemned to death, his judges discovered that although a Jew, he was also a Roman citizen, and therefore his execution must be by beheading and not by crucifixion as in the case of Peter.


The next great character connected with medicine was Soranus (A.D. 60). Born at Ephesus, and later going to Rome, he was the first specialist in obstetrics and gynaecology, and it was he who wrote the textbook De Morbis Mulierum, and it was he who taught version for obstructed labour - and that 1,900 years ago.


Galen, who lived about seventy years later, was medical officer to the gladiators. With him there was “No phenomenon without a name, and no problem without a solution.” He developed the fire, air, water and earth theory - fire was hot, air was dry, water was wet and earth was cold, and disease, according to him, was due to the balance of these four being disturbed. He was full of dogmas and he wrote prolifically, but all his theory and knowledge was based on animal dissection. (Incidently, 400 years before this, Theophilus, in the name of Alexander the Great, vivisected 600 criminals!)


The Dark Age was about to begin and Galen’s teaching lasted for nearly 4,000 years - until the Renaissance. This was unfortunate as he was utterly lacking in sound judgement and his teaching lacked it too, and the only real advance from A.D. 130 to 1500 was the building of hospitals. During the Crusades, between 1095 and 1271 (there were eight Crusades during this time) the Knights Hospitallers founded the hospitals in Europe and the Holy Land and cared for sick and wounded Crusaders. It is interesting that the Saracens already had hospitals and were considerably more advanced than the Crusaders, and they practised conservative surgery with great success, thereby saving many lives. Earlier (in A.D. 830) the Hotel Dieu had been founded in Paris. This was, it is true, a hospital - a building which could house the sick, but I will quote here an extract which refers to it.


“There were 1,200 beds. In one bed of moderate size lay four, five or six persons besides each other, the feet of one to the head of another; children besides grey-haired old men; indeed men and women intermingled together. In the same bed lay individuals affected with infectious diseases beside others only slightly unwell; on the same couch, body against body, a woman groaned in the pangs of labour, a nursing infant writhed in convulsions, a typhus patient burned in the delirium of fever, a consumptive coughed his hollow cough, and a victim of some disease of the skin tore with his nails his infernally itching integument. The whole building swarmed with vermin, and the air was so vile in the sick wards that attendants entered them with a sponge soaked in vinegar held before their faces. The bodies of the dead usually lay twenty-four hours or longer on the death-bed before they were removed, and during this time the sick were compelled to share the bed with the rigid corpse.”


During the Dark Ages medicine and obstetrics were crude in the extreme. Women in labour were bounced up and down to encourage delivery or held head downwards and shaken, or frightened by burning faggots placed beneath them. In an era when superstitious beliefs and practices flourished it was perhaps not surprising that an ailment might be considered to come from an evil spirit within, and there are many pictures of devils being cast out - usually from the patient’s mouth.


An event of particular interest took place in 1500. This was the first successful caesarean section in which the mother and baby both lived, and was performed not by a member of the medical profession but by a Swiss peasant on his wife, after the failure of the ‘lithotomists’. There were no sutures, and the patient subsequently delivered herself twins, and later of four other children, she herself living to the age of seventy-seven. (Recently, doubts have been raised as to whether this operation had, or had not been on a uterine pregnancy, as a secondary abdominal pregnancy could account for the successful outcome and the subsequent live births.)


The Renaissance, which we have now reached, is the beginning of the third stage of medicine. The first doctor of repute was Ambroise Pare’ in 1510, who was a Frenchman, and his contribution to medicine was of enormous value. He re-introduced ligatures to control bleeding, and he revived a similar version for minor degrees of contracted pelvis, a manoeuvre which, in fact, saved the life of his own daughter during her confinement. He also stopped the practice of cauterising the wounds, and the story of this, whilst he was an army surgeon, is well known. During one night he realised that he had forgotten to cauterise one of the wounded he treated the day before. His anxiety about his patient, and one may imagine his amazement when he found that the man with only the simple dressing was a great deal fitter than those who had their wounds cauterised. Pare’ was one of the few who had survived the massacre of St. Bartholomew’s Eve, because the King of France felt him invaluable, and said “it was not reasonable that I should die.”


A compatriot of Pare’, a Hugenot too, named William Chamberlen, also escaped the massacre by fleeing with his family to England. The Chamberlen family consisted of five, of which two, both for some reason named Peter, were Doctors. Both were interested in Obstetrics, and Peter the Elder became physician to James 1st of England and his queen, Anne of Denmark. It was probably Peter the Elder, too, who invented the obstetric forceps - a secret which was kept in the Chamberlain family for three generations. One member of the third generation was Hugh, whose claims for the obstetric forceps were very much exaggerated, and on this point the French surgeons, Mauriceau (to whom the family secret had been offered for the equivalent of about £2,000) took him up. Mauriceau had in labour at that time a rachitic dwarf, with the head above the brim. He felt that if she could be delivered by Chamberlain, then Chamberlain must have something worthwhile selling. Hugh boasted that fifteen minutes would be enough for his secret to do its work, but after working solidly for three hours, he admitted defeat; the patient died of a ruptured uterus the next day. Mauriceau’s especial skill was his excellence at breech deliveries, and his method of dealing with the after-coming head is still practised at present time.


The 17th century saw the beginning of science as we know it, when William Harvey (physician to Charles 1) discovered circulation. Having found that two ounces of blood flowed from the heart with each beat he did some calculations and realised that this added up to nearly six tons a day. Obviously this enormous quantity of blood had to go somewhere, and he came to the conclusion that it circulated back again; in other words, the heart was just a pump.


The first transfusion was from animal to man; man to man came later, but there were a great many fatalities. These were considerably reduced by the discovery by Lansteiner in 1900, of blood groups, and improved on still by the discovery of the Rhesus factor in 1940.


To go back to the personalities of the 17th century, we must remember William Smellie, whose knowledge of the physiology, mechanics and pathology of obstetrics was detailed and accurate. He trained 900 students, each of whom had to pay 6/- for the support of the “Poor labouring women,” and from 5/- to 10/- for each case which they personally attended. It is said by some that Smellie was a little slow on the uptake. I would doubt it. On one occasion when he was delivering a patient under the bedclothes (as was the custom in those days) he accidentally divided the cord on the wrong side of the ligature, the result being a fair haemorrhage before the bleeding end could be tied again. He solemnly explained to the midwife that this was his own method of “preventing convulsions”! He was certainly a great obstetrician and a great teacher.


In the 18th century we have William and John Hunter, to whom we owe amongst other things our knowledge of the foetal and placental circulation. William, in contrast to Smellie, with whom he quarrelled, was an advocate of masterly inactivity and enjoyed showing his forceps, rusty with disuse, and remarking that “it is a thousand pities they have been invented, for where they save one they murder twenty.” He was extremely conservative, and it is likely that his influence on Crofts (who was accoucheur to the Princess Charlotte) may well have been responsible for the decision for non-interference, which was followed by the death of first child, then mother.


Bartholomew Mosse, who founded in Dublin the fifteen-roomed house for “Poor lying-in Women,” the beginning of the world famous Rotunda Hospital, was followed by Fielding Ould. He it was who advocated episiotomy for delay due to a rigid perineum, and whose knighthood gave rise to the verse.


“Sir Fielding Ould is made a Knight,

He should have been a Lord by right,

For then each Lady’s prayer would be

O Lord, Good Lord, Deliver me.”


In this same century the contagious aspect of infection was recognised first by Burton in 1751, and then by John Leake, and the first treatise was by Alexander Gordon of Aberdeen in 1795. He showed the transmissability of disease and the need to disinfect both doctor and nurse. He had based his theory on seventy-seven cases and, with no knowledge of organisms, said that “Every person who comes into contact with a patient with puerperal fever becomes charged with an atmosphere of infection, which can be communicated to every pregnant patient whom he treats.”


The 19th century produced men who supplied theories and practices which were of vast importance to the medical profession and to the patient. Charles White of Manchester, who so strongly recommended fresh air and cleanliness in the treatment of illness; Oliver Wendell Holmes, and Ignaz Semmelweiss, the Hungarian who qualified in Vienna and was so struck by the difference in the death-rate in the wards attended by students, and those attended by midwives. In the students’ end of his hospital the death-rate was one in eight confinements, and the midwives’ end one in twenty-five. The death of his pathologist friend from septicaemia, following a prick with a knife during a post-mortem, caused Semmelweiss to appreciate a possible source of infection, and he surprised and shocked his students by insisting that they wash in a solution of chloride of lime before touching any patient. In three years the death-rate fell to one in eighty. So likely had death following confinement been part of this hospital, that the patients themselves had realised their danger and begged not to be sent into the wards run by students. The whole setting must have been depressing in the extreme. The lay-out was such that, to reach a patient in that part of the building where the death-rate was highest the priests arrayed in their robes, and with an attendant walking before them ringing a bell, had to pass through five wards first, and the constant deaths, necessitating constant processions, must have been disturbing.


A useful discovery by Laennec was the value of the stethoscope to help in diagnosis - and also keep the doctor away from the verminous bodies - the collecting of vermin from their patients was one of the occupational hazards of the doctors of that time.


Dr. Morton of Massachussetts discovered ether in 1846, and the first operation under it in England was at University College Hospital, performed by Liston, when Lister was still a young man. A year later Simpson discovered chloroform, to which a good deal of publicity was given, and interest in it was enthusiastic. At a dinner party Simpson and some of his friends tried out this new anaesthetic, until gradually, one by one, the guests slid to the floor, or slipped under the table, though one young lady, who was also trying out the new discovery, ran around waving her arms and shouting “I’m an Angel - I’m an Angel” before she, too, collapsed.


Joseph Lister’s introduction of antiseptics in 1851 almost eliminated death from the compound fracture, and medicine was by now advancing steadily. Germs were demonstrated by Myerhofer, and then, in 1897, came Pasteur, with his demonstration of haemolytic streptococci, and his use of vaccines. Lawson Tait of Birmingham introduced asepsis, Rontgen in 1895 discovered X-Ray and three years later Marie Curie showed us the value of radium.


Nowadays it is difficult to appreciate that there was no real nursing in this country until Florence Nightingale, who had trained as a nurse in Germany, began her care of the sick and wounded during the Crimean War. The hospital where she and her friends carried out their great and valuable work was at one time called Scutari, on the opposite side of the Bosphorus from Constantinople.


Having now come through the ages to the present day I would like to mention two medical centres in Yugo-Slavia which I visited last summer. Zagreb, the capital of Croatia, had in one hospital an exceedingly efficiently run obstetric and gynaecological department, and whilst I was in Zagreb, I visited their gynaecological clinic, and also spent some time watching their operating sessions, and was most impressed, not only by the work, but by the attitude to obstetrics and gynaecology. It was amusing to find in the maternity block, the patients, together with the doctors and nurses, were locked in, because, the Communist country thought it may be, the visitors are extremely difficult to control, and if entry were possible, would come and go at will. Each time one of the staff wished to enter or leave the department he had to wait to be let in or out by someone with a key to the main entrance, and when visiting time did come, and the doors were unlocked, it was the patients who rushed out to see the visitors.


At Zadar too, a lovely old former Italian town on the coast, I found again an attitude to obstetrics very similar to our own, and the members of the medical profession I had the good fortune to meet were, without exception, extremely interested in our methods in this country. What was disconcerting the doctors while I was there, was that they had just been told that in October all private practice would cease. This would mean a drop in income at the top level from about £3,000 a year to just under £1,000. Another point which I thought interesting was their method of dealing with medical cover for villages. Apparently it is quite easy to find doctors for town practices, but the only way of enticing them to the country ones is to pay them at a higher rate, and in fact, allow them to take in several villages, so that their total earnings might well exceed that obtainable in a town by a very considerable amount.


In the Pre-Dark Ages these islands in which we live knew little of medicine. During the dark ages themselves, our people joined other European countries in forgetting and ignoring what had already been discovered by great personalities of the past, and allowing prejudice and superstition to control what little knowledge of medicine was remembered, but since the Renaissance we have all moved ahead, slowly at first, and then more rapidly, until the beginning of the application of science to medicine in the 17th century produced more and more great men, and the 18th and 19th centuries brought discoveries and knowledge to the profession, for much of the time the world owes its graditude to the British Isles. It is earnestly to be hoped that whatever the geographical, radical and political boundaries and distinctions, the great men of science and medicine will continue to share and improve their knowledge and skill, to the benefit of the whole world; fortunately there is strong evidence that this hope is being fulfilled.


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