“The Trent and I go wandering by”

Robert George Hogarth


Chapter 2

In Practice – And How It Developed

"God, and the Doctor, we adore,

When danger threatens – not before.

The danger over, both are then requited,

God is forgotten and the Dr slighted."

In commencing this chapter, I think it might be most fitting to tell a story about the very first patient whom I had in practice.

In 1891 – long before I came to Nottingham – in fact only two days after I passed my Final and become qualified, I had a word with my mother, then living in Salisbury, that if I passed my Final she hoped I would come home – since Dr. Harcourt Coats was very anxious to see me. Now this Dr. Coates had taken a great interest in my career, and when in my student days I could get home for the holidays, he would take me round to the infirmary, and where he thought I might be interested. All this was greatly to my advantage, for Dr. Coates had what was probably one of the finest private practices in the country, and attended everyone of note for many miles around the city of Salisbury.

So it came about that I had not been home for very long before Dr. Coates arrived at my house and said – "Look here, young fellow, I am off to Epsom Races tomorrow morning and shall be away for four days or so. I want you to run my practice while I am away." What a responsibility for a young man qualified but a few days before!

"Good gracious," I said, "I couldn't possibly run your practice! You have such grand patients, and they just wouldn't have me in attendance!" "Yes", he said "they would, and will, for anyway, I'm going to the Races."

"Now," he added, "you just be down at my house at eight o'clock tomorrow morning and you will find that I'm off."

Somewhat nervously I obeyed on the morrow – living in hopes that if I did get a call it would not be from one of Dr. Coates high and mighties. Of course that's just what did happen!

I had not been more than 20 min in Dr. Coates surgery when a horse-backed messenger from a noble Earl came to summon Dr. Coates to see the ailing Countess.

My heart sank within me, but I ordered the high dog-cart, which shortly arrived, driven by a smart groom. This carriage was drawn by a beautiful fast trotting horse – a real picture of a beast, and one of seven horses which Dr. Coates then kept. So I was soon driven over to the Castle, where, as I can well remember, I knocked meekly on the door, feeling that of all people, I should not be the one to make a noise.

In response, an enormous liveried footman opened the door, looked at me questioningly, so I thought, and asked me my business.

"I have come from Dr. Coates," I said quietly, whereupon the footman eyed the doctor’s carriage and looking at me somewhat disdainfully, ushered me into the hall. There a very large and pompous butler came forward, and I timidly announced that I was the doctor and that I had understood that someone in the house was ill.

Whereupon this he ushered me into a very spacious Drawing Room and left me alone. After a while in came the Countess. Her ladylike bearing allowed her to hide what must have been her great astonishment at seeing me – for I looked much more like a 15-year-old, and certainly too juvenile to be a qualified medical man.

I asked her what I can do, and she complained that she had rather a sore throat – which might have meant anything. As bad luck (or possibly that excusable inexperience) would have it, I failed to bring a spatula – (one of those instruments which hold down the tongue to get a clear view of the throat) – so I said “Oh! might I have a spoon, a tablespoon will do?"

She rang the bell and gave the order to the majestic butler – who returned with the spoon placed in the middle of a very large silver salver. How well I remember that in taking the spoon my nervous hand allowed it to beat up a sort of tune, as if I was playfully using the salver as a drum. I doubt very much if the Countess would have been surprised at my playing the drum on her salver, for she must have regarded me as quite a youngster!

However, I did my best to appear professional, and proceeded to look down her throat, but however much I manipulated the spoon in the mouth I just can get tongue out of the way – with the result that I actually saw very little of the throat!

But in order that I should cover up this lack of elementary ability, and not display ignorance nor inexperience, I said, "There's nothing much to worry about, and I shall order you a gargle which I'm sure you will find a relief."

Now the only gargle which then came to my mind was Chlorate of Potash, with which everyone is familiar, so I wrote that on a scrap of paper and hurriedly left the house."

Once the dog-cart had reached the Lodge gates, I lit a cigarette – and wasn't this a nervous soother for the first ordeal of the juvenile doctor!

This was not the only episode connected with those four or five days when I was doing Dr. Coates’ work, and he was enjoying himself at the Races.

Some while after I attended the Countess, I was in the Infirmary with Dr. Coates. One or two other doctors, and one of the sisters and some nurses were present when Coates suddenly said, – "I must tell you people about Hogarth. As you know, he was called to see the Countess of – when he was taking my work for me. When I was next summoned by her Ladyship she told me that if ever again I dared to send a young boy like Hogarth to see her, she'd never have me in the house again! She even said that both she and the Butler at first mistook him for the newly engaged Hall-boy.

The little assembly chuckled, but, no doubt, in their hearts had a feeling for me. So that was the judgement upon this young medico’s appearance before his first private patient! But time went on, and with it my experience widened, and I feel that I might today say to myself – I wonder if that Countess would have spurned by professional advice at the end of say 10, or 20 or even 30 years after 1891, in which year she had not taken too kindly to being treated by a mere boy. (I'm sure she used these words). Somehow I doubt it!

Because I been nearly 7 years a Resident in Hospitals, and I wasn't feeling very well, or perhaps merely thought I wasn't (the failing of mine, I fear) – I did nothing in the way of doctoring for a year. But I did perform one operation which was important enough in itself – I went and got married!

Following on this I again gave some help to a doctor in a practice at Salisbury, where my home was. But it was not long before I again made tracks for Nottingham, and taking a little house which was vacant, at the end of the Ropewalk and facing the present Hospital gates my wife and I settled in.

In many ways it was an inconvenient little house – but it became ours and we managed to live in it quite comfortably for 25 years. We got used to it – but my friends used to draw attention to the awkward approach, for there were a great number of steps up to the front door.

To start a practice entirely on your own and without the backing of capital was less easy then than today. I had no capital and so dare not take a house on a long lease, nor, in fact, any place which would require more than a quarter's notice. But, when I really got going in my practice, my Landlord gave me a month notice, and so I was forced to buy the place for much more than its true worth.

It is rather curious, but nevertheless an established fact, that the more successful a Doctor or Surgeon becomes, the more unpopular he is likely to be amongst his professional brethren. I suppose, though, that this merely follows the general rule that "a successful man always has enemies." It is, I wonder, a more pronounced weakness in our profession than in others? Anyway, it is somewhat understandable, because it often happens that one doctor becomes exceptionally successful while his next-door neighbour (even if more highly qualified and equally able) cannot get together or build up a good practice at all! To a man who knows himself to be so qualified this "distinction" by the public must be very galling.

It is not all humbug all bluff which gets you in your practice, you know. In my case I know I didn't deserve the measure of success which came my way, nor could I for a moment claim that I was the best Surgeon in Nottingham – but I certainly can claim that I have the biggest practice – in fact one of the largest surgical practices in the Midlands. And there have it – success by pure good fortune, and possibly something else, just a good sense of one's fellow men!

To return to the progress of my practice. In the first year I managed to make an income of £60, and most of that was obtained through Mr Anderson asking me to give the anaesthetics for his operations! In those days, remember, the anaesthetist only got half a guinea for his fee – and you could not get very far on that!

To add to these fees I did get a few patients here and there – some from West Bridgford, and some from Sneinton, and to any patient I was quite prepared to go – on a bicycle – for a fee of 2/6 a visit. That's how it began!

But not long after I had started to build up the practice a stroke of good luck befell me. I got the appointment which had been advertised, as Surgeon to the Samaritan Hospital for Women. Added to this was the good fortune that one day Sir Thomas Birkin the Rev Russell of Wollaton (what a well-known name!), and Mr Spalding, came to offer me the post of Surgeon to the Children's Hospital.

This Hospital was then situated in Postern Street, and is now merged in the General Hospital.

Of course I was tremendously thrilled at the idea of being the Children's Hospital Surgeon, for up to that time they only had one Doctor, Dr Marshall, who has virtually monopolised the place and controlled it to his own liking.

To the offer I felt bound to reply, however, "My dear Sirs, there's nothing I should like better in the way of work, but it would be more satisfactory to me that you should advertise the post, and then if you really do feel that I'm your man, he will vote me the position!"

They expressed indifference but appreciated my point and acted upon my suggestion. There were a number of applicants, but I found myself selected!

And that started my long association with the Children's Hospital, for I remained as its Senior Surgeon for some 30 years – 30 of the most happy and pleasant recollections.

It was later that this Hospital moved from Postern Street to Forest house, upon the gift of that by Sir Thomas Birkin. Since then, Mr and Mrs J. D. Player have gone one more generous step forward and have provided the magnificent Children's Hospital which now stands there, and which I personally regard as being one of the finest Children's Hospitals in the Country.

I have mentioned my good luck of the early days. The following shows how that good luck stayed with me.

Mr Anderson, whom you'll remember my mentioning as the world's worst cyclist, had a nasty fall from his cycle in Chapel Bar, and very seriously injured his right knee. I suppose that I had only started in practice three months previously, and I was definitely not a known man at the time.

On his being carried home, the news of Anderson's accident soon spread and two of his colleagues came in to see him, suggesting this and that and saying that they'd return in a couple of hours or so and would put up the injured knee in the sprint.

Meanwhile Anderson decided for himself and told his wife to summon me. "Look here, Hogarth," he said, on my arrival, "I badly smashed mine the. Have a look at it – now go back to the Hospital, get whatever type of splint you consider best and come back and put it up for me. Oh! – further, I'd like you to take charge of my case – so please hurry, and get the splint fixed before those other fellows return!

I was only too glad to get busy!

And so, of course, it soon got around that "Mr Anderson had insisted upon Mr Hogarth looking after him" – and you can imagine what an excellent piece of advertising this was for me! My friend and mentor or had done me a far more useful service then I had him.

Before I came to Nottingham I played quite a lot of first-class football – so it is not surprising that from the very early days of my practice I like to see either the Forest or the County play. One day – it was on the Forest ground – Spouncer, the Outside Left, got hurt. It happened on the opposite side of the ground from me, and there was a sudden call for a Doctor. There were obviously many doctors present, but I determine to be first on the scene, and being still a sprinter above the average, I won the doctor race with some ease and the injured outside left was my patient from that moment onwards. But that was not all, for upon this I was engaged by the Forest Club to be their official Doctor, and I have been closely associated with the Club ever since. Today I am in the proud position of being its President! There will be more to tell of my happy association with the Forest Football Club later on.

One more fortunate contact came my way soon after I arrived in Nottingham. The Duchess of Portland (now the Dowager Duchess) came to see me and said "I am very interested in crippled children. I am going to get them collected in various centres in Nottinghamshire, and I shall ask you to be good enough to come and see them for me, and to advise in what way they best can be helped."

Of course I was just delighted to accept!

Anxious to clinch the matter, the Duchess asked me to stay a night at Welbeck, and there to discuss our plans.

It is only natural that as a rather shy young Surgeon I should feel somewhat nervous on being entertained at Welbeck – but need I have been? – No, the Duke and Duchess were in residence alone and in their charming way made me feel not only completely at home, but definitely their friend and adviser.

Thus began the Cripples Guild.

Later followed the foundation of the Hospital (which I looked after for many years) at Grindley-on-the-Hill. This Hospital was provided by the generosity of the Duke of Portland and Gen Sir Joseph Laycock, and is now an annexe of Harlow Wood Orthopaedic Hospital. So it may be seen that Harlow Wood emerged from that modest beginning to become one of the largest and most important Orthopaedic Hospitals in England.

This has all been achieved by the boundless energy, and enthusiasm, and (let us not forget), the kindly feeling for those who suffer, for which Winifred, Duchess of Portland has been renowned through the many years of her life.

When Harlow Wood was opened, I, in my turn, had the honour of being appointed Honorary Consulting Surgeon.

I must not omit to say at this stage that I also obtained a third appointment, that of the first of two Assistant Surgeons (a newly-created post) at the General Hospital. Either speak came attached for duty to Dr Owen Taylor and Mr Anderson. The other newly appointed Assistant Surgeon was Mr Morley Willis, while two new Assistant Physicians, Dr Jacob and Dr Cattle were also brought on the staff.

These new posts were eagerly sought amongst the profession and were the subject of much competition.

Dr Jacob will be long remembered in Nottingham. A vast number will recall what a splendid Physician he was. Unfortunately for his many friends in Nottingham he no longer resides here but has selected Malvern for his retirement.

I had thus attained the position which more than any other up to that time I wanted – to be on the staff of the Nottingham General Hospital.

As I now have three appointments it may be seen that I had plenty to do – but I was also very rapidly getting together a good practice.

The speed with which this building of the good practice progress has also an element of good luck associated with it, as the following will show.

There was a certain Dr in Nottingham who had the reputation of being very self-opinionated, very pompous and altogether very pleased with himself. He had a very fine practice, probably the best in the place. Just about that time one of his best-known patients had a fall, injured his knee, so that he found it most difficult to straighten it again. After he had been in bed for almost a week he was told by his doctor that the leg would have to be put in plaster of Paris for some six weeks, for an internal lateral ligament had been torn.

Well, as I have said, having attended Dr Anderson for his knee injury (and having by now being appointed the Forest Football Clubs doctor – and later in similar capacity to the Notts County FC), quite a number of people began to point to me as "the man who knew all about joints." I think this might have been true, for I had gained excellent experience just previously, having been House Surgeon in London to the great Howard Marsh, and he was absolutely first class on the subject – the treatment and manipulation of joints.

This Nottingham big noise must, therefore, have heard about me, for he suddenly summoned me to his house. However, he mentioned that as yet he had not told his own doctor that he was calling me in.

For my part I thought it politic not to go until the man's own doctor you this, so I went myself to see that doctor, and explaining the position asked if he would make an appointment so that we could together see his patient. He bluntly refused! "I know perfectly well," he said, "what's the matter with the man's knee."

His abruptness I met with "Very well, if you are not coming with me, I'm going alone" – and I did.

The patient was in bed with one knee slightly bent and nurse standing by – a pile of plaster of Paris being handy to put up the joint in this plaster for, maybe, six weeks or more.

I looked at the knee, formed my own opinion (quite contrary to the man's own doctors), for it was obvious that all the treatment required was immediate manipulation. I asked "Can you stand a bit pain?" He said that he could, so I took the knee, bent it up sharply and quickly straightened it out. It hurt him a little – but the job was done!

"Now," I said, "you just get up and walk around the room." So he got up and walked along quite normally. Upon this I said "Now then, you are quite fit to go to business this afternoon. You must keep using the knee, otherwise try to forget it, and I'm sure it won't bother you anymore. You might, by the way, send this nurse round to the doctor with his plaster bandages, and at the same time let him know that your knee is cured, and that you are now going back to business." The delighted patient, concurred!

Of course, that healing story soon got about, and much of my practice soon consisted of the one-time patients of this man's doctor – for they came, as a result of this recommendation, asking me to be their family doctor.

I kept to the rule of saying that I'd be delighted to attend but they must first write to their previous doctor to let them know they were making a change.

It was thus that in quite a short while I find myself with the rapidly forming and already highly remunerative practice, which included attendance upon some of the best-known families in and around Nottingham.

From my personal point of view this was, of course, all very satisfactory, and to add to it I also had the three Surgical appointments at the General, the Children's and the Samaritan Hospital for Women.

Now to be a purely Consulting Surgeon has always been my real ambition, but to launch out into this would mean making one of the most momentous decisions of my career, because I should have to decide upon the merits of giving up this excellent general practice and then to take to Surgery alone.

If you wish to be a consulting Surgeon At it is no use attempting to carry on any general practice at the same time. You must concentrate on Surgery alone.

There is more to it than that – for when you become a Consultant the whole of your practice depends upon the goodwill which you establish with other doctors, who feed you by sending their cases to you, or by calling you in as a second opinion.

It was definitely a difficult decision for me to take – having started virtually from zero and having obtained such a good income in the short while I had been in general practice. There is, of course, bound to be some uncertainty as to whether you will be the same success as the Consultant as you were as a General Practitioner.

However, after much consideration I took the plunge, gave up my general practice and became a Surgeon – a decision which, I am glad to say, turned out to be wise.

Very naturally I was loathe to give up all those nice kind people who had placed their faith in me as a doctor, so I had to begin this transformation by accepting no new patients, and gradually dropping off the others. It needed tact, and had to be carried out by easy stages – resulting at the outset in a considerable drop in my income.

However, I soon began to get a fair amount of surgical work, and then my previous good luck held, for I was elected to the full surgical staff of the General Hospital, upon Mr Chicken’s resignation.

To mark this notable step I had launched out into ownership of a motorcar, and I fancy that I must have been the first doctor in Nottingham to possess one.

There followed the peaceful period which we now all know to have been the "calm before the storm," and when eventually the First World War broke out, a great many doctors had to join the forces, the piece-time strength of the Royal Army Medical Corps being quite inadequate from the outset to cope with the need.

The recruiting took all the younger men, leaving the three elder Surgeons, Dr Anderson, Mr Morley Willis and myself to carry on as Consulting and Operating Surgeons for the Hospitals, Civilian and Military covering the whole of the immediate surrounding area of Nottingham.

As they were considerably more than 1000 beds reserved for Military use in Nottingham – including those at Bagthorpe and those put up at the General Hospital in the hut built over the back lawn – we were kept exceptionally busy, in fact almost worked to breaking point, seeing that we also had to attend to our private operations.

As some relief from pressure, I must note, I had by that time ceased to be working at the Samaritan Hospital for Women – but more and more work came my way.

Now to be added was my appointment as Consulting Surgeon to the Duchess of Portland’s Hospital at Welbeck, secondly to Lady Charles Bentick’s Hospital, Mapperley and finally to Mr Charles Birkin's Hospital that Lamcote – truly I had a whale to carry on my back.

It is to be wondered that I have a tale or two to tell?

My first was produced by a curious coincidence. A man came into hospital after the Battle of the Marne and I removed the shrapnel from his right leg. The leg eventually healed and the man in due time return to the Front. Some eighteen months later he was again wounded – this time in an exactly similar place but in the other leg. Back he came to England – into an ambulance Train – out at Nottingham and, would you believe it, finding himself once again in the same bed as he had occupied before. Same Surgeon, same recovery – but different leg.

The rarity of the coincidence may easily be seen, for on arrival as a stretcher case in England, myriad are the hospitals in which he might have found himself – but same wound – same bed – same surgeon was fortunes decree!

I find the strangeness too in the following. In hospital was a soldier with a bad shrapnel wound over his left buttock. I took out a lot of varying shapes of shrapnel, deeply embedded, but at the same time I removed from the wound some five or six German coins.

When I saw the man later I told him what I had found and said "How the Dickens can you account for coins in your wound?" He remembered and said "Just before I was hit I took the money from the dead German and put the coins in my hip pocket." The coins have been carried into the body from the shrapnel!

As Consulting Surgeon to the Bagthorpe Hospital I was one day escorted by Dr Cole of Beeston who had charge of the ward I was to visit. "Hogarth", he said, "Here’s something strange for you. Lying in adjoining beds are two soldiers who arrived by last night's convoy. One is named Hogarth and the other, Cole!"

So I became quite interested in my namesake Hogarth, for the name is not very common, and I enquired of his parents and place of birth. Apparently he lived in Norfolk and was a schoolmaster’s son. And, being a namesake, I sought to do all I could for him, even down to ensuring that for his convalescent he should go to Welbeck, where he would be so well looked after. The Duchess accepted him upon my recommendation, but, I regret to say, the man did not live up to his name, and being rather more than a nuisance there, he was eventually turned away elsewhere. But how was I to know who had laid claim to such a name?

Unfortunately our colleague, poor Morley Willis, contract a fatal disease during this War period, and a great deal more work was required of Mr Anderson and myself.

The War Office did offer us the help of another man, but, to the credit of Mr Anderson, an older man than me, he decided to carry on alone – and carry on we did.

It was probably verse that in 1918 we found ourselves awarded the C.B.E.

There were difficulties too at the General Hospital, for we could not get any Male Residents. It was finally decided that we should apply to the London School of Medicine for Women, and then get some Women Doctors in the place.

How particular fortunate I was in having Miss Glen Bott's attached to me as my House Surgeon, in which post she remained as my active aid for four years.

Afterwards she started in practice for herself, and there are very very many in Nottingham who knows what a success as a Surgeon she has been. She is certainly the best woman Surgeon I have known, for I saw much of her work, been fortunate to have her for many years as my Assistant for private operations as well.

I also had very often, as an Assistant in private, Mr Llewellyn Davies, for which it can be seen that I had exceptional and fortunate aid, for the last two named can be styled as two of our leading local Surgeons of today.

By leaps and bounds my private Surgical practice grew after the War, and I soon found myself in increasing demand in the City and its surrounding districts. By this time I had taken over the complete Nursing Home, with sixteen beds, and situated in Regent Street. It was always full!

Much as I enjoyed that work, I never like to stray in my affection, nor neglect any duty in the General Hospital, for it was from this Hospital that I derived more pleasure by association than from all other of my varied work.

Do not blame me for harping upon my good fortune – it seems to have been so recurring.

A great piece of it fell to me when in 1926 I found myself selected as the President of the British Medical Association – one of the finest and largest professional Associations in the world, to be President of which would be any man's pride.

Having been President of the Nottingham Division of the British Medical Association, and also of the Midland Branch, I had been given the tip that I was well in the running for the National Presidency, and though I personally thought my chances remote, I duly (and most gratifyingly) found myself elected.

To deal with the events of the term of this office would almost need a volume to itself, suffice it to say here that the office, though high and acceptable, is not all beer and skittles but proves rather a difficult position to hold.

In my year of office there was doubt in some quarters about the venue of the British Medical Association's General Meeting – and there were some who thought that it would hardly prove a success if held in this Midland City – but success it proved to be, in fact the meeting is remembered as one of the most successful and universally acclaimed of all held to that date.

In this ancient (and yet in many ways most modern and progressive) city of the Midlands was found a place more pleasant and more hospitable than many had dreamed!

The Presidential Address of such a General Meeting, finds itself reported in almost all the press of the country, and in that of much of the world beyond our shores. Are you surprised and that any ordinary medico should find the delivery of this Presidential Address somewhat of an ordeal?

The setting of the scene in the Albert Hall I thought most impressive; the Doctors all in Academic Robes, the Ladies in evening dress – and representatives of all our Dominions and Colonies present too.

We followed up our assembly with a grand Reception at the Castle where some 2500 and accepted the invitation to be the guests of myself, my wife and the Nottingham Division.

It was a gay scene – the grounds all lit up by fairylike, and in the large marquee a Cabaret Show and Dancing – dancing to the full band of his Majesty's Grenadier Guards, which – partly to the good auspices of my son, who served with that Regiment – I had been able to obtain for the occasion.

It was a sad blow to us that this son, who had served in both the World Wars, should lose his life while serving in Italy in 1944 – so close to the year when peace was once more secured.

As President on such a historic occasion one very naturally receives kudos for the success obtained. I would rather point and say thank you to the whole of the Medical Profession – both of the City and County – for theirs is the truly valuable work of organising.

Much of the success was undoubtedly due to Mr Webber the Honourable Secretary – but who nobly too did the women respond, Mrs Webber, Miss Kirrage, for whom I and most indebted to the B.M.A. and to whom I can as thankfully and appreciatively address myself today – before she remains my secretary still!

But a Presidents task is not finished with the Annual General Meeting and its attendant functions, for there is the most incessant call upon one's time to attend meetings, and Branch functions up and down the country.

As a consequence time is spent in travelling, hours are erratic and a practice – even though good and well established practice – is bound to lose some of one's attention. But what a grand year of office it was!



The Trent and I go wandering by