Many people know the name Cheddar or know it’s association with Cheddar cheese.Some have heard of the 450 foot depth Cheddar Gorge, in the Somerset Mendip hills, and some have heard of Glastonbury ,the famous International Festival and the associated Crown of Thorns story. Few have heard of Cheddar Man, who is the oldest complete male skeleton found, in 1903, in Britain. Let’s educate you and then talk about my two years spent as a doctor in Cheddar in 1965 -66.
Cheddar Cheese was developed in the village of Cheddar in the 12th Century and was very popular at Nobles’ banquets. King Henry II bought 10,000 pounds of it in the year 1107 and called it the ‘Best in Britain’.It is rated in 2020 as the second best on earth, by Americans.There are claims,
all over the world by companies producing Cheddar cheese that their cheese is absolutely authentic and in keeping with the original recipes.There are equally disputes ,all over the world, that these claims should be refuted. The advice should be ” caveat empor.”
Who is Cheddar Man?Well this man is a human fossil,discovered in 1903 in Cheddar.He is the only complete male skeleton, in Britain, and radiocarbon dates him back to the Mesolithic age some 10000 years ago i.e. approx 7100 BC. In life he was probably a typical Western European 166 cm tall with light greeny/ bluish eyes, dark brown hair and dark to blackish skin.His current home is the Natural History Museum in London.
Glastonbury is a small town a few miles west of Cheddar. Since the 1970’s
a Special June Festival ,lasting a few days,has been held there. Glastonbury has a rich history of spiritual pilgrimage, has magical healing energies,many sacred sites and has an adorable worship of sacred feminism as well as being the Heart Ch aka of the planet earth.It is the largest Green-fields Musical and Performing Art Festival in the world, occupying a site equivalent to 500 soccer pitches.Already 135000 tickets have been sold for the 2021 festival and,whilst other venues may have far greater attendee numbers,Glastonbury is ultra special.
There is a legend that a Holy Thorn tree was planted at Glastonbury 2000 years ago by Jesus’s uncle Joseph of Arimathea,who had cut a piece of the Crown of thorns that the Roman soldiers had placed on Jesus’s head prior to his crucifixion at Calvary and kept it.He planted it at Glastonbury on his travels across the world.It grew there,was revered, and looked after,horticulturally ever since,despite attempts to damage the tree by Puritans and other religious dissenters over the centuries.
Regrettably, on Friday the 23 May 2019, the tree was intentionally destroyed by vandals and the landowner removed all trace of the remains.
The legend is mentioned in William Blake’s famous hymn ”Jerusalem” with the words, ”And did those feet ,in ancient times ,walk upon England’s mountains green. And was the Holy lamb of God on England’s pleasant pastures seen.”
Cheddar’s Medical Practice was an NHS one, which provided medical and allied health services to a wide surrounding Somerset country area.This included 10 other small villages, within a radius of 4-8 miles of the Cheddar surgery. The Maternity Dept in Wells District Hospital, 7 miles away, enabled a GP to deliver the babies of some mothers, with a low risk medical and obstetric history, in keeping with best care practice in 1965.Cheddar has always had a thriving tourist industry as well as farming and fruit growing smallholdings. I was pleased to play Rugby ,Cricket and Tennis for their local Clubs.
I recall a number of events which I felt were worthy of including in this section of my small tome.
A CASH STASH IN THE COUNTRY
The big,burly, PC from the local cop shop, phoned me at 11 AM one weekday morning.He requested my urgent attendance at a delightful, white walled, thatched two bed-roomed country cottage some 4 miles out of town.
He himself had been urgently summoned to the cottage by a close neighbour of the cottage owner.It seems that the 75 year+ old lady had failed to appear outside of the front door to perform the daily routines which the neighbour was accustomed to viewing, and, because her routines were fixed and inflexible, he suspected that she might have died,which she had ! This was confirmed by the burly bobby. He needed reassurance that I was able to support his suspicion of her death.I could provide a death certificate,after examining her, so that the Coroner would not need to be informed and so that he could then find out if there was a relative he could inform.
The dear deceased was lying flat on the sofa and, when I stood up,the PC and I both noticed that the ceiling above was significantly bowed instead of being straight. We scuttled up the short stairs, and,there in the spare bedroom, was a huge collection of silver coins,piled high and wide across the sagging carpets
.The PC phoned the local Banker asking him to come immediately and bring a spare teller,lots of sacks and a couple of extra pens and paper.I was fortunate enough to also receive an urgent call to return to examine some living patients at the surgery. The others remained to pick up and count 20,000 pounds sterling in 10 and 20 pence coins.
It was a quickly solved scenario and there was no need to invite Hercule Poirot to the cottage in the country to unravel clues. This dear lady had owned,with a relative, who had passed some years before,a small, but cash profitable, local tourist haven. I guess it gives credence to the expression ”The BEST place to put your money ,darling, is under the bed so that no- none will ever find it” ….that is no one except a big burly PC and the local GP acting on the suspicions of a nosy neighbour.
HOME VISITS…….A COUNTRY PRACTICE OR NOT ?
All GP’s who work in rural areas of the country expect to visit a number of their patients at their home.In the 1960’s doctors in practice were paid, by the government, a fixed amount per year,called a capitation fee,for each person registered to your practice.
Whether you saw your patient once a year or once a week you got the one annual payment through the free National Health Service. You couldn’t ask the patient to pay any extra at all, whether they were seen in the surgery,at their home,nursing home or in a hotel and whether it was at 4 am , 10 am or 11-30 pm at night.
The government was ,to say the least,mean and you could only make a bit more money by signing up more and more patients to your practice.Some extras were paid for immunisations,ante- natal care, obstetric procedures, special medical exams and reports.
Your expenses, and cost of living matters, always outweighed any tiny increase that was negotiated by your Medical Association. This meant that, if you were a new, poor GP with a rubbish car and hungry kids,your signed- up patient numbers had to be very large,say 4000-5000 to get the financial ball rolling. But,the more patients you had, the more was the demand on your time and the quicker and quicker you had to work.In addition, you were asked to do more home visits because the service was free to everyone and therefore you found that you had landed on a never ending treadmill which went faster and faster the more you worked …get the idea?This often led to tired older doctors taking less and less of the load and enthusiastic young ones getting burnt out much sooner than expected.
This situation,with a free system for the users, has remained a thorn in the flesh of British GP’s during the last 60 years.Apart from trimming at the edges, there has been no fundamental revision of the NHS status- quo.In the 2010- 2020 decade, 25%-30% of British doctors migrated to other stable countries and have been lost to their country of birth.This is a regrettable fact not simply a bit of political commentary.
Which takes us back to home visits.
I loved doing regular home visits, and most patients used them wisely when a real need arose.In rural regions there are less cars,less trains and less buses and it is unwise to try to go to the surgery on your bike if you’ve got vertigo, a broken ankle,bad bellyache or impending pneumonia. I have,however, seen salt of the earth country folk do all of these things rather than “troubling the doc” by calling him/her out.
In the City, the ambulance often fits this task.though it is probably more frequently abused incorrectly rather than used correctly. A home visit opens the door into the sanctum sanctorum of your patient and both patient and doctor learn a lot about each other during these short or long events.If a mixed variety of generations of the family are in the house, when you are proffering your professional wares,so much the better.
My doctor’s bag always generates keen interest with youngsters.It is a mythical, magical leather box of never ending drawers brim full of a seemingly endless potpourri of pills and potions and usually accompanied by another case full of instrumental wizardry, a “just in case, case”.
This is sometimes a convenient occasion,unless the patient’s illness denies you, to wise up the kids with a stethoscope or auroscope demonstration.One should refrain from showing ampules of morphine or opioid tablets.In the 1960’s it was very common to carry necessary drugs of addiction in your doctors bag but GP’s in 2020 are often loathe to do any home visits for fear of being followed and accosted and assaulted by drug seeking villains.
In Cheddar it was usual to do a circuit of a regular 10 or so visits around the traps a couple of days a week in addition to the usual 3-5 new daily requests.Folks were almost always pretty considerate though. I frequently returned home after work with a couple of punnets of Cheddar strawberries,some delicious cheese, or other local produce or flowers, from grateful, understanding patients.
WE HAD A GUT FULL ON CHRISTMAS DAY AT CHEDDAR IN 1965.
Not all home visits leave you feeling fulfilled, and, in 1981, singer John Denver helped to explain this in his song ”Country Roads”……”Some days are Diamonds,some days are Stone.” Christmas Day in 1965 was hard labour stone.
At six o’clock on Christmas day morning a young woman phoned me and asked if I could visit her in Wedmore , a village 4 miles away, because she she had tripped in the pub where she was working as a waitress, and had twisted her ankle ”really badly doctor.” “Of course “, I said, and picked up a few bits and pieces and my doctor’s bags, hopped in the car on a freezing morning,and arrived at the pub in Wedmore after 15 minutes.
She had a minor sprain,did not need an x ray, responded to I.C.E., a mild pain killer and a bandage and I arranged for a post- Xmas follow up.I turned on the Christmas radio program, arrived in Cheddar in 15 minutes. I walked up the stairs to be greeted by Anita who said,”Alan I just took a call from Wedmore ,they’ve got a baby over there with a rash and her mother is pregnant and they want to know if it’s German measles.Yes, German measles can be very dangerous, if a mother catches it in pregnancy and she has never had German measles herself when she was a kid and hasn’t been immunised against it.Anita, being a well informed mother and Nurse/Midwife was right. I got my brolly, hopped in the car again, and 15 minutes later arrived at a small flat in Wedmore.
Lovely little baby with a nappy rash,fully examined and mother reassured.I went back to the car,brolly in hand ,snow falling down and drove back to Cheddar ready for a hot coffee and biscuits in 25 minutes.Anita was at the top of the stairs to greet me with Daniel.
Daniel our son was eighteen months old, was screaming with the tummy ache ,farting profusely and had yellow green smelly diarrhoea dripping down his legs.
Anita asked if I could have a quick look at Daniel because he was vomiting as well as dripping diarrhoea down his legs and onto her lap. I pulled out some special Paediatric Electrolyte mixture from my doctor’s bag and some anti vomiting medicine having retrieved from a frozen, snow covered car and handed them to Anita.
Just as Anita climbed back up the stairs,she said,””Look, i’m really sorry but yet another call came in from Wedmore just as you pulled into the drive.There’s a 20 year old bloke who was stung by a bee on his left elbow and he feels dizzy and thinks he might be badly allergic to bee stings.Is that OK ? I told him to put a ”Blue bag” on top of the sting to neutralise it, and that you’d come over straight away.”
I nodded,Daniel farted and exploded a huge amount of smelly diarrhoea over the towel on Anita’s lap and onto the stair carpet.
At that moment I knew that I should race back to Wedmore, and hoped that the guy wasn’t developing acute anaphylactoid shock.Fifteen minutes later there was our bee stung young man, looking as fit as a fiddle,and greeting me with ”Gees Doc, your missus is pretty bloody smart ,she’s fixed it with the bloody blue bag! Happy Christmas mate, see ya!”
Back to the car radio and ”O Come all ye faithful,”and 20 minutes later, shivering around our 3 kw heater,I re-examined Daniel,and watched him guzzle his Paediatric Electrolyte mixture.
I made sure that he wasn’t too dehydrated,took a big swig of coffee and another four biscuits and sighed,saying “Thank God that’s all over,now we can try to enjoy Christmas.”BUT IT WASN’T”! I was just closing my eyes for a short, well earned kip, when the phone rang again.
It was an anxious 18 year old country girl who was staying at Wedmore for the Christmas holidays.She said shyly and furtively….
”Yea, well you see, Doc,look, I’ve come up from Bridge-water (20 miles away)
and, yea, well, look, I left my packet of Contra pills at home.She rambled on that,”Yea we had ,you know, sort of had it last night and last week and i’m really f…..g scared that I might be in the f…..g, family way because I forgot to take them a couple of times last week as well.Yea, I know i’m not one of your patients,Doc, but my friend says that she knows you and that you wouldn’t mind if I phoned even though it was,like, Christmas Day.My Dad would f…..g kill me if he found out,Doc.”
I swallowed my Adam’s apple,groaned inwardly and,having got her address, raced down the stairs ,hopped into the snow covered car,turned up the heater and pointed my steed west towards Wedmore.Fifteen minutes later ,after struggling to find her address,the 18 year old greeted with a”Thanks for coming Doc.” Thankfully I did remember to bring my Pregnancy testing kit and a refill for her Oral Contraceptive Pill.We had to have quite a long chat about the birds and the bees and the importance of her role in correctly managing her own lifestyle matters and associated responsibilities.Her pregnancy test was negative and she agreed to repeat it in a few days, in the surgery, before going home to Bridge-water .The modern “morning after” pill regime was not available in 1965.
Anita and I had made frugal preparations for our evening Christmas dinner ,bearing in mind that I was the only doctor on call for Cheddar and it’s environs.
We managed an entree,in between Daniel’s personal requirements, but still copped a couple of early evening emergencies,The last of these was a distraught mother whose two year old son had developed an acute onset gastroenteritis,with associated vomiting and diarrhoea.It was not of the dripping down the legs and puking on Mum’s hair variety. Mum hadn’t seen it this bad before and asked me if there was much around?
I empathised and placated her,assessed the extent of the problem and her child’s general condition and we decided that, if little Charlie wasn’t any better, or if he was any worse,at 9 pm,she should call me and we could have a good look at him, otherwise we’d see them in the morning,and yes there was the odd child with the gut rot down the street.She followed my treatment and Charlie seemed much better on the following day.
Yes,the 18 year old Country girl’s pregnancy test continued to be NEGATIVE.
Every year, since 1965, our family have celebrated Xmas family dinner on Christmas Eve.We recall John Denver’s immortal words each year.”Some days are Diamonds,some days are Stone”..SHINE ON!!
WELL AT LEAST I DIDN’T LOSE MY RIGHT MIDDLE FINGER .
Now here is a medical story of intrigue and mystery.
It all happened in Cheddar and it all happened to me. Was there a happy ending or not?
I was sitting in the Clinic and started to shiver and shiver and shiver and yet it was midsummer.My teeth started to chatter and,i’m told that I started to look hot,sick and pale.
Sister felt that I should cancel the rest of the clinic or hand the remaining patients over to my senior colleague Dr Mike,which I did.There wasn’t any ‘flu around,I didn’t have a cough,abdominal pain or hidden gallstones,but I did have a temperature of 39.4 degrees and an itchy right middle finger, especially on the skin at the back of it’s middle phalanx bit. I took two aspirins and water and slowly drove home and went to bed.
Dr Mike kindly visited me later and we both thought I had caught ”some sort of a virus” and needed to sweat it out ,at home, for a couple of days, and we’d see what transpired in the meantime.
Well the symptoms persisted with sweats ,headache,nausea and aching muscles and then a small blister appeared on the back of my right middle finger. After 24 hours the blister festered into a shallow ulcer. At the same time,a couple of small lymph node lumps appeared in my right armpit.
Both Dr Mike and I were concerned that I might be developing Cutaneous Anthrax,a rare infection caused by the skin on my finger having been exposed to a bacterium, bacillus anthracic. This bug gets into you if you touch the wool or hide of an infected, wild grazing or domestic animal.
Rural farming areas have thousands of sheep and other animals,and, although anthrax is as rare as rocking horse manure,20% of patients infected with the skin infections die. 80% die if they have the infection in their lungs unless urgently given intravenous Ciprofloxacin or doxycycline antibiotics for at least 60 days.
After an urgent call, to the regional Hospital, an ambulance arrived and, with all lights blazing and all bells ringing, deposited me into the care of the Emergency Department where three gowned Specialist doctors took all my details,swabbed and phlebotomised me
They slipped in an IV line to provide fluid and antibiotics and huddled together, into a speculative diagnostic conference.Whilst they could not exclude anthrax they were at pains to say that they would include it as a possible cause of my affliction ..”Just in case, Alan,and, by the way could you give us Anita’s private phone number,again just in case.”
.My condition ,though not rapidly improving over the next three days, did not deteriorate.The fever started to subside, though the ulcer got blacker and spread to the base of the middle finger and the armpit lymph nodes increased in size.
There were no definite diagnostic clues in the blood tests and swabs except that the Special lab tests didn’t grow any Anthrax bugs. The Three Wise Specialists declared that I had been ”a tad septic”. A couple more days of hospital rest and I felt fit enough to escape back to Cheddar country.The only strange thing that persisted for 4-5 more days was the black scab on the finger which gradually lifted itself to reveal a pink area,the size of a 10 cent piece,replacing the black one.
The skin blemish eventually became wrinkled, like the crow’s feet on an aged forehead, and it has remained thus over the last 55 years.
So what was the mystery and what was the diagnosis?
Well, in the 1960’s, we were still vaccinating children, and unvaccinated adults, against smallpox, because the disease had not yet(until about 1980) been declared, by The World Organisation, to have been cleared in the world.
We offered vaccination,in the clinic,freely when necessary.
A few days, before my illness began,I had vaccinated a young woman who developed a local reaction, on her upper arm,to the vaccine.The reaction produce a large blister and an area of redness and heat around the blister.This was not uncommon but I was concerned whether or not the redness and heat was a primary reaction or was a secondary infection from a local skin bug.
It was taught in medicine that the top back part of the middle finger, when placed against hot skin, can give you a reasonable idea as to whether actual secondary infection is present or not and whether you therefore clean it up and cover it with a bandage or whether you would be justified in giving the patient a course of antibiotics.
In 2020 this situation would never arise because we no longer give the smallpox vaccine.Of course the situation would never have arisen anyway if I hadn’t been so stupid when my finger on her arm to test for heat in the first place.
Ah! You say “But how could the smallpox virus have travelled through your skin unless there was a cut or split in your finger skin through which the Virus could enter?”
Good question, simple answer!
I had been cleaning an antique chest of drawers in my garage, using thin wire wool and a special home made cleaning mixture of vinegar,linseed oil,turpentine and sugar.The thin wire wool had chaffed the skin on the back of my right middle finger and allowed a tiny area for bugs to travel down even after scrubbing my hands before and after examining each patient. I had never been told that,as a child,I was not vaccinated against Smallpox,the matter had never been raised at home.I recall,in later years, that lots of country people in those days didn’t believe in it anyway.
I am so pleased that I did not lose my right middle finger because it would have limited my ability to,in Western Culture, offer someone a phallic gesture.Apparently “Giving the middle finger,or the bird”,is the most ancient insult gesture known.
Anthropologist Desmond Morris said that the middle finger, used either in humour or otherwise,represents the penis and the curled fingers on either side are the testicles.It’s a good job,isn’t it, that I didn’t touch my testicles when the finger blister erupted ,otherwise ,in Tennis terms, I could have lost both sets and the whole match!!!.
WHAT IS THE BIBLICAL CONNECTION BETWEEN JACOB AND CHEDDAR?
Cheddar Gorge was formed from limestone 1.2 million years ago and 500,000 visitors go there every year.
The 450 ft high Gorge can be approached by foot or car.Jacob’s ladder is a path, 274 steps in height and sturdy, fit folk can walk to the top.If you then add another 48 steps to the pinnacle you finally reach a most magnificent Lookout.The Ladder was named after Jacob who,as recorded in the Biblical book of Genesis,dreamt that he saw a ladder stretching from the earth right up to heaven and that there were angels of God running up and down the ladder.
He was on his way to Canaan at the time,and,it is said that he met a man whom he fought and wrestled with all night,but the man left in the morning without giving his name. the Bookies betting money seems to favour that the man was God.The Biblical story apparently represents progress, ascension and a spiritual passage through a variety of initiation levels.
Certainly, Jacob’s gymnastic dancing angels, were pretty fit and nimble, doing all that running and climbing and not having to pay for the exercise equipment.
Visitors to Jacob’s Cheddar Ladder never seem to look quite so nubile and nimble.and from what they told me in 2018, the journey up is tight on your calf muscles and tight on your wallet. Don’t miss doing the climb though if you ever go to Cheddar to buy your cheese and bickies.
SCHOLARSHIP TO BRISTOL UNI 1966 AWARDED TO OBTAIN A D.P.H.
Zoe Jane,our first of four daughters, was born in Wells Maternity Unit on the 4th June 1966 .I had just been awarded a Scholarship by Somerset County to study for a Postgraduate Diploma of Public Health at Bristol University Medical School, full time for one year.
Anita and I were very pleased because my first five years after graduating had been very stimulating, though quite tiring, and without much time out.
.
We felt that a long term commitment to a General Practice in the UK, at this point in time,was not really for us. I knew that in about 12 months Exeter City Health Department, in my home County, would need an Assistant Medical Officer of Health and a D.P.H. was an essential Postgraduate qualification for applicants. There were very few available DPH doctors in South West England.
Minky, our Championship smooth red coated Dachshund, had presented us with nine gorgeous pure bred puppies,which,when sold brought in additional cash.
So it was off to Bristol(35 miles) 3-4 days a week,by car,to satisfy the face- to -face Multiple Module exam requirements and to gradually complete my special Essential Research Project …”The Early Detection and Treatment of Hearing Disorders in Infants and Children.”
I found a novel way of supplementing my scholarship money by learning a lot about antiques from a wonderful elderly couple who owned a special Antique Shop outside of the community. They had no one else in their family who were interested in antiques or to whom they could pass on a plethora of tips and acquired of their trade.
I loved it, lapped it up and became proficient enough to act as a salesroom buyer for Ted and his wife as well as buy particular pieces for myself which I would clean up and repair professionally and sell on elsewhere some time later.I have been a long time collector ever since!
Ten refreshing months later we were Exeter bound with kids, a dog, a good job and a 4 bedroom Tudor style house 5 minutes from the seafront and Rugby Club and 5 minutes from the best grass and all-weather tennis courts in Devon. I re- honed my skills at both Clubs ,mercifully kept very fit whilst doing so, and regularly rolled up to train and play in Club matches around the County.