The cause of care is

The atrocities in Manchester and London highlighted the heroic work of the emergency services and the need to improve them further, argues Professor Hugh Pennington

n the 1960s I was a Casualty Officer (what would be termed today a junior doctor in A&E) at St Thomas’s Hospital in London. I often walked over Westminster Bridge to its buildings facing the Houses of Parliament across the Thames. Later I lived in Southwark.

From the point of view of terrorism, and violence in general in London, it was a golden age. I never saw a patient who had been stabbed, never mind shot. The IRA was almost defunct; the far more lethal PIRA -the Provisionals – hadn’t got going.

The thousands of Turkish and Greek Cypriots in London kept their mutual hatred – occasionally spilling over into violence - to themselves, and one felt perfectly safe eating at the far-famed Greek restaurant, Jimmy’s, located in a Soho basement, where the food was cheap and excellent. Religious fundamentalists were just harmless minority groups.

But we had big worries. The Bomb lurked at the back of the minds of most. We broached celebratory champagne in Casualty when the Cuban Missile Crisis ended. With the benefit of hindsight we were right. It marked the beginning of the end of the Cold War.

From the medical point of view other transformative things were also happening. Kidney failure was a sentence of death, but dialysis was on the verge of taking off. We now take it for granted, as we do hip replacements, for all practical purposes developed as routine by Charnley in the same year as the Cuban Crisis.

At St Thomas’s I saw John Mallard developing MRI. All it could do then was tell that there were cells in a test tube. Scanning, particularly CT, is now life-saving in defining damage done by trauma.

It is reasonable to guess that its role was crucial in the care of some survivors of the London Bridge and Borough Market terror outrage.

But some problems persist. When I was a Casualty Officer I had great difficulty in finding a safe care environment for patients suffering from acute psychosis. It was tempting to blame Enoch Powell, not for his 1968 “Rivers of Blood”, but the one he made in 1961 as Minister of Health, the “Water Tower” speech: “There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside – the asylums which our forefathers had built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault. Let me describe some of our defences which we have to storm.”

Powell was describing the end of institutional care for those with mental health problems, and its replacement with care in the community. Unfortunately, that is still very much “work in progress”.

St Thomas’s has faced terror before –from the skies. Ten staff were killed by the Blitz. Nazism was a faith-based death cult like ISIS.

Destroying it was difficult. But we won. ● Professor Hugh Pennington is an emeritus professor of bacteriology at the University of Aberdeen. He has chaired inquiries into E coli outbreaks in Scotland and South Wales.