| Description | Prof ASHLEY MOWAT interview on Monday March 20, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) NORMAN ASHLEY GEORGE MOWAT, born on 11th April 1943 in Cullen. Retired in 2007 with a personal Chair in Medicine/Gastroenterology and as a Consultant Physician, with an interest in Gastroenterology, for Grampian Health Board. Came from a fishing background on both sides of his family, explains. Because of the hardship of the fishing industry, his father and mother were very keen that he and his four brothers should all get either educated or get an apprenticeship. Recounts being taken to sea at the age of ten by his father, sole purpose to put him off going to sea. On his mother’s side there had been six kids, his uncle Bill was selected for education and did Medicine at Aberdeen before the War, and eventually became a Consultant Neuropathologist at Queen’s Square Hospital in London; a big driving force. Ashley’s oldest brother Alex decided to do Medicine and eventually became a Professor of Paediatric Hepatology at King’s College in London. Had a lot of support from his parents and his brothers. (0:05:30) Educated at primary school in Cullen, did not enjoy it; then went to Fordyce Academy, totally different environment, explains. Rector had a big influence on him, explains. Went to university at 17, quite a cultural shock, 3-hour journey from Cullen to Aberdeen on the bus; having a landlady a new experience. Medicine in those days a six-year course, explains. Some of the lecturers were inspirational; Jack McKenzie who also hailed from Cullen, taught us Embryology and Histology. In pre-clinical years he also met Dr Hans Kosterlitz, who did huge amount of work on the endorphins, explains about his influence. (0:10:11) Talks about what it was like to be a medical student in Aberdeen in the early 1960s. Talks about the Kirkgate Bar, run by Sheila and Ian Queerie, the medics’ bar across from Marischal College. Explains about having to do Spotter Exams in Anatomy once a month, got the marks immediately; across to the Kirkgate to face Sheila, who would not serve you if you had not scored well. About 1963 had to move to the clinical side and act like young doctors. Remembers his first patient, on a ward with a fairly strict consultant, Tommy Morgan; tells anecdote about interaction with the patient and how it was all part of the teaching. (0:15:27) At that time no, or very few, specialties; but there were consultants who were developing specialty interests, including Gastroenterology, Ashley heavily influenced by that as a student. Got exposed to Charles Douglas Needham, hit if off immediately; explains they did student locums then, Ashley did a locum in his ward, absolutely inspirational, explains in detail. Needham’s interest was Gastroenterology; when Ashley got the chance to be a Houseman there he absolutely jumped at it. Needham talked him out of his original ambition to be a Cardiologist, explains. Talks in more detail about Needham; when Ashley went there as a Houseman in 1966, Needham had already made up his mind that he was going to be a Gastroenterologist. Had already been inspired by the writings of Sir Francis Avery Jones; also mentions Sir Arthur Hurst, founder of Gastroenterology. (0:21:00) Sir Francis Avery Jones wrote the first textbook on Gastroenterology. Ashley’s eldest brother Alex became a Paediatric Gastroenterologist; Ashley wanted to steer his own course. Talks about GI (Gastrointestinal) units elsewhere, including King’s College in London where his brother Alex was; had to get good enough to get into one of those, Talks of his life having been one of good fortune, by the time he had finished his general medical training and did the MRCP (Member of the Royal College of Physicians) exam, needed another academic attachment, Stuart Douglas arrived in Aberdeen in 1971 as Professor of Medicine, Ashley a Registrar in that unit at the time - explains this was Ward 6 at Woodend Hospital, which eventually became the GI Unit; Peter Brunt arrived in 1971 as well. By this time Ashley was a Lecturer in Medicine. Explains about Stuart Douglas and his background. Mentions John Mallard in Medical Physics, really helped him a lot, explains. Stuart Douglas and John Mallard got a mobile total body counter, installed beside Ward 6 at Woodend Hospital; Ashley used this for one of his first proper laboratory experiments, explains. Describes the machine. Eventually got a total body scanner installed in the basement at ARI (Aberdeen Royal Infirmary); Ashley helped one of John Mallard’s friends, Dragutin Gvozdanovic, to calibrate it, explains how. (0:27:15) Comes back to the clinical side at Woodend; Douglas Needham and two major figures in adult gastrointestinal surgery, Peter Jones and James Kyle; both worked in Ward 7 at Woodend, explains their significance. It was into that background that Peter Brunt arrived in 1971, appointed as a General Physician with an interest in Gastroenterology, first time the specialty had a recognised place in teaching in Aberdeen. It was about this time that George McNicol became Principal of the university; from Glasgow, also with a medical background, had worked in the same unit as Stuart Douglas at one time. They were very keen to get teaching of Medicine integrated, explains in detail. George MacNicol keen that they use textbooks from across the UK, called Integrated Clinical Sciences; Peter Jones, Peter Brunt and Ashley were charged with doing Gastroenterology. A great success; but some of the others weren’t, whole idea fell through, explains; gastroenterology version was used as a template for part of the St Bartholomew’s General Medicine textbook, explains. (0:31:18) Clarifies the timelines he is talking about, as George McNicol did not arrive in Aberdeen till 1981. Talks about his first and second research papers. First one done with Prof Walker from the City Hospital on the relationship between Tattooing and what was then called Serum Hepatitis, now called Hepatitis B, influx of cases. Published in The Lancet, before publication Ashley did a lot of reading, came upon paper about two cases of Serum Hepatitis written by an Army doctor in the RAMC (Royal Army Medical Corps), who turned out to be Ashley’s tutor in Forensic Pathology, (Captain) W.T. (Bill) Hendry, explains. Turned out to be important because wife of one of the patients also got Serum Hepatitis, she was pregnant, and when baby was born it also had it; could be transmitted not only by a needle, but sexually, and you got vertical transmission from mother to baby. A great paper out of clinical research, Ashley got asked a lot about that when he went to London. Explains that when he was a student, and also a Registrar, Douglas Needham realised you could use the stable population of the North-east to study the natural history of disease in way not possible elsewhere; he got Ashley looking at Gastric ulcers, and relationship with Gastric cancer; analysed their data with punch cards and knitting needles, explains; they wrote up the history of Gastric Ulcers. (0:37:01) Explains in detail what the specialisation of Gastroenterology is all about; much later in the development of the unit, had Emad El-OMar explaining why duodenal and gastric ulcers are related to an infection, Helicobacter pylori; explains about his continuing enthusiasm for Gastroenterology. Talks about the introduction of Endoscopy; fibre-optic gastroscopes introduced in 1970. Aberdeen spent about thirty thousand pounds on the scope; Ashley remembers a surgeon who had just retired, Jimmy Philip, had an interesting malignant disease. He thought Aberdeen should have an endoscope, got funds, great friends with Louis Gillanders, head of X-ray at the time; said to him should not be doing barium meals, should be using endoscope. Peter Brunt had arrived at that time, 1971, we were allowed to use this endoscope down in the X-ray department at ARI. Explains about the pecking order to use it; Louis Gillanders, then Peter, then Ashley. Side-viewing scope, explains; getting into the duodenum from the stomach was tricky; great excitement when Ashley managed to do it, explains; Peter Brunt developed the idea of Endoscopy in Aberdeen, eventually got specialised unit at Woodend. When Ashley went to Barts (St Bartholomew’s Hospital in London) he was as good at endoscopy as anyone else at the time; given the job of setting up Endoscopy there (1973-74). (0:43:36) Explains how he came to go to Barts; was at first meeting of the British Society of Gastroenterology, in Aviemore in 1969 or 1970, met Anthony Dawson (later Sir Anthony), head of the GI unit at St Bartholomew’s; explains. Later applied for job as Lecturer and Research Fellow in Gastroenterology at Barts; explains what happened. Totally different place to Aberdeen; his research task was to look at patients with liver disease, explains in detail. Asked for help from Prof Mike Besser, Professor of Endocrinology, explains why. Data analysed by a computer, which looked like an (electronic) organ. Talks about competitive atmosphere when presenting data, and how he learned a lot from the process. (0:49:22) Explains why he decided to come back to Aberdeen. Tony Dawson keen for him to stay at Barts, he applied for a Welcome Fellowship; meanwhile post came up in Aberdeen, encouraged to apply, discussed it with his wife Kathleen, three children, eldest just started school; knew he would have to do private practice to survive in London, did not want that, or to commute daily. Tony Dawson tried hard to persuade him not to go back to Aberdeen, explains in detail. Link with Barts remained; Tom Sinclair, who joined the Aberdeen unit as a consultant, also went to Barts about four years later. Ashley says it was not easy for him to come back to Aberdeen, explains why in detail; mentions his good relationship with Peter (Brunt), managed to develop the unit; tremendous benefit of having Peter Jones and James Kyle there. Peter (Brunt) had set up weekly meeting with Peter Jones, James Kyle and Peter Ward, who was then the Radiologist at Woodend; joint meetings long before they became a necessity or popular. When Ashley came back he extended these meetings, explains in detail; people from all over the world invited to join symposia. Element of luck; when he was at Barts Prof of Gastroenterlogy from San Francisco, Marvin Slessinger, was on sabbatical there, became good friends. He came across for one of these meetings, colleagues in Edinburgh very upset because they had tried and failed to get him to come across. Refers to picture he has of that meeting, brother Alex is in it, Tony Dawson, Peter Brunt, Tom Sinclair, picture taken by Alastair McKinlay who was then Senior Registrar with us. (0:57:59) Came back to Aberdeen to be a Consultant Physician Medicine and Gastroenterology; all Aberdeen consultant appointments at that time carried university Senior Lecturer grade, paid by NHS; explains what this involved. Ashley had to face up to the Professor of Surgery at that time, George Smith, explains. Idea that the NHS and university guys should be interchangeable was Stuart Douglas’s, worked well. He joined the department again in 1975, but explains it would have started in 1971. Recalls meeting Peter (Brunt) for the first time; it wasn’t till the 1980s or 90s that we transferred from Ward 6 Woodend to ARI. Ashley part of the department from its formation. Talks about having to build their reputation in early days; staffing was a Sister at the male end and the female end of the ward, eventually a Sister in charge of the Endoscopy Unit, so three Sisters and related Staff Nurses; great team, explains. Explains rest of staffing in detail; Peter Hamilton their first Senior Registrar, about 1974 or 1975. Stuart Douglas appointed Richard Crofton as a Lecturer; slotted into the research framework that had been set up with John Mallard and their friends at the Rowett (Rowett Research Institute), explains in detail. (1:05:10) Lots of other areas of collaboration that were important; one with Pathology was very important, explains; mentions pathologists Stanley Ewan and Graeme Murray. Other big development was in Duodenal and Gastric ulcers, explains in detail; Peter Jones and James Kyle and Douglas Needham had shown in clinical studies that the mortality rate in North-east Scotland was high. Not down to poor care, but poor organisation. Set up the GI Bleeding Unit, explains there were only two in the country at that time. Explains how their treatments developed; talks of how the unit operated. The other major development was screening for Colon Cancer; explains about this in detail, set up in conjunction with their colleagues in Ninewells (Ninewells Hospital in Dundee); mentions Professor of Surgery Bob Steele, who had trained in Aberdeen, and Gordon Paterson, who was Chief Medical Officer here at the time. England started at same time, but gave up after a year. We did it with Tayside and Angus, needed about a million and a half population; still going, explains; numbers of Colonic cancers in Scotland greatly reduced, eventually persuaded government to fund it in all areas of Scotland. Ashley’s son Craig now a Gastroenterologist at Ninewells, major player in the national study on Colon Cancer screening. Ashley also talks about importance of training, people trained in Aberdeen that then went on elsewhere. Marie Maclean still in Dundee; David Williams in Elgin; Arthur Dunk went to Eastbourne; Helen Delal to Glasgow; Mark Hudson to Newcastle; Richard Crofton to Monklands; John Masson and Gillian McKnight now in Australia; Umesh Prabu in Nova Scotia; Kulwinder Dua is Professor of Gastroenterology at the University of Wisconsin; Paul Lochhead currently employed by Harvard University; Chung Wo Mui went back to Hong Kong; Cho Cho Khin came to us from Burma and went to Chelmsford; David Koumansingh went back to Trinidad. (1:14:33) Refers to a book Scotland Impressions by Alan Chung Wo Mui, became a photographer when he retired, tribute in his book to Ashley, pictures of Woodend, including Peter Brunt carving Xmas turkey at the male end of the ward, Ashley doing the same at the female end. Explains that they decided everyone should be there on Xmas Day if they could for the patients on the ward, explains some patients were readmitted for review so they could have Xmas Day and Boxing Day there, Salvation Army Bands, local entertainers, and judging of the best Xmas Fairy and best Santa Claus. All eventually stopped. One of Ashley’s ex-mentors on Ward 6, before it became the GI Unit, was Bill Gauld; he introduced the idea of the Xmas Lunch, doctors had to serve the nurses, explains. Mentions a ward orderly, name was Bob Sinclair, was there when Ashley was a student, still there when Ashley returned as a consultant; very much part of the team; we knew all the ward cleaners; move to ARI, much bigger, terribly impersonal, no more carving of turkeys. (1:19:45) Move to ARI was in the 1990s, it was protracted; some blood spilled, Peter Jones and James Kyle’s unit had already moved, consequences explained. Goes through in detail what would have been a typical day for him when he returned to the unit as a Consultant; including working hours, and how those changed as legislation changed; how Peter Jones operated. Then had to do the Shetland clinics as well, for 19 years; describes this; refers to a Reader in Medicine at the time, Ken Palmer, who was sent to do the clinic, Ashley sent with him as a lecturer; it was a terrible night, got on the old St Clair ferry, describes what happened; it was decided after that that they would fly up and back. Had a general surgeon called Ronnie Cumming at the Gilbert Bain Hospital in Lerwick, was a talented guy who could cope with most things; tells anecdote about a drunk Shetlander coming up and accosting Stuart Glover over Ronnie Cumming’s skills. Pays tribute to the quality of the Air Ambulance Service if patients needed to be brought to Aberdeen from Shetland. Says that Shetlanders were quite different, they did not miss clinics. (1:32:10) Talks about the challenges he and his colleagues faced when he went back to the department in the 1970s. Major challenge was having Gastroenterology accepted as a genuine specialty; not just in Aberdeen, across the country. In the course of ten to fifteen years Gastroenterology became one of the biggest specialties, explains how things used to be and how they changed with introduction of endoscopes. For him personally was a challenge, coming back to a set up where he had done his student training, explains. Remembers when Emad El-Omar was appointed to the chair, did not have basic lab attached to GI, huge drawback, explains. Duncan Rice (university principal) said you have to appoint a chair; Ashley had known Emad, a Glasgow graduate who was Jordanian; met him in Washington, told him about the possibility of a chair coming up in Aberdeen. Duncan Rice slotted him in; what a find he was, became editor of GUT, the journal of Gastroenterologists; totally transformed the academic side of the unit, explains. The rest of us were clinicians and amateur scientists, he was a properly trained scientist, explains. He’s now in Sydney. Marie Maclean came as a Senior Lecturer; Paul Lochhead came as a Resident; best graduate of his year in Glasgow, asked Ashley for a job, explains. He’s now at Harvard, explains. (1:40:30) Explains in detail how he divided his time between his academic and his NHS responsibilities; talks about some of his family members, and how he ended up with his wife in a big house in Cullen; commuting to Aberdeen, and working hours. (1:44:24) Talks about how he loved teaching; totally changed over the years, explains; tried to follow the principles that Jack McKenzie had set, explains. Thinks they have got the selection process wrong, now being done almost entirely on grades; having very bright people dealing with clinical problems is not always best; missing out on more rounded students, explains. Opportunity for role models in Medicine now is gone, have American-style of training where everybody is rotated, no one feels they have a responsibility towards junior staff, explains. Political dimension, set up an Acute Receiving Unit in Aberdeen, but done in such a hurry that people put at risk, explains in detail. Talks of loss of four general wards in Aberdeen, beds used to be run on 80% occupancy; when COVID came we had no slack. By the time Ashley retired their bed occupancy some days was over 100%, explains. (1:49:51) Talks about the move from Woodend to ARI; move out of necessity because had to have access to surgeons, explains. Talks in detail about the need for administrators, and gives his assessment of them. Misses the patients, and the students. Talks about being made an honorary Professor in 2002; at personal level, very proud of that, explains. Talks about becoming Physician to the Queen; not sure how it was decided, but Tony Dawson in London was head of the Medical Household, may have had influence; Peter Brunt was Queen’s Physician before Ashley. Talks about going to the Palace, being there with members of his family, and talks in detail about what happened there. (1:57:49) Was appointed as Physician to the Queen in Scotland in 2001, and remained in that post till the Queen’s death in 2022; Ashley talks about the experience, and what he learned, and the disadvantages. Mentions the GP at Ballater, Dougie Glass, had a surgery every morning for everyone that came up (with the Royal Family); Ashley not just Physician to the Queen, but to everyone in the Household. Also responsible for visiting politicians; tells story about time the G8 was held at Gleneagles. There was no money in the position, it was just your duty. (2:02:54) Confirms he treated the Queen, the Queen Mother, and the Duke of Edinburgh, and one or two of the others; Dougie (Glass) would handle the day to day stuff, and Ashley would be phoned. Talks about visiting the Queen Mother. (2:05:45) Describes the contribution that he feels Aberdeen has made to the specialisation of Gastroenterology. Thinks it has made a big contribution; Alastair McKinlay became President of the British Society of Gastroenterology; Emad El-Omar still the editor of GUT. Ashley talks about his research interests; most of it was in inflammatory bowel disease, explains. Talks in detail about patients with rare metabolic conditions, danger of mortality, working out how to treat them; talks about two patients behaving as if they were drunk, but not drunk, suspected they had D-lactic acidosis, but at that time not supposed to occur in humans. Ashley went to Professor of Chemical Pathology, recounts what happened. Then had to find out why these patients had this condition; thiamine deficient, explains in detail. Mark Hudson got his name on a paper, very important for the metabolism of some bowel disorders. Did a fair amount of work on ulcerative colitis, and demonstrated that in this part of the world there was a high incidence of it. Very interested in duodenal and gastric ulcers, till Barry Marshall in Australia discovered H. pylori, explains. (2:12:28) Ashley wrote up his liver disease research, hormonal changes, important papers as well. Talks about working closely with Emad, lot of papers about bacteria in the gut, still a huge field. Describes how Emad needed expensive equipment; we had a friend, Alan McLeod, best pal of Ashley’s brother Alex since childhood; had died and donated a million pounds, explains, some of that money went to Emad. Talks in detail about becoming President of the Scottish Society of Gastroenterology in 2002, and how society came about. Alastair McKinlay one of the people who helped draw it up; Ashley did not want to be president, but ended up as the first elected president; explains the meetings were always friendly, unlike cutthroat meetings in London. (2:17:39) Ashley became President of the Association of Scottish Physicians in 2004. Talks about then unit Senior Registrar "VJ" (Dr Vijayan) getting the prize year after Ashley stepped down, explains. Talks about how Gastroenterology has changed and evolved since he retired; now super specialist, explains. Narrow field of interest not so good, as many of the conditions in Gastroenterology are whole body conditions, explains. Mentions research with Professor John Forrester, professor of Ophthalmology; very interested in inflammation in the front of the eye, called Anterior Uveitis; this condition is one of the early presentations of inflammatory bowel disease and especially ulcerative colitis. Explains about doing mutual research on their respective patients. Comments on the current state of the NHS; very sad, underfunding by successive governments, started with Margaret Thatcher. Blair and Brown introduced the new GP contract, a disaster for the health service; explains. Care in the Community a good idea, but it hasn’t been funded; comments on various expenditures. Says John Mallard really set the cat among the pigeons with various scanning techniques. Tells anecdote about John Mallard, when Australian government decided to go non-nuclear they had a cyclotron; John Mallard thought it would be good idea to get it to Aberdeen, producing isotopes at a fraction of the cost. But had to raise money to get it here; university not supportive, ended up in the farm at Woodend. Talks about the prototype MRI scanner, an extraordinary thing; John Mallard persuaded Ashley to be scanned, explains. (2:29:43) Talks about what he feels he has achieved in his field. Most important thing seeing youngsters join us, and develop. Proud of getting a personal chair. Doing a long-term study on drug Azathioprine and Crohn’s disease, with colleagues in Edinburgh and Dundee; long follow up, which continued after Ashley retired. It was published in The Lancet, first name in the paper is his son’s name, Ashley’s name is further down the list, explains what this means to him. Mentions Stuart Douglas, who when he retired became interested in SAD (Seasonal Affective Disorder), produced 24 papers on this. (ENDS 2:33:29)
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