Chapter One

 

Arrival

 

I had arrived in Collintrae on April Fool’s Day, 1965 - not an auspicious date. On April 3rd, the local newspaper, the Carrick Herald, kindly featured me on the front page. ‘NEW DOCTOR SETTLES IN’ was the muted headline, and my career, from my birth in Glasgow to my schooling in Lincoln, and my medical training in Birmingham, was politely reviewed. I would have been encouraged were it not for the article immediately beside it.

Its headline was in larger, much bolder print. ‘FIVE DEATHS IN THE STINCHAR COMMUNITY IN ONE WEEK. UNPRECEDENTED TRAGEDIES.’ Under it were five photographs of recently deceased people, all of whom would appear to have shuffled off their mortal coil in direct reaction to my arrival in the area. Apparently the paper’s staff had looked up the records. Never before had five people from our little collection of villages died in one week. It didn’t matter that I hadn’t actually seen any of them. Four had died in hospital and one in a road accident miles away, but the connection seemed sure and augured ill. The local newspaper obviously felt the same. It seemed that I was too young, and worse still, I had qualified in England.

With this less-than-encouraging coverage in the local press I had to tackle my first day as doctor, and this was to take place in Barrhill, one of the three villages under my care. Three times a week, the Collintrae doctor drives inland, up the valley of the river Stinchar through the village of Kilminnel to Braehill. The surgery there was in the house of a Mrs Jeanie Braidfoot, and had been fully kitted out by the previous doctors, all of whom had stayed a while then left for better, bigger and less solitary practices. Like a mother hen Jeanie had looked after my predecessors, and the tradition would, it seemed, continue with me.

Seven or eight elderly ladies were busy chatting in Mrs Braidfoot’s front room, which served as my waiting room. They didn’t look ill. They could have been there for afternoon tea, not to see me. But see me they were determined to do. It became clear that it was I, not them, who was to be examined and assessed. These ladies had seen off five doctors in the last decade, and they were going to add another one to their list.

My initial glance at the room had missed a much younger woman, who had been sitting behind the door. When I called for the first patient, she walked across the hall into the room that served as the surgery. My first thought was relief: she looked well and happy enough. I didn’t have the sinking feeling that comes when an obviously ill person walks into the room. That is, until she rolled up her sleeve.

On the front of her forearm, just above the wrist, was a skin problem that I had never seen before in a person - only in gory photographic detail in my ‘skins’ textbooks. It was a lump about two centimetres across, fiery and infected, raised above the skin and with a thickened edge. It looked horribly sore. Mary Bryant, its ‘owner’, said it wasn’t. In fact, it was painless.

That wasn’t good news. If it wasn’t painful, all my training suggested that it was malignant. The medical name for it was a ‘squamous cell cancer’, and at that size it was surely very advanced. It had appeared and developed in only a week, so I assumed it was growing extremely fast. With a sense of real foreboding I reached for the telephone. 

I was lucky. The consultant in ‘skins’ was doing a clinic in Ayr that afternoon, and if I could get Mary up to him before it closed, he would see her that day. But the conversation took a curious turn. It went something like this: 

Me: I wonder if you could see this young lady urgently. I’m worried that she has a very fast-growing lesion on her wrist. It looks like a squamous cell problem (Mary was in the room with me, so the language had to be guarded).

The dermatologist: Oh yes? And what does she do, this lady? 

Me: She’s a shepherd’s wife. 

The dermatologist: Oh yes? And how long have you been in Braehill?  

Me: I started today. 

The dermatologist: OK. Send her in. I’ll see her for you. 

Ayr was an hour’s drive away, so I wrote a letter to the dermatologist, gave it to her and packed her off. I expected to hear later that she had been admitted to hospital.

Around four o’clock the phone rang. I was still wading through my series of elderly ladies. It was the dermatologist. The conversation was brief and to the point:

Him: So where did you train, doctor? 

Me: Birmingham. 

Him: Not many sheep in Birmingham, then? 

Me: Er, no. 

Him: You’ve just sent me a case of orf. 

Me: Pardon? 

Him: Orf. Sheep pox. She has caught it from feeding a lamb. Never heard of the Folies Bergères?  

Me: Pardon?  

Him: The Shepherdess Follies. It’s in Paris. Read up about it. Welcome to the district. And don’t worry, you’re not the first to make that mistake. 

Me: So how do I treat it? 

Him: You don’t. It gets better on its own. Wait and see.

 

The dermatologist, Tommy Cochrane, and I eventually became great friends. We looked after many patients together, but he never let me forget that first conversation. Orf has three lines in the most complete textbook of medicine, and doesn’t appear in any of the others. It’s related to smallpox and cowpox. Only people who work with sheep catch it, and once infected they are immune for life from further ‘orf’ attack and from other pox viruses. Lambs get it around their mouths, and it spreads to humans who have to bottle-feed them.

So why the reference to the Folies Bergères? It’s simple. Sheep farmers and their shepherdesses would catch orf at an early age. All it produced was that one patch. Sheep pox doesn’t spread further in humans. So when the mark healed, they were unscarred and immune from smallpox. Two hundred years ago, everyone else caught smallpox. The survivors were ‘pock-marked’ – with pitted scars all over their bodies, and particularly their faces. Only shepherdesses and milkmaids (who caught cowpox in the same way) had smooth features and healthy complexions. So the Folies recruited shepherdesses for their shows. 

My episode with Mary Bryant didn’t do me any harm. Mary was a newcomer to the village and to farming, and didn’t know about orf. If she had been a born-and-bred local she wouldn’t have bothered me with such an obvious problem. But the locals understood that I had done my best for her, and that was all that mattered.