Chapter Seventeen

 

‘Twas Christmas Day in the practice, and the patients all sat on the stairs…

 

Christmas Day wasn’t a holiday in Scotland in the Sixties. I learned that the hard way. Assuming that no one would expect a surgery on my first Christmas Day, I walked downstairs that morning in my dressing gown and slippers to make coffee and toast, to find six men waiting in the hall. It was only two months after moving in to the Collintrae house, the planned waiting room wasn’t yet ready, and the hall had had to do in the meantime. It was comfortable enough, with a Rayburn stove and plenty of chairs. The overflow could sit on the stairs if they wished – in fact, two of them were doing just that.  

The men clearly expected me to be working as usual and, as some of them had come several miles, I didn’t want to disappoint them. I quickly ran upstairs, put on my clothes and arrived, a bit breathless, a few minutes later, to start the surgery. No one bothered about this strange behaviour, presumably because the young doctor from England was a bit green yet, and didn’t know the rules. 

What I hadn’t known was that for most of the men, Christmas Day was their only official break from their duties as dairymen or shepherds, at least at my normal surgery times. It was the one day in their year in which they could grab an opportunity to do important things – like seeing their doctor.  

That was Christmas 1965. From then on I did hold a surgery on Christmas morning, but I let nurse Flora spread it around in her masterful way that it was for emergencies only. As each Christmas passed, and the social climate changed, there were fewer and fewer Christmas attendees.  

On Christmas Day 1967, I had just one patient to see. He brought in a problem quite unlike any other I have ever had. Charlie Welsh was the physics teacher at the local academy in Girvan. He was good at his job, because the school had excellent ‘Highers’ results, with many of the pupils, boys and girls, going on to study science at university. His real love, however, was birds. Every day, before driving the fourteen miles to the school, he would walk a few miles along the shingle beach, noting the numbers, types and behaviour of the birds he saw. The shingle bank to the north of the mouth of the River Stinchar is home to nesting terns, and it was to Charlie’s credit that it was made a site of special scientific interest and protected for the foreseeable future.  

That Christmas day Charlie sat down in the surgery and pulled out a package from the inside pocket of his overcoat. He unwrapped it to reveal a dead grey-backed gull.  

‘What do you make of this, Doc?’ he asked.  

‘Well, Charlie, it seems to be dead,’ I said, grinning at him. ‘I’m not sure I’m qualified to tell you more.’ 

‘There are thousands more like it on the beach,’ he said. ‘And it’s not just grey-backs. There are fulmars, kittiwakes, black-backs, shags and cormorants – all of them dead. They’ve appeared in the last two or three days. There are a few still alive and staggering around, choking as if they can’t breathe. They have bubbles of mucus around their mouths, and I could swear that some of them are coughing.’ 

I looked at the dead bird again. I was obviously no expert, but the mouth was flecked with mucus and even tiny spots of blood.  

‘I suppose they could have some form of pneumonia,’ I said, ‘with bleeding into their lungs, but I’ve no way of telling. Why don’t you let the vets know?’ 

‘They aren’t interested in dead gulls,’ he said. ‘They’d just laugh. I wondered if you’d be able to throw any light on them.’ 

‘I don’t know that I can, short of doing a post mortem on it, and even then I wouldn’t know what I was looking for. And I’d be a bit concerned about close contact with the bird’s tissues. It could be botulism – poisoning from scavenging on the rubbish tips when sea food is low. I wouldn’t want to expose myself or you to that. I don’t know, either, whether germs from dying sea birds can be transmitted to humans. If it is a form of pneumonia, the only one I know that does transfer between birds and man is psittacosis, bird-fancier’s lung, and that’s a chronic chest disease, like chronic bronchitis. To be frank, I don’t think you should be handling the birds. I couldn’t tell you for sure whether there’s a risk or not, and it would be better to be safe than sorry.’ 

‘I’ll do what you say, Doc,’ Charlie said, lifting the bird and wrapping it up again in the paper. Then he added, ‘I’ve seen botulism before, and it isn’t like this. The birds stagger around, semi-paralysed, then lie on their backs and wave their legs and wings about, weakly, till they die. It doesn’t take long, and they don’t cough or produce this amount of mucus around their beaks. In any case only gulls scavenge – shags and cormorants eat only fresh fish, so they aren’t exposed to botulism. My hunch, like yours, is that it’s some form of infection, but it must be pretty powerful to hit so many birds of so many species, all at once. Could it be pollution – say a poison in the sea, a discharge from shipping?’ 

‘The only kind of discharge like that would be oil, wouldn’t it?’ I said. ‘And there’s no spill, is there, on the beach?’ 

Charlie shook his head.  

‘There’s just one thing nagging at me,’ he said. ‘I’ve seen this once before, around ten years ago. Thousands of dead birds, around Christmas time. We never found the cause then. It took years before the populations of the different birds climbed back to normal. When I go home I’ll look up my records to see when it was, and I’ll let you know.’ 

He turned to leave.  

‘Oh, and by the way, Merry Christmas,’ he said. ‘I hope you aren’t too busy.’ 

‘Thanks,’ I said, ‘and Merry Christmas to you, too. So far I haven’t any calls, so the signs are good.’ 

Charlie left and I walked from the surgery through the short corridor to the main part of the house, sat down to have a coffee and to open the presents with Catriona, now two- and-a-half and a really active toddler, and Alasdair, who at fourteen months had just started to walk. Mairi was speaking on the phone. 

‘You have a call,’ she said, once off the phone. ‘It’s at a place called Auchencleoch. It’s one of the forestry houses on the hill road from Braehill to Glencree. Two youngsters have really bad coughs and are finding it difficult to breathe.’ 

‘Youngsters? How old?’ I asked her. 

‘Early teens,’ she said. ‘Their names are John and James Dougan: their father called. He is Daniel, his wife is Agnes, but I can’t find them in the records. They must be new. He thinks the boys need urgent treatment. They haven’t been ill like this before.’ 

I looked at the Ordnance Survey map for the district. The Braehill to Glencree road snaked up into the hills along the river valley for twenty miles. It took me a while to pinpoint Auchencleoch, hidden in the narrow contours a good three miles off the road, with a single dotted line winding up to it.  

I screwed up my face. Single dotted lines meant an unmetalled single track road, probably with gates and cattle grids, and usually plenty of potholes. I had never been called to the house before, and hadn’t even known that people lived there, so far out of the way. I left Mairi and her mum, Bessie to prepare the Christmas dinner, and walked out to the car. 

It was one of those cold, frosty days with no cloud in the sky. The sun shone, but there was no heat in it. It took me twenty minutes to reach the makeshift sign on the Braehill to Glencree road that pointed the way to Auchencleoch. I blessed the weather. I had been right about the dotted line. The single-track road would have been a quagmire if its surface hadn’t been solidified by the frost. I had to slow to around five miles an hour and sometimes slower to navigate over the ruts, the holes and the rocks. Twice I had to get out to open and shut gates, put there to keep sheep in and deer out of the grazed moorland. About a mile along the road the forest started, and the track improved a little. Auchencleoch was two miles into the forest.  

The house, small and four-roomed, with smoke rising from the two chimneys, one at each gable end, had seen better days. The white paint was peeling, revealing patches of the grey stone underneath. Littered around the sides were rusting relics of farming and forestry machinery, and an old car that hens were using as a roost. There was no attempt to make a garden, though there was a square of ground a few yards away with some sad leeks and Brussels sprouts sparsely poking up from the frosted soil. Beside it a washing line held an assortment of clothes, white and stiff as boards. In a small paddock was a dejected donkey. Beyond was a pond, on which were some birds, possibly geese, maybe swans. They were just too far away to be seen clearly. 

I walked to the door. Before I could knock a man in his fifties greeted me, and led me into the main room. He was big and burly, in a shirt opened at the neck, a waistcoat, and old, baggy, thick tweed trousers. He hadn’t shaved for days, and looked tired and drawn.  

A woman, thin and careworn, was sitting by the fire. She was about the same age as the man. I assumed she was Agnes. She smiled at me, but didn’t rise or introduce herself.  

‘Dan Dougan,’ the man said. ‘Thanks for coming. I’d like you to see the boys. They have got really bad colds, and can’t shake them off.’ 

Bad colds, I thought, and he wants me to come all this way, on Christmas Day, just for that? But I was polite, smiled back at him, and let him lead me to the boys’ room. They were lying side by side in single beds. They were flushed, finding it difficult to breathe, constantly coughing, and holding their heads as they coughed. They told me that they had felt ‘awful’ for several days, had had shivers and sweats, had pains in their limbs and back, headaches, and couldn’t breathe easily without their ribs hurting. 

I listened to their chests, took their temperatures and pulse rates, and knew I wasn’t dealing with colds. They had true influenza. I was curious about this, because they were the first cases in the district. In fact I didn’t know of any cases in Scotland. There was nothing about an impending epidemic in the medical news or on the medical gossip grapevine. 

Stranger still, the boys hadn’t been anywhere to catch the ‘flu. They had not been at school recently, they said, and in any case it was now the school holidays. They had been in and around the house for the last month, and had met no one. The furthest they had been was to the pond to try to bag a bird.

‘And did you bag one?’ I asked. 

‘No,’ the older one, John, said. ‘There were a few dead ones lying around, so we thought they might be poisoned. So we left the rest alone.’ 

‘Why would they be poisoned?’ I asked. ‘Who would do that?’ 

‘The local gamekeepers leave poison around for the buzzards, and we thought it might have got into the water,’ said James. ‘So we kept clear of them after that.’ 

‘Did you touch any of the dead birds?’  

‘We buried four of them, just in case any animals might eat them and get sick themselves. So we touched them. But we washed afterwards.’ 

Curiouser and curiouser, I thought, then turned to their father. 

‘They both have chest infections, probably ‘flu,’ I told him. ‘I’ll give them antibiotics for now, and you can come to the surgery after Boxing Day for some more. Keep them in bed for the next two days and give them plenty of food and drinks. They’ll take a while to recover completely, but they should be fine.’  

He thanked me, I said goodbye to the boys, and we walked back into the main room. 

A much younger woman had joined Agnes by the fireside, sitting beside her in an easy chair, her arms across a very large abdomen. I walked over to her and smiled. 

‘When’s the baby due?’ I asked. 

‘It’s not very long now,’ said Agnes. ‘A few days, I suppose.’ 

‘So, are you visiting?’ I asked. 

The younger woman looked puzzled.  

‘Why do you think that? I live here,’ she replied.  

‘Then why haven’t you been to see me?’ I asked. ‘Have you at least seen the nurse?’ 

‘Oh, no,’ said the older woman. ‘We like to do this our way – we don’t like clinics or hospitals for a natural thing like having children.’ 

‘Natural isn’t always the best,’ I said. Turning to the young woman, I asked if she minded if I examined her. She didn’t. In fact, she looked relieved. 

I was shocked to find that she was in early labour and had a blood pressure that was going through the roof. If I didn’t get her into the maternity unit in Girvan fast, we might have a tragedy on our hands. Her blood pressure rise meant that she was at extreme risk of having convulsions if we couldn’t bring it down, and we plainly couldn’t do that in Auchencleoch. 

First, however, I had to know who she was. She didn’t appear on my list of people signed to the practice. Dan explained that she was his step-daughter Carol, the daughter of Agnes by a previous marriage. I didn’t ask about the father-to-be, sensing that the answer might be difficult. Nor did I waste time probing why she had had no antenatal care.  

I explained to them why she needed to be in hospital, and used their phone to dial the ambulance service. The only available ambulance would take forty minutes to get to the house, so I decided to bundle her and Agnes in my car, and meet the ambulance on the way. We left Dan to look after the boys. 

Being rumbled about on a forestry road when in labour doesn’t calm things down. Halfway to Girvan I had to stop to tend to Carol, who was now ready to push. As luck would have it, we were outside the only inn on the road. It would be easier to deliver the baby in a bed than in the car, so I sent Agnes off to the front door for help. She came back within seconds. 

‘The hotel is closed for Christmas,’ she said, beginning to panic. ‘There’s no one here to give us a room.’ 

Just at that moment the ambulance drove up. The two ambulance men and I lifted Carol out of the car, placed her on a stretcher, and wheeled it into the back of the ambulance. That’s where we delivered her of a healthy baby boy, seconds later.  

I eventually sat down to my Christmas dinner a few hours late. It was worth waiting for. Sitting in the lounge with Mairi and Bessie afterwards, I mentioned that I thought I was going to miss out on Christmas completely, but Bessie reminded me that I had a more complete Christmas than most. After all I had met a Christmas Carol, and delivered her of a baby boy when there was no room at the inn.

 

Two days later, Carol and her new baby left the hospital against our advice. When I went back to Auchencleoch a day later to check up on her, the family had gone, taking with them their few sticks of furniture. They had left only the donkey, which the local innkeeper, the one who was away for Christmas, was glad to look after. We never heard where they went, or how they managed to survive. It turned out that they had been squatting in the house. The boys hadn’t, in fact, been enrolled in the local school. We presumed that they didn’t want to be traced officially for whatever reason. We are not even sure they gave us their real names.

 

The next day the ‘flu hit the practice with a vengeance. I had six calls that morning. The numbers expanded to twelve, then twenty and by the end of the week I was seeing thirty ill patients a day, and dealing with another twenty or more on the phone. Jimmy Anderson helped out, as did the two nurses, who both caught it and tried to struggle on.  

Despite being in the midst of all these ‘flu cases, I didn’t catch it. 

Charlie Welsh didn’t catch it either. He came to see me on New Year’s Eve. 

‘Remember I said that we’ve had a winter of bird deaths before? It was 1957,’ he said. ‘The birds aren’t dying any more,’ he added. ‘Whatever killed them seems to have passed. Do you know, it’s a funny thing, but ‘57 was the only time I’ve had ‘flu. Do you think there is a connection? I hear there’s a lot of it about now.’ 

I remembered Christmas 1957, my first year at medical school, very clearly. I was in the university sanatorium, with ‘flu. I still have the scar on my right lung to prove it. That winter hundreds of thousands of people all over Britain had caught the worst ‘flu for many years.  

‘I’ve never heard of ‘flu being transferred from birds to humans,’ I said, ‘but I suppose it’s possible.’  

I should have taken Charlie’s suggestion more seriously. Forty years later, the experts were worrying about people dying from bird ‘flu in China, and they have uncovered a lot about how ‘flu epidemics have spread via seabirds.  

They are fairly sure, for example, that the great pandemic (the Spanish ‘flu) of 1918, that killed 20 million people in four months as it spread around the world, started with pigs. They are still puzzling over the epidemics of 1957, the Asian ‘flu I caught as a student, and 1968, the Hong Kong ‘flu that hit us that Christmas. They do know that people who caught the Asian ‘flu were immune, as Charlie and I were, to the Hong Kong variety. They also seem to be immune to the swine ‘flu of the spring of 2010, that is thought to be identical to the Spanish one of 1918. 

The names relate to the first place that the ‘flu virus was found. The puzzle for the British experts is that in 1957 the first case of Asian ‘flu in Britain was reported from Stornoway, in the Outer Hebrides. In 1968 the Hong Kong ‘flu started in the Black Isle, north of Inverness.  

Why is that a puzzle? Because the ‘flu virus, once you inhale it from another infected person, takes only two or three days to produce the illness. It doesn’t make sense that the first cases would be in places so far from the usual ports of entry into Britain. Anyone carrying ‘flu caught abroad would have become ill before they reached areas like Stornoway and the Black Isle. Far more feasible is a spread from the sea. Were those dead birds the real clue to the ‘flu epidemics of 1957 and 1968? Charlie Welsh and I believe they were, but then, we’re not experts.