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'We in the UK know what a triumph the creation of the NHS was … and how, in our own throes of the coronavirus, it must be cherished and guaranteed'

John Wilson Foster


The lockdown has allowed John Wilson Foster to become reacquainted with the almost-forgotten, Coleraine-born surgeon J Johnston Abraham, whose battles against 20th-century epidemics hold lessons for us today

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J Johnston Abraham

J Johnston Abraham

Spanish flu victims in Kansas in 1918

Spanish flu victims in Kansas in 1918

An NHS Nightingale hospital in Birmingham

An NHS Nightingale hospital in Birmingham

POOL/AFP via Getty Images

J Johnston Abraham

Under lockdown, I have derived a great deal of comfort and optimism from my reacquaintance with a now-forgotten author, James Harpole. I have the 1947 30th edition of The Surgeon's Log (1911), a hot seller for decades. It is a marvellous account of his short time as a young ship's doctor on a cargo boat bound for Egypt, Malaya and Japan.

Harpole, in the course of his life, was a civilian and Army surgeon, novelist, broadcaster and essayist, who acquired along the way a DSO, CBE and Serbian knighthood. Harpole was the most celebrated medical populariser of his day.

Harpole, he explained in his engrossing autobiography, Surgeon's Journey (1957), was a pen name, made necessary because medical etiquette back then forbade doctors engaging under their own names in anything that could be regarded as self-advertising. His practice was between Harley and Wimpole streets, hence Harpole.

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Spanish flu victims in Kansas in 1918

Spanish flu victims in Kansas in 1918

Spanish flu victims in Kansas in 1918

He was, in fact, J Johnston Abraham (1876-1963), whose family came from Aughnacloy and Newtownbutler. His earliest memories were of watching the burning of Lundy's effigy from the window of his Coleraine home. His father was a tea merchant, his grandfather a linen merchant. His people were Methodists despite the Jewish-sounding name and he grew up fluent in braid Scots. But his pride of ancestry was without rancour, as such pride usually is in those who travel the world.

Besides, his medical reading of history lent him an even-handed humanity we in Ireland still need to learn. He knows the besieged in Derry died in their thousands of typhus fever, diphtheria and dysentery, but knows, too, that King James' army was likewise decimated by disease and melted away.

At Trinity College, Dublin, he studied both literature and science, as one could once do, but opted for the security of a profession. That choice did not prevent him from writing a novel that became what they called a succes de scandale.

All in all, Abraham may have been the best-selling Ulster author of the 20th century. The Night Nurse (1913), about the private lives of nurses and young doctors, was banned by hospital matrons in every English hospital save Guy's in London and sold promiscuously. He was an elected member of the prestigious Athenaeum Club and became a friend of Rudyard Kipling.

Abraham chose to be a surgeon over a physician and he proved to be a skilled and venturesome one. He recalls for us some hairy moments, such as retrieving a service knife out of sight in the bag-like membrane that encloses the heart, plunged there by a suicidal Great War soldier in Egypt who had convicted himself of cowardice. The soldier survived the operation, but died days later (of typhus) - not an unfamiliar story in medical annals, it seems.

Though a surgeon, Abraham's posts in hospitals in Dublin, London and overseas involved him in epidemics of bacterial and viral diseases of the kind we all now face. He admitted his fear of tetanus and, when he served with the British Red Cross Serbian Mission in the Great War, he saw it kill soldier after soldier horribly.

He was equally afraid of typhoid fever, which he watched ravage the Royal Irish Constabulary when he was with Dr Steevens' Hospital in Dublin. In Serbia during the Great War, Austrian prisoners died in thousands before the epidemic spread to the civilian population. He was in the midst of the London smallpox epidemic of 1902, having been familiar with the disease in Dublin where it was not uncommon.

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An NHS Nightingale hospital in Birmingham

An NHS Nightingale hospital in Birmingham

POOL/AFP via Getty Images

An NHS Nightingale hospital in Birmingham

Engaged with the Royal Army Medical Corps (RAMC) in Egypt towards the end of the Great War, Abraham fought malaria as well as diphtheria and typhus. But even those menaces paled beside the great influenza pandemic of 1918-19, when the base hospitals in Palestine were overwhelmed and casualty clearing stations had to hoard their patients.

Surgeon's Journey reminds us of our human vulnerability to the ills that flesh is heir to. All adults are now being taught this fearsome lesson. Yet it is a story, too, of inspiring drama that we are now witnessing: the drama of testing, diagnosis, containment, treatment and intervention - and, fingers crossed, cure.

But as time goes on, fingers need to be crossed less frequently. We are now aware of who the utterly necessary professionals are in our midst. We should become aware of how this expertise - the diagnostic and healing powers - came into being.

Abraham, in the course of his autobiography, tells us what extraordinary medical introductions, procedures and breakthroughs he witnessed during his career. Appendectomies; X-rays; surgical masks; customised operating tables; inoculation for diphtheria; serum for tetanus; penicillin; vaccination for typhoid; the discovery of hormones; the cure for rickets, and so on.

Above all, or so it seems to us, though less obviously to Mr Abraham, was the creation of the National Health Service in 1948. He writes of doctors being in "the throes of negotiating" with a socialist government over the terms of the National Health Act of 1947 and of "the shadow" of the coming NHS falling over the hospitals. But the private system that had lasted for centuries was ending. We in the UK know what a triumph the creation of the NHS was and how, in our own throes of the coronavirus, it must be cherished and guaranteed. It was the nationalisation in the air after the war that made temperamentally conservative doctors in private practices apprehensive, but Abraham admits his own fears were exaggerated.

Surgeon's Journey, like Abraham's other fascinating books made from his extensive medical casebook, is a story of painstaking detective work, but also of resolve, action and energy. How timely to read of the scarcity of hospital beds under canvas on the eve of the third Battle of Gaza in the Great War in 1917. Between sunset and dawn, within earshot of the opening salvoes, the RAMC readied 3,000 beds up and under cover for the expected casualties.

No wonder Harpole-Abraham called one of his volumes of memoirs The White-Coated Army (1938). He saw doctors (and we can now add nurses) as "officers in a health army fighting the long fight against disease". Under lockdown, I appreciate that thought infinitely more than when I first read it.

John Wilson Foster is Professor Emeritus, University of British Columbia. His most recent book is published this month: The Space-Blue Chalcedony: Earth's Crises and the Tyler Bounty.

Belfast Telegraph