explained -title of a concertante by J S Bach's contem-porary Jan Dismas Zelenka. It has recently beenrecorded on a Teldec compact disc.With so much dual talent it is hardly surprising to

learn that at the 1932 meeting of the Canadian MedicalAssociation a Dr Forde McLoughlin conductedhis own work, Influenza, A Tone Poem. Could anyCanadian reader tell us more about this occasion orprocure a copy? As recently as 1948 Dr Herman MParris produced, with the Doctors' Orchestral Societyof New York, a 10 movement orchestral suite, TheHospital, with movements entitled Anaesthesia (presto),A Nurse (allegro amabile), and a Pre-operation Prayer.Does the event figure in the society's annals?

Blow by blow descriptionBut there is nothing new. The French viol virtuoso

and composer Marin Marais celebrated an "operationfor the stone" with his Lithotomy Sonata for viola dagamba and harpsichord, which gives a blow by blowmusical description of the operation together with arunning commentary:The Patient mounts the Operating TableHe takes fright, and tries to get down again.His limbs are restrained with silken Cords.The Incision.The Blood Flows.The Cords are untied and the Patient is put to Bed to recover.Dance of Relief and Rejoicing.

The dance of relief and rejoicing was presumablyperformed by surgeon and staff, not the patient.Samuel Pepys would have loved it, for in 1658 (whenMarais was a child) he suffered an operation for theremoval of a kidney stone and thereafter celebrated itssuccessful outcome with an annual "stone feast."

Victorian doctors and their patients, pharmacists,and patent medicine manufacturers often figuredin ballads and music hall songs, which from themid-nineteenth century, thanks to cheap colourlithography, resulted in a great abundance of delight-fully illustrated sheet music. Although sex was stilltaboo suggestiveness was permitted, and songs aboutdoctors, ailments, cures, remedies, and popular health

.i ... .. . .;.'... ,, '::.;.::

Z U

...

,~~~~~~~~~~~~~~~~~~~~~~~~~~~~p

"The Quack's Song"

crazes were always popular. They were sometimesissued as barely disguised "commercials"-forexample, Phrenology-a New Song Dedicated to theHeads of the Universities, Public Schools and PrivateFamilies, Ipecacuanha, Morrison's Pills, or MrsWinslow's Soothing Syrup, which the young EdwardElgar immortalised in one of his works-a veritableprocession of musicomedical social history. Somesongs even managed to offer primitive health educa-tion with the help of music, like The Hygeia Waltzand The Death of King Dirt-a Domestic Revolution,being a parody on the popular ballad, The DeathofNelson.

The pictures in thearticle are from FritzSpiegl's collection.They form part of a"Spieglers"entertainment- TheMedical Muse: Songs,Verse, and Prose forDoctors and TheirPatients.

"Human guinea pigs" -a history

M H Pappworth

In 1962 I was approached by the editor of TwentiethCentury (a now defunct literary magazine) to contributeto a special number entitled "Doctors in the Sixties."My article, called "Human Guinea Pigs: A Warning"appeared in the autumn of 1962, describing 14 experi-ments in lay language; no names were named andjournal references were not given. This was an earlyevent in the debate in Britain about human experi-mentation. The debate excited much interest in boththe lay and medical press and led eventually tothe establishment of local medical research ethicscommittees.The reasons why I chose to write on this subject were

several: firstly, several of my postgraduate students,especially whenever I mentioned recent supposedmedical advances, told me about unethical experimentsthat they had personally observed in British hospitalsin which they were either junior staff or attendingcourses. Some told me of their dilemma whether or notto take an active role, or even a passive one, inpersuading a patient to volunteer, knowing that non-cooperation might jeopardise their careers. For many

years as a background to my tutorials for the MRCP Ihad spent hours in the Royal Society of Medicinelibrary scanning journals in which experiments inhumans were described that seemed to be unethicaland sometimes illegal.A further concern was that promotion in teaching

hospitals depended primarily not on clinical or teachingability but on published work. As Beecher wrote,"Every young man knows that he will never bepromoted unless he has proved himself as an investi-gator."' So whenever I read an account of an unethicalexperiment I wrote a letter to the journal protesting,often as not to have it rejected. Medical research hadbecome sacrosanct, based on the dubious dogma thatits continuation must be the prime concern of teachinghospitals.

Press reactionsMost of the popular press reported the article with

banner headlines and there were many letters from laypeople and doctors either condemning or congratulat-

London NW3 lAXM H Pappworth, MD, retired

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ing me. The oddest contribution was a letter to theGuardian from Professor Sir John McMichael claimingthat none of the 14 experiments described had beendone in his hospital. The editor published my replystating that, possibly unknown to Sir John, half ofthem had been done in the Hammersmith Hospital. ABMJ editorial stated, "There has been for some timepublic disquiet and uneasiness about investigationscarried out in hospitals which have not always been inthe interests of the subject of the investigation.""Undoubtedly many investigations have been harmfulto patients, even if only temporarily." "We could addother similar examples, including those given by DrPappworth, to indicate that the physician's humanobligations to his patients are sometimes abused."2

I did an Independent Television programme withDr Charles Fletcher and asked him for his opinion on astudy in which 43 diabetic patients, including childrenand those with complications, had had their insulindeliberately withheld so that they became comatose,and then liver, and some renal, biopsies had beendone.3 His reply-"The person was young andenthusiastic at the time and should be forgiven" -hitthe headlines of the national press the next day.

Royal Coliege of PhysiciansIn November 1965 Professor DM Laurence and

Professor AC Dornhorst together with Sir FrancisAvery Jones wrote a long letter to the president of theRoyal College of Physicians (Lord Rosenheim)emphasising the problems of research in humans.They quoted Beecher4 and the public reprimand givenby the US Surgeon General to some doctors from theSloan Kettering Cancer Research Institute who hadinjected live cancer cells into a group of patients withadvanced cancer and a control group (mainly prisoninmates of a state penitentiary), amounting to over 400subjects in all. In addition they had injected the samematerial into 19 elderly people with chronic illnesseswithout any explanation or consent.56

Lord Rosenheim wrote in reply "The topic hasbeen discussed on many occasions, the last was at aconference of the Presidents of all the Royal Colleges.It is clearly a responsibility to the public which cannotbe shirked." A working party was set up and maderecommendations in 1967 but these were not madepublic until 1973. Unsolicited, Sir Francis AveryJones wrote to me, "I would like this opportunitypersonally to say how very much I appreciate the effortyou have made in recent years to focus attention on thisvery important subject.... You did a very good job inhighlighting the subject and I am sure that others thinkso too."

In 1984 the Royal College of Physicians issued newguidelines and in 1985 a 22 member committee was setup; it published an excellent 40 page report in January1990.7 The new president wrote, "In 1967 the RCPrecommended that research involving patients andnormal subjects should undergo ethical review. Thisled to the establishment of local -Research EthicsCommittees. The college feels that it has now becomenecessary to review and update the Guidelines.-Theydeliberately refrained from dictating a right solution."(Nevertheless, why had it taken so long to issue such aforthright document?)

Why I wrote the bookI met Sir Victor Gollancz at a party late in 1962,

when he asked me to expand my article into a book, buthe gave me a time limit. I was very busy, mymanuscript was hastily prepared, and he did not like it.Unfortunately he did not employ a literary editor, whocould have helped, and hence amicably the proposal

was dropped. Nevertheless, I increasingly determinedto get such a book published. Neither financial gain norself advertisement were the motives, as some cynicssuggested; indeed I spent much of my own and mysecretary's time in preparing the manuscript and waseager to defend myself against any vilification. Mysolicitor, after reading my revised manuscript, advisedme to reread it carefully- a laborious task- and checkthe accuracy of all the quoted articles to ensure that thesummaries were correct.The difficulty then was to find a willing publisher.

Each of four in turn kept the manuscript for severalmonths, and, after consulting one ofthe'two legal firmsspecialising in libel, decided not to publish.A fifth publisher, one of whose directors was

a neighbour of mine, expressed interest, but afterdeliberating for over six months his colleagues decidednot to go ahead. I then approached another acquain-tance who was the senior director of Routledge, and heagreed to publish it. The book finally appeared in1967,' and was to encounter criticism in both the pressand parliament that the most recent studies describedhad taken place several years before. But that wasentirely due to the time lag in getting it published.

I was amazed to get telephone calls at different timesfrom three men claiming to be senior physicians, alltelling me that they knew the details of the proposedpublication and urging me "for the good of theprofession" to withdraw the manuscript. None of themwould give his name or say how and why he had readthe manuscript.Random House intially agreed to publish the book in

the United States but changed its mind when, on theadvice of my lawyer, I refused their demand to sign acovenant stating that I would be responsible for anylegal damages and costs. The Beacon Press of Bostonthen published the American hardback and paperbackeditions.

CodesMany lay people err in thinking that all medical

graduates have to take the Hippocratic oath. But thathas not occurred for over 30 years, and in any case itneeds altering and updating, something which I myselfattempted.9 But let us go back several years before Ipublished my book.

In 1947 after the trial of over 200 doctors concernedin infamous experiments, including leading doctorsfrom Germany and Austria, the Nuremburg Code wasformulated.'°" A laboratory technician, J A Tolly,each week for 10 weeks sent postcards containing the10 rules of the code to the Minister of Health, leadingnewspapers, medical journals, and many members ofparliament, asking "Will the, Minister give a clearpublic undertaking that the 10 articles will apply to allmedical experiments on patients in the NHS?" Hisefforts were unrewarded, but in 1952 the WorldMedical Association formulated a new code (which wasupdated 10 years later). Several British doctors objectedto this on the grounds that it would, impose unduerestrictions on research, but the code was updatedagain in 1964 and became known as the Declaration ofHelsinki.'2 This was the year that the AmericanMedical Association refused to endorse any of thecodes, a leading physician claiming that it would wipeout experimental medicine and would make life veryarduous legally for researchers. Conversely, the HighCourt judge and physician Sir Roger Ormrod stated,"The primary function of a professional code of ethicsis to adjust the balance of power so as to protect thepatient or client against the practitioner who has theimmense advantage derived from knowledge andexperience.... A secondary, but no less important,function of codes of ethics is to protect the main body

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of practitioners, who comply with the provisions,against exploitation by the black sheep who are pre-pared to defy them."'3We now have to consider the role oftwo other official

bodies in Britain. In 1953 the Medical ResearchCouncil issued memorandum 649, which dealt with theethics of experimentation on humans but did notemphasise the details of informed consent. A muchmore strongly worded memorandum, indicating thatthe previ,us one had been ineffective, was issued in1964.As to the General Medical Council, according to

a previous president its prime purpose is not theprotection of doctors but of the public. In a letter toWorld Medicine I asked why the GMC had not takenaction against some doctors named in my book, andwhy it had not publicly condemned the use of hospitalpatients for experimentation without their consent.'4When the South Place Ethical Society wrote to theGeneral Medical Council on this matter its reply was,"The Council [is] not empowered to deal with mattersof professional conduct which, though they may beopen to criticism, do not raise the question of infamousmisconduct.... The Council has not in fact receivedany complaint or information concerning any of thematters described in Dr Pappworth's book.... If yoursociety wishes to bring a complaint that the doctors hadbeen guilty of infamous conduct in a professionalrespect you are open to do so. It would be necessary forsuch complaints to be supported by one or morestatutory declarations, and to identify the doctorsconcerned and provide evidence of the matterscomplained of." In a letter to me dated 17 November1972 the GMC wrote, "If you considered the mattersdescribed in your book raised a question of seriousprofessional misconduct then it is up to you toformulate a complaint. The contents of your book didnot appear to be appropriate for the Council to takedisciplinary proceedings." So much for the GMC's"protection of the public."

ParliamentFrom the mid-1950s onwards there was a series of

parliamentary questions and answers about humanexperimentation. Thus in 1955 in answer to a question

The Nuremburg trials resulted in a code for medical experiments that was later updated to become theDeclaration ofHelsinki

about an experiment done in a Bristol hospital Mr lainMacLeod, then Minister of Health, replied, "Only theclinicians in charge could say what is right and proper.It would be entirely improper for me to try to lay downwhat ethical principles should govern the conduct ofprofessionals in the work they do in hospitals. I amabsolutely convinced it would be quite wrong for theMinister to issue directions on this matter that isessentially one of medical ethics."

In 1958 the health minister, Mr Derek Walker-Smith, was asked concerning experiments done inLondon on mentally defective people and replied,"Ivestigations of this kind involve ethical matterswhich are not susceptible to control by leglislation. " In1962 the minister, Mr Enoch Powell, was asked underwhat circumstances experiments were permitted inNHS hospitals and to what extent they were carried outwithout consent. He replied, "Guidance was given toall hospital authorities in 1959. I have no reason tosuppose that they are not generally observed."

In 1967, soon after the publication ofmy book, threeMPs at various times and independently called for apublic inquiry. On behalf of the government MrAllison gave the following replies on differentoccasions: (a) "Allegations that doctors in the UK havecarried out unauthorised experiments onNHS patientsare not based on facts"; (b) "Evidence is lacking in thecases brought to the attention of the Department andthe author has not been prepared to support them"; (c)"The allegations cannot be grounds on which theapparatus of public scrutiny should be brought intoplay. They have been promptly denied by hospitalauthorities"; (d) "The medical profession for genera-tions has been guided by strict codes"; (e) "Allegationsof experiments on cancer patients in the USA may betrue or not but they have no parallel in Britain." Withregard to the last statement, I draw attention toresearch I had summarised in which a 75 year old"moribund" man with general paresis and bowelcancer with metastases had been subjected to a studywhich could not possibly have helped him."My supposed lack of cooperation with the Ministry

is based on a visit I had had from an official from theDepartment of Public Prosecutions, whose onlydemand had been that I name the person responsiblefor the experiment (on page 26 of my book) in whicheight patients with peptic ulcer and haemorrhage hadbeen submitted to lumbar aortography under thesupposition that it was a routine investigation of pepticulcer. Three patients had died as a direct consequenceof the experiment, and the official pointed out that anamed person would be liable to prosecution formanslaughter. That study was the only one in which Idid not name names. On the advice ofmy lawyer I hadrefused to give these, which had been given to me byone of my students who later became a professor ofmedicine and were corroborated by another who hadheld a junior post in the radiology department of thathospital.

In answer to a question in 1967 Mr Snow, aparliamentary under secretary, laid great emphasis onthe fact that over half the experiments I described hadtaken place in the United States. But he then admittedthat when he read on a very early page of HumanGuinea Pigs my likening some unamed British researchworkers to Nazis he had thrown the book away anddeclined to read it further. In the Daily Telegraph of 21June 1967 Peter Simple wrote, "What sort of anargument is this? Mr Snow's interest far from lapsingshould have been greatly intensified."

In a House of Lords debate on 25 January 1973 onthe government bill on the reorganisation of the NHS'6Lord Beaumont proposed an amendment to makemedical ethical committees a statutory obligation forall NHS hospitals in which studies on patients were

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being done, stating that at least a quarter of thecommittee's members should not be doctors, para-medical workers, or anybody else employed in theNHS. Lord Strabolgi, who seconded the amendment,said that there had been demands "in the other place"for an inquiry into allegations about clinical experi-ments, but these had leen turned down on threeoccasions. Opposing the amendment on the grounds ofthe impossibility ofdefining "experiment," Lord Platt,who was then president of the Royal College ofPhysicians, added, "In most hospitals where there areactive investigating departments there is now an ethicalcommittee. I [have no] objection to there being writteninto this Bill some recommendation that there shouldbe an ethical committee, whose business it would be tomeet from time to time and consider any majorinvestigation which was brought to their notice. Idoubt whether you can go further than that." He alsostated, "I know that experiments have been done inhospitals which I would not have done, but which haveturned out to be completely justified by experience."The view of Lord Brock, the president of the RoyalCollege of Surgeons, was that "The provision ofthese ethical committees is not a suitable subject forlegislation. We should leave things as they are and trustin the good sense and responsibility of the doctors."Lord Vivien supported the amendment, saying that

though Human Guinea Pigs was not a popular bookwith the medical profession, the allegations could beinvestigated if the amendment were accepted. LordAberdare on behalf of the government opposed it andsaid, "I noticed that the cases cited in this book werecollected over a long period and from a number ofcountries other than the United Kingdom. Although inthe past unethical experiments may have been carriedout, I am sure that under present arrangements theopportunity for further similar unethical procedures isnegligible." The amendment was not carried.

Reaction of some doctorsThere is strong evidence that few doctors have read

my book. Thus when I addressed over 100 staff of theHammersmith Hospital I asked how many had readmy book and only two raised a hand. A few privatelyassured me on other occasions that they had never doneany unethical work, but they became speechless when Itold them that their names were in my book. Aprofessor of medicine boasted that no such work hadever been done in his medical school and was surprisedwhen I told him that his own senior lecturer (laterhimself a professor) was mentioned several times.On 4 February 1972 the Radio Times published an

interview with me on human experiments. Dr CharlesFletcher subsequently had a letter published in thatjournal in which he stated, "How easily a long interviewby an obsessional doctor with a special bone to pickwith his colleagues can mislead. A very few doctorshave occasionally abused their patients' trust and usedthem for research without their free consent. Thisno longer happens because of their strict control.Pappworth is to be commended for the part he hasplayed in getting ethical committees instituted. He is tobe condemned for his continued public attacks on hisprofessional colleagues."My opinion remains that those who dirty the linen

and not those who wash it should be criticised. Somedo not wash dirty linen in public or in private and thedirt is merely left to accumulate until it stinks.One of the most influential writers on medical ethics,

Professor H K Beecher of Harvard, the author of animportant book,4 attended a conference in 1964 on theproblems and complexities of clinical research. Hiscomplaint of "breaches of ethical conduct in experi-ments which are by no means rare but are almost

universal" produced a vitriolic attack on his good faithfrom some of the audience. He was so shocked that heapproached the editor of the New England Journal ofMedicine, who advised him to summarise some of theobjectionable experiments. The published article,which I had helped to compile, summarised 22 experi-ments including seven instances supplied by me.'Nevertheless his account was written in very technicallanguage and no names or journal references weregiven; he told me that this had been done on legalgrounds given that the investigators might be liable tocriminal proceedings. I believe that giving names andreferences has, at least in small measure, acted as adeterrent.

Limitations of ethical committeesThe BMJ has recently had an excellent editorial on

the shortcomings of ethical committees.7 Neither thecommittees nor their decisions have any legal status,and their establishment is not mandatory.

Their performance is variable and influenced bytheir composition, the procedures followed, the timespent on deliberations, the frequency of their meetings,which protocols must be submitted, and which submis-sions should be allowed. Some members, thoughunhappy about the work of some colleagues, may takepride that it may possibly bring prestige to theirhospital. There is also the possibility of collusion-ifyou approve my work I will approve yours.The effectiveness of such committees in Britain has

never been investigated or monitored, sometimesbecause the members refuse to act as policemen. Amedicolegal expert has written, "The aim of gettingconsent of an ethical committee for an experimentalprocedure is to ensure the patients' interests. It shouldnot be a purely procedural and defensive step."'"Most importantly, ethical committees have no

sanction of instituting penalties against those whoignore or act beyond the limits of an agreed protocol.The Royal College of Physicians' report admits,"Plainly the investigator who bypasses or ignores theirrecommendations creates a potentially serious problemwhich could make him vulnerable to professionaldiscipline or even legal procedures."6 In Australiainsurance companies refuse to give cover to doctorswho engage in research on patients unless their workhas been submitted to and agreed by an ethicalcommittee. Yet Dr Richard Nicholson, editor of theBulletin ofthe Institute ofMedical Ethics, has stated thatone in nine ofa large number ofcommittees investigatedin the United Kingdom conducted their proceduresentirely by letter or phone.'9

Editorial responsibilityEighteen years ago the journal Clinical Science listed

eight rules for editors to bear in mind when they weredealing with articles reporting experiments onhumans.20 Yet how many medical editors abide bythose rules? The Royal College ofPhysicians' guidelinesstate, "It is desirable that authors indicate theirresearch has been approved by an ethical committee."Why merely "desirable"?

Beecher wrote to me that "The Law-MedicalInstitute ofBoston questioned the editors of61 medicaljournals produced in the United States of Americaasking, 'Would you have concern for the social obliga-tions of clinical research activities as part of youreditorial responsibility?' Seventeen editors had replied'No."' Elsewhere he stated, "How many would carrvout experiments if they knew that they would not bepublished? Valuable data which has been improperlyobtained should not be published even with sterneditorial comment. "2' I believe that the time has come

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to tighten all these aspects up. Researchers themselves,their units, hospital ethics committees, and editors ofmedical journals all have a vital role-otherwise legalsanctions will inevitably raise their heads again.

1 Beecher HK. Ethics and clinical research. N EnglJ Med 1966;274:1354-60.-2 Anonymous. Experimental medicine [Editorial]. BMJ 1962;ii: 1108.3 BearD AG, Billing BH, Sherlock S. Hepatic glucose output and hepatic insulin

sensitivity in diabetes mellitus. Lancet 1951;ii:698.4 Beecher HK. Experimentation on man. Springfield, Illinois: Thomas, 1959.5 Southam CM. Hormotransplantation of human cell lines. Bull NY Acad Med

1958;34:416-23.6 SouthamCM, Moore AE. Induced immunity to cancer cell homografts in man.

Ann N Y Acad Sci 1958;74:635-53.7 Royal College of Physicians. Guidelines on principles of ethical committees. 2nd

ed. London: RCP, 1990.8 Pappworth MH. Human guinea pigs: experimentation on man. London:

Routledge, 1967. (Also published in paperback edition (Penguin, 1968);American edition (Boston: Beacon Press, 1967); German (Vienna: Muller,1968); Italian edition (Milan: Fetrinelli, 1971).)

9 Pappworth MH. Modern Hippocratic oath. BMJ 197 1;i:668.10 Mitscherlick A, Mielik F. Doctors of infamy. New York: Schuman, 1949.11 Bean WB. Treatment of duty: some strictures on moral responsibilities in

clinical research. J Lab Clin Med 1952;39:3-9.12 Anonymous. Human experimentation: code of ethics of the World Medical

Association. BMJ 1964;ii:77.13 Ormrod R. Medical ethics. BMJ 1968;ii:7-10.14 Pappworth MH. GMC's attitude to human guinea pigs. World Medicine

1972;18 October:15.15 Pappworth MH. Human guinea pigs. Harmondsworth: Penguin, 1968:278.16 House of Lords Official Report (Hansard) 1973 January 25;338: Cols 262-7,

279-83. (No 29.)17 Lock S. Monitoring research ethical committees. BMJ 1990;300:61-2.18 Brahams D. Ethics in clinical development.JR Soc Mqd 1990;83:469-70.19 Nicholson R. Ethics in clinical development. J R Soc Med 1990;83:469.20 Anonymous. Ethics in human experimentation. Clin Sci 1972;43:309.21 Beecher HK. Research and the individual: human studies. Boston: Little,

Brown, 1970.

Turning the BMA into print

Gordon Macpherson

BMA members attending their first annual representa-tive meeting must wonder how decisions can everemerge from such apparent confusion. One manskilled at turning the turbulence of the BMA's demo-cratic process into the order of the printed page hasjust completed over 40 years of continuous attend-ances at ARMs. Lawrie Wootton, until recently seniorpartner at T A Reed, a distinguished firm of parlia-mentary and court reporters, signed off his final setof transcripts for the BMA at Bournemouth thissummer. Gordon Macpherson, who retired as deputyeditor of the BMJ in October, talked to him about hisexperiences.

Few men can boast that they were present at theLuneberg trial of the guards of the Belsen concen-tration camp, the birth of the state of Israel, thefoundation of the Council of Europe at the Hague, theinterrogation of spies in wartime Britain, the trial of thenotorious Heath, hanged for murder, and the parlia-mentary debates on the founding of the NHS. LawrieWootton recorded all these events in his 200 words aminute shorthand. Ironically, his path to reporting themore mundane occasions of BMA meetings startedduring the war at a courtmartial of an army medicalofficer. The transcript of that trial was admired by thethen senior partner ofT A Reed, who when the war wasover invited Mr Wootton to join his team of parlia-mentary and law court reporters.

Acceptance of that invitation led to a worldwidecareer producing verbatim reports of conferences,parliament, the law courts, Guildhall dinners, theGeneral Medical Council-where he recorded thedisciplinary hearing of the court martialled medicalofficer-meetings of the BMA, and conferences ofother professional associations. He could have coveredthe trials of the top Nazis at Nuremberg but, admittingto a youthful "lack of a sense of history," he was moreanxious to get demobilised than record the courtroomdrama that marked the end of Hitler's Germany.

After two years' wartime service in the RoyalArtillery Lawrie Wootton was called to the War Officeand transferred to the judge advocate's department toapply his verbatim reporting skills acquired workingfor a local newspaper. Apart from courtmartials, herecorded the interrogation of several spies, doingso behind a screen so that "the interrogators anddefendants weren't distracted by my pen scratching."Transcribing question and answer after question

and answer, "you become a bit like a machine," hesaid. The information "went in your ear, throughyour brain, and down your arm, and someone oncedescribed such verbatim reporting as one of the finestexamples of coordination ofhearing, brain, and hand."T A Reed was, he said, always reckoned to be

the Rolls-Royce reporting service-only about 100reporters could do what he did-and the firm coveredall the technical conferences, "where the words withmore than four letters were used." Though he trans-cribed his notes as soon as practicable, Mr Woottonoften had up to six meetings "in my shorthand books"at one time and this may have included the BMA, theBritish Dental Association, the architects, the church,and an international commodity conference. "I'vesometimes had to read my notes seven years after a caseand as soon as I started to read them I could see thecourt and the people involved."

250 000 WordsHe has always been meticulous about names, and as

a double check of his transcripts he may borrow thenotes of those speakers who use them. Such skills wereessential for the BMA's annual meeting, when around400 pages of transcript-approximately 250 000 words-were produced. He could not do such a concentratedtask on his own and was helped by three or fourcolleagues, each doing 15 minute reporting stintsbefore breaking to type out the shorthand record.Thus, as with parliament, the complete record was tohand within an hour of each day's session ending, aninvaluable service to those of us who had to prepare asubedited report for the next week's BM7. Thirtyyears ago his reports on an annual meeting would fill 66pages of the journal-over 60000 words-but thestyle of presentation has changed as readership tasteshave changed and the pressure on space has greatlyincreased. In his final ARM Lawrie Wootton's 250 000words were condensed by Scrutator to around 20 000.

His reliability was evident early on from a request byThe Times to accompany Aneurin Bevan during hisspeech making tours during the launching of the NHS.The Minister of Health had complained of beingregularly misreported. "A superb speaker, he nevermade notes, and The Times wanted an accurate recordof what he said," commented Mr Wootton. Theywould have had that, without doubt. Throughout hisprofessional life his reports were never successfullychallenged. Nor was he ever asked to doctor a report,

British Medical Journal,London WC1H 9JRGordon Macpherson, MB,former deputy editor

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