Friday, 31 October 2014

The English Language

This review was written on August 31st 2012

The English Language. 

I bought this book from Kindle in August 2012.  I was, as always, interested in the origins of the English language.  This book is authored by a very learned scholar of language, and much of his long dissertation contains unusual but not inappropriate words in the text, such as orthography, philologist, palaeontologist, consontental, triphthong, phonetics, the copula, praeterite, etymology, prosody, euphony etc. which must be a little beyond the ordinary reader

Robert Gordon Latham C. 1860
The text was probably published in the early 20th century and the author, Robert Gordon Latham, was Professor of English Education in London University.  It is long, perhaps about 700 pages. Its contents must be hugely important to any real scholar of the English language, containing as it does so much detail about every aspect of the language’s evolution from the earliest Etruscan roots to the constructions of the present day language.  Much of its details were lost on me but nevertheless I learned enough to follow the general evolution of the English language and its relationship historically and in other respects with many other ancient and modern tongues.

Archaic Etruscan Alphabet 7th - 5th Centuries BC
Apparently the first alphabet known to us was Etruscan and the earlier pre-Roman and pre-Greek languages are described as Gothic, Celtic or Germanic.  There is much information about the so called Germanic languages which include those of the Nordic countries, Iceland and the North Atlantic islands. The name England and Anglo-Saxon were derived from the immigrant Angles and Saxons.

The initial chapters deal largely with the origin of the English language during the 6th and 7th centuries A.D. with the various invasions of the Saxons, the Angles and the Jurists from Germany and surrounding cultures.  These sects invaded different parts of south-eastern England and they have left the remains of their languages in some of the place names in these areas.  The book provides many examples of modern names and place names in the east and south of England which can be traced back to these earlier Germanic tongues. These Germanic languages were preceded by the Roman invasion of England at the time of Caesar but the Romans left little trace of Latin after their departure, whatever about their archaeology remains.

Viking Runic inscription
The Vikings during their long stay at the end of the first and early in the second millennia left their mark too in their language and were more influential north  of the country’s south-east.

Later chapters deal with the evolution of English at the time of Edward the Confessor in the 13th Century.  It was then that the educated speaking Latin and French were first to start corresponding in old English and it was Edward the First who was the first to communicate with his subjects in this way. 

There is much of interest in the origin of language in Scotland where the low level Scots spoke English while the Western areas spoke Gaelic and were heavily influenced in the North of Scotland and in the contiguous northern islands by Scandinavian roots with Gaelic dominant in the Highlands and the Hebrides. 

I have to confess that many chapters were fast read by me where the author deals with such aspects as terminology, pronunciation, declensions and grammar; I was primarily concerned with the origin of the language.  I was of course interested to enquire into the origin of Irish in Ireland and the Celtic languages still existing along the Atlantic seaboard. It was extraordinary that the Celtic tongues continued to exist for so long on this narrow strip of coastland stretching from the North of Scotland, Ireland, Wales, Cornwall, Brittany and the northwest of Spain.  There is a section suggesting that the Irish in Ireland was particularly related to the ancient Punic languages, presumably from North Africa, but the evidence of this is hardly convincing or perhaps not fully understood by myself. In one chapter, it was stated that Irish was of Carthaginian origin but it is apparent that Celtic preceded Greek and Latin as one of the earlier languages in Europe and the Eastern world.

There is much reference in the text to the influence of the Scandinavian or Norse languages. The Viking invasion of England (and Ireland), an occupation which continued for five centuries or more, left place names as well as other language  traces. Examples in Ireland are the terminal place name word such as ford, which is derived from the Norse word Fiord and why did the family names including the initial Fitz remain common in Ireland and not in England? 

The reference to Edward the Confessor underlines the importance of the Norman invasion in 1166 when French and Latin became the spoken and written words of the better educated and which had a huge influence on English terminology, particularly in the areas of science, law, the professions and the gradual expansion of education.

Reading this long and specialist book reminds me of certain limitations in the use of Kindle.  These may be partly an expression of my own ignorance of the usage of this medium of reading. The Kindle is unsatisfactory in dealing with maps, photos and designs.  Maps apparently cannot be changed to do different fonts, so that they cannot be enlarged or studied in detail.  There is also the problem of making quick and easy reference to other aspects of a long book, particularly where there are many characters and many chapters. 

This book is, for example, divided into four parts, one at least of which has more than thirty chapters, and each of which is on a different aspect of the English language.  Of course the book itself may be heavy for the older person and its font may not suit the elderly. These are problems for me with my visual impairment and the cramps induced by the weight of the book on my hands.

At the year 1,000 A.D it was believed that the language at the time owed 75% of its origin to Anglo-Saxon, 12% to Anglo-Norman, 2% to Celtic, 4% to early Latin, 3% to Scandinavian and the rest miscellaneous. Clearly by the 21st century much has changed through the later Norman influence based as it was on the earlier Latin and the preceding Greek, and of the influence of the extensive regions which were dominated by and greatly influenced by the British Empire during the last three centuries. Among the educated at least, and particularly those of the medical profession, the many prefixes (pre, Latin) and suffixes (Greek ism, Latin ble) derived from these two classical languages is a prominent part of our daily speech.

Reading this book at my advanced age confirms my regrets that I had not read it and similar works about the origin of the English language and its progressive change over the last two millennia. It reminds me how poor was the standard of education, primary and secondary, during my earlier years. It also should remind us that Latin and Greek are still important for the medical profession if we doctors are to maintain a proper insight into the culture and into the history of our profession.

Friday, 24 October 2014

My three boys in Nunraw

Sancta Maria Abbey Nunraw.
My three boys in Nunraw, September 2014

My paternal parents and their offspring were interested in education and in professional advancement. Their progress could be described as the product of the Catholic Emancipation Act of 1829 and of the proliferation of the Irish Catholic secondary schools during the gradual emergence of the Catholic middle class during the later years of the 19th   century

Brothers three: Dad, Sam and Paddy
My father was the eldest boy, born in 1886, and Sam was the youngest of the eight children. He was born in 1900. It is Sam who is the subject of this essay. He studied for the priesthood and joined the Cistercian Order in 1924. I deal briefly with his career and in doing so I refer to my three sons who joined me in visiting the monastery established by Sam at Nunraw in East Lothian in Scotland in 1946.

Sam was prior of the Cistercian monastery and secondary school at Roscrea in Co. Tipperary when he was appointed as the founder and Abbot of the first post-reformation Catholic monastery in Scotland. It was sited in East Lothian in 1946 just after the end of the World War. It seemed a very ambitious undertaking and almost a provocative challenge that a Catholic monastery would dare to establish itself in the heart of Scottish Presbyterian country and that it would acquire extensive land and buildings after their arrival there. On the contrary, the monks were well received by the local people and were greatly helped in settling down during their early years.

Land acquired extended eventually to 1300 acres, which was mostly worked by the monks with some local farmers but the fall in vocations among young people has led to the disposal of the land and the loss of the traditional role of the Cistercians in farming and providing for their members.

The monks (and their many skills).
The monastery was completed by 1969 and had acquired a large guest house close by. The monks built the monastary completely by themselves during its 23 years of construction with the assistance of volunteers and a few local building experts. As the first abbot of Nunraw, Dom Columban (Sam) soon became a close friend of the head of the Church of Scotland and both were enthusiastic in sharing their interest in and hopes of ecumenical progress within the Christian world. Dom Columban had an obvious impact both locally and in the wider world. He received widespread publicity at the time of his death in 1970 including a full programme presented by Malcolm Muggeridge on BBC television.

I remember my uncle as having a most happy and gentle disposition, a feature of many of the other monks we met as children and as we were to meet this year when we arrived in Nunraw. He was clearly very progressive in his outlook and may have found the very conservative rule of the Cistercian Order to be incompatible with changing attitudes aimed at greater communication created by better education and the expanding nature of modern society.

An example of his progressive nature was his concern about the appalling diet on which he and his colleagues in the order were confined to. No meat, fish or other sources of protein except hard cheese could be found on their table. He arranged for me and my colleague, Noel Hickey, and our dietician in my department at St. Vincent’s Hospital to visit Mount Melleray in  Co. Waterford, the head and sister house of the Cistercians in Ireland and to make recommendations about a healthier diet for the Order worldwide.

We investigated the causes of death of the previous 50 monks as recorded in the County register in Co. Waterford and found a relatively poor life expectation among the community. We attended their main meal of the day (including our female dietician – possibly the first female to attend such an event!) and made recommendations to my Uncle Sam which were sent to Rome and apparently acted upon on behalf of the entire Order. Meat and fish were still prohibited, as I recall, but pulses – a mixture of beans, peas and lentils – and eggs and other protein sources may have been allowed.

At Nunraw: David, Self, Richard, Dom Caira and Hugh.
Earlier this year during a conversation with my son Hugh we spoke about Dom Columban. Hugh suggested that we ought to visit the monastery as a tribute to his memory. After some thought I wrote to the current abbot Dom Mark Caira and I was kindly invited to visit Nunraw with my three sons, Richard, David and Hugh. Flying directly to Edinburgh, we hired a car and settled ourselves in an excellent hotel. Next morning we drove to Nunraw, a distance of about 35 miles where we spent up to three hours in intensive conversation with the abbot, with his immediate predecessor, Dom Raymond, and his predecessor and successor to Dom Columban, Dom Donald. The latter was appointed shortly before Columban retired and the latter’s  early death just at 70 years.  Obviously with the next three abbots alive and well, the life span of  the monks has greatly extended since the early  days, perhaps because  their dietary habits have improved or might it be the bracing air of Scotland?

Sam's grave is just to the left of the big cross.
Not unexpectedly, we found that there has been a marked fall in vocations and that the monastery needs to reduce its facilities for the visitors who attended and used the monastery and guest house as an environment designed for prayer and reflection. There are now about twelve to fourteen monks, all of them above seventy years. They had a complement of about 64 in the early 60s but vocations have been falling slowly and inexorably since Vatican II and I am told that the paucity of vocations entering monasteries is evident worldwide. In the late 1960s I recall my uncle being greatly stressed by the early changes occurring in the monastic world after Vatican II.

We found the same personalities among our hosts which I recognised in my uncle and predecessor whom I knew so well, a sense of happiness, contentment, courtesy and optimism despite recent changes in the spiritual and secular world. And clearly they showed a special regard and reverence when they spoke about Dom Columban.

Richard, David and Hugh; when things were more black and white.
The visit for me had another and equally meaningful and lasting effect. It was the first time I had spent alone with my three boys, all now in their fifties. It was a reminder of the gulf which exists between generations in terms of interests and current affairs. It also is a reminder of how warm can be the relationship between father and son. I was treated like a lord in terms of hospitality and consideration and reminded so fully of the warmth of their affection. It was as obvious to them as it was to me that this short break from full family life, removed from the daily affairs of an extended family, had a binding effect on our relationship. 

When together in the hotel, pub or elsewhere there was never a moment of silence. Talk was incessant but it was generally shared by the three and on subjects which were more often of interest to their generation. The first evening we arrived we spent about two hours in the lounge/bar and I found that I was a little remote from the conversation, not only because the subjects were closer to their interests but because of my inability to catch many parts of their conversation, aggravated by the constant noise in the background of the bar and the inevitable loss of hearing as part of my age. At first I was a little concerned about my patchy exclusion from the discussions and the likelihood that this would remain during the entire stay of our time in Edinburgh but I decided that my real role was to study the three of them during their frequent and sometimes intense conversations and to analyse the relationship between them.

Pinting with Hugh
This proved to be an excellent decision and, although there was no loss of attention to me and my presence at times, it was fascinating to be a listener rather than a participator and to study their different characters. Their friendship was clearly apparent and at no time was there any evidence of discord but it was clear that Hugh needs to be alone at times and it is good to be alone with him to share a pint. Richard tends to have strong views but is amenable to other opinions and is safe behind the wheel. He did not seem to resent the modern gadget at the back of the car which in flat and monotonous tones advised him that the next turn was 350 metres to the left. It seemed a help in Edinburgh to the unfamiliar, dominated as the city is by the Castle, by the confusing pattern of streets surrounding it and the heavy weekend traffic and crowds  

David, Self and Richard, enjoying the 1970s.
David likes to keep in close communication with his family and his profession and is in constant use of his mobile phone and his camera. I had the impression that he was the calmest of the three but this could be disputed. When the three were together there was little evidence of calm. Hugh was less communicative with his wife and family at home. He probably contacted them not more than three times daily while David would have comfortably exceeded that number. Richard was the most economical in the use of his ‘phone. He rang his loved one once every day as he retired to his bed in my room. Most obvious to me was the affection the boys shared, their generosity, their common interests and their constant concern about my welfare and comfort.

Altogether it was a most happy reminder of the good fortune which can exist in family life and particularly in the extended family of which I have had the good fortune to belong.  Apart from our visit to Nunraw I thought the happiest moments of our visit was sitting in a crowded pub with a pint of Guinness in my hand listening to and sometimes even intervening among my three boys.

Spot yourselves boys.

Friday, 17 October 2014

Clearing the Air

Clearing the Air - the Battle over the Smoking Ban Noel Gilmore. The Liberties Press, 2005. 

This review was written on March 18th 2005

Life expectancy in Ireland has been increasing gradually during the last century, thanks to various social, public health and medical measures. It has extended more rapidly in the last 25 years largely as a result of the anti-smoking campaign which first started forty years ago at the time of the first Royal College of Physicians and the Surgeon General’s reports. Life expectancy will gather momentum because of the recent public smoking ban in Ireland, followed as it will be by similar measures worldwide. Indeed, it may mark the beginning of the end of cigarette smoking as a health hazard. The trend will be further increased by changes in the production of cigarettes – smaller cigarettes, reduced tobacco content and lower levels of tar and nicotine.

The ban will have a powerful effect on the culture of nations and on public health, particularly as most smokers in Ireland are now in the younger age group who do not yet manifest the clinical effects of the smoking diseases. Older persons, septuagenarians, octogenarians and older, who are likely to be non-smokers or who had stopped smoking when at an earlier age, will become an increasing proportion of our population.  It is well established from epidemiological studies that the healthy smoker who stops gradually reverts over five to ten years to the same risk status as the non-smoker.

Budget 2015 - another 40c on a pack of fags.
In terms of legislation, the Irish ban is unique as a measure of social engineering. It was promulgated by a minister, cabinet and a parliament for the common good with no obvious motive of political gain or advantage. The exchequer will not necessarily be affected as the price of cigarettes will almost certainly be subject to increasing taxation. The ban was implemented after a widely conducted and controversial campaign involving every stratum of Irish society. The commercial vested interests were harnessed most powerfully to oppose the ban; but the Minister and his department adopted a brilliant public relations strategy, receiving increasing and vital support from a variety of organisations, including voluntary, statutory, health, social and environmental bodies and members of the medical professions. In political terms, it was the most altruistic piece of legislation in my memory and, in terms of public benefit and approval, it is in the same realm as the banning of plastic bags.

The success of this legislation contrasts with some other aspects in our country. The neglect of education, civics and the provision of better infrastructure for transport, cycling and healthy exercise, are some of these, and our appalling planning policies at a time of great prosperity and of waste as consumerism takes precedence over more pressing social obligations.

Noel Gilmore, a former director of the Government Information Services, provides a fascinating account of a well organised public campaign which up to recently would not have been envisaged in our wildest dreams. The author writes well and is supported by detailed research into the origin and the progress of the campaign. It makes easy and sometimes amusing reading, and is a comfortable gossipy account but is none the worse for that. It is an important reminder of what can be done by our politicians for the common good. Let us be thankful for this rather rare example of our government’s genuine concern for Irish society.

Micheál Martin, Minister for Health, 2004.
Some months after the ban was implemented I was invited by an old-standing colleague in Munich to attend a meeting on medical epidemiology and to address the audience from various European countries on Ireland’s success in banning smoking in public. The audience was suitably impressed by our government’s altruism but I thought it appropriate to add my own view that there was one factor which received no publicly in Ireland but which might have been in the mind of the minister for health and his cabinet colleagues. Talk was being heard at that time that some of the staff in our public houses were aware of the increasing information being published about the carcinogenic effect of passive smoking. Such workers were obviously exposed to a heavy atmosphere of cigarette smoke during their employment. Those inflicted by lung cancer, emphysema or coronary disease were likely in future to raise this matter when seeking compensation and would certainly succeed in their plea of risk exposure. I suspect that our minister for health must have some inkling of this potential hazard and that his altruistic act must have had a tinge of a political motive. 

Friday, 10 October 2014

Darwin’s Garden

Darwin’s Garden – Down House and the origin of species. Michael Boulter. Constable and Robinson, London. Photos. plans, illustrations. pp 251

This review was written on August 27th 2011

I finished my autobiographical My Challenge to Ageing in March and published it on Amazon in April 2011. For the first time I found the writing stressful, either because of my advancing age or because I was undertaking a new form of publishing. I was depending on my son Richard’s cooperation, advice and knowledge of electronic publishing.  I was determined to stop all serious writing and return to reading and listening to music. My reading was poorly organised and desultory for the next few months but I settled back to a more normal frame of mind with a visit to the RDS Library which got me started on the above title. I had of course read a long biography of Darwin some years ago which is in my library (The Origin of Species by Natural Selection, Penguin, 1987) but this more technical and recent book seemed likely to reintroduce me to the reading habit again.

Darwin’s family background was not surprising in a person of such intellectual standing. His grandfather was the famous Erasmus Darwin and his father a well-known doctor. His mother, Susannah Wedgwood came from a neighbouring family in Shrewsbury. They were the potters who established their famous brand. The Darwin antecedents were in the vein of the great liberal and progressive movement at the beginning of the 19th century in England which encouraged the scientific and natural history activities at that time.

In his earlier adult years Darwin had spent four years circumventing the world on the Beagle during which he was indefatigable in his curiosity of the natural history of the many countries and climates he visited and which prepared him for his subsequent devotion to the natural history of plants and animals and eventually to his publication on the factors which determine the survival and the changes which were part of the natural history of species.

There is much in the book about Down House which the young Darwin bought. It was in its extensive garden where Charles was to carry out many of his observations and experiments and it was the garden rather than the house that induced him to settle in Down Village just outside the south-east of London.   

I knew already that Darwin had a great regard for the publications by Malthus on population, I found, therefore, to my surprise that he first heard of Malthus’s ‘An Essay of the Principle of Population, Penguin Classics, 1985, (see my previous blog dated May 13th 2013,) as late as 1838 although Malthus had published his first and widely read edition of his work as early as 1798. I also found in the text that Wallace, who shared Darwin’s view on evolution, only first refers to Malthus in a letter to Darwin, a year or so before Darwin published his Origin of Species. Both Darwin and Wallace attached great importance to Malthus’s view on the dependence of food supply and other factors which determine the fortunes of the human and other species. It was Wallace’s letter to Darwin in 1858 which decided Darwin’s hastening the publication of his The Origin of Species, and although he was generous in acknowledging Wallace and his similar researches and insights into evolution, it was Darwin who is largely credited with the great advances in our natural history since then.

From the practical point of view, if we are to think of the future of the human species and the well-being of our natural surroundings, we must surely realise that the principles established by Malthus are more important and relevant to humanity and our natural world than the contribution of Darwin, Wallace and the many great naturalists of the past two centuries. The significance of Malthusian principles must surely be evident to us to-day when we see the threat to humanity and to many other species of fauna and flora which are literally staring us in the face as we witness the rapid degradation of our natural surroundings.

Darwin’s Garden is a relatively short book which includes two principal themes. There is much about Darwin and his devotion to his garden as a source of his many experiments and observations, about his home and family and about his relations with the many other naturalists who were active in Britain and abroad during the mid- and late 19th century. It was remarkable to find the huge detail and time he spent in observation and experimentation in his study of pigeons, barnacles, bees and common domestic and carefully tended exotic plants.

Darwin's greenhouse at Down House
The second theme relates to the natural history movement which was gathering pace during Darwin’s time, the many different opinions of the origin and evolution of species, the history of the earth in terms of longevity based on fossils, and the constant conflict existing between those who were guided by natural phenomena and those who were committed to biblical sources. Religious objections to slow species transformation persist to this day.

His magnum opus, the Origin of Species by Natural Selection, was published in 1859. The book was received with great interest but with opposition by those who were committed to religion and the bible.

I must confess that I got lost during parts of the author’s account of the different views being promulgated by the many naturalists, geologists, anatomists, horticulturists, economists and others who provided such protean views about our planet, its origin and its natural history. My failure to understand aspects of natural history theory – evolution by natural selection with the added argument of divergence - may be related to poor understanding of terminology but I might have improved my insights if I had spent more time and concentration on the more theoretical parts of the text. His final comment is a profound one, taking in mind, I suppose, the long history of the earth over many millions of years and its many catastrophes. The garden must eventually return to nature as we approach the next of nature’s catastrophes. He might have added the prospect of a human contribution to the next holocaust because of the huge dominance of humanity in terms of uncontrolled numbers and our indifference to the welfare of the other aspects of nature on which we depend. He could surely not have envisioned the massive fossil fuel production of the last one hundred years and the adverse effects it is having on the future of humanity and the natural world.

Friday, 3 October 2014

My first Locum

This is a variation of an excerpt in my autobiography Memoirs of a Medical Maverick, Liberties Press, Dublin, 2010

I spent four years in London training in cardiology. I virtually had no income but I used to work for some of the Irish general practitioners, usually night clinics for which I was paid one and one half guineas. My experience of general practice also extended to one period of three weeks in Ireland. I had a month in London without any commitments in the summer of 1949. I thought I might add to my depleted finances by doing a locum in general practice in Ireland, while at the same time making welcome contact with home and the family. I wrote to Tom Prendiville, my brother in law and county physician in the south riding of County Tipperary, asking him to make enquiries about holiday locums and, in doing so, I emphasised the importance of finding a lucrative one which would allow me to live in the luxury to which I aspired. He was good enough to respond by finding me a holiday locum in the village of Killenaule in the heart of the Tipperary hinterland, and about equidistant from Fethard in the south, Cashel in the west, Urlingford in the north and Ballingarry in the east.
Cormack's in more recent times.

I should have known that Tom was too unworldly and detached from the realities of life to understand the circumstances of a poverty stricken young doctor and to occupy himself with such mundane matters as money. I was paid seven pounds a week for my services to the dispensary or publicly assisted patients. This was exactly what I paid for my weekly board and lodging at Cormack's Hotel, a small and modest hostelry and pub on the rather unkempt, narrow, long and winding main street of the village. However, I was entitled to keep any private fees I might earn.

The principal whose locum I was doing had recently retired from the army after the Emergency and apparently had little experience or knowledge of general practice. It was government policy at the time to appoint those doctors who had joined the army during the Emergency to a dispensary to ensure that they were not disadvantaged by their courage and patriotism in playing a part in the defence of their country. The doctor appointed to Killenaule failed to gain the confidence of the local community, apparently because of an error of prognosis soon after his arrival, when a young girl who was complaining of a severe headache was not hospitalised immediately. She died soon afterwards from a subarachnoid hemorrhage.

The doctor's practice was largely confined to his dispensary patients. Private patients were attending doctors in the surrounding towns and villages. He had no private practice. I had only one, at least for the first two weeks of my three week stay. It was the duty of dispensary doctors at the time to provide medicines for their public patients, but I found little evidence of these in the dispensary building, where the shelves were mostly stacked with DDT powder. This chemical had been discovered during the recent world war and was being freely distributed by the authorities to control the insects and other fauna which were widespread among homes and people at the time. My dispensary duties were largely confined to handing out packets of DDT powder to those who arrived at the rather primitive and mean building which housed the dispensary. I soon found that even the dispensary patients were attending doctors in a private capacity in the surrounding areas.

I did, however, have a private patient during my first week. I was approached one day in the main street by a tall, gaunt, cadaverous creature with a shifty look and with an old cap drawn down over his eyes. Furtively looking around the street, he asked me of I was the new doctor from London. He then told me that he was getting very deaf and could I do something to help him. I told him to accompany me to the surgery where I could examine him. Although I was perfectly aware of the diagnosis as soon as I had a superficial look at him, because I could see the wax protruding from his two ears, I made a little fuss about examining each ear with my auriscope, and then saying

"You've got wax in your ears. It's blocking the ear passages. I'll have to syringe them out. That should put things right."
"And how much will that cost, doctor?" says he.

Never having discussed or asked for a fee before, I was immediately thrown into a state of panic, but I managed to blurt out  "a pound" and then I made the first commercial mistake of my career, although by no means my last. I added "ten shillings an ear!" 

He said "Well, doctor, I'll have to think about it" and out he went to the street, no doubt to commune with his long dead mother or his favourite saint. Ten minutes later, during which I waited with feverish anticipation, he returned. "I'll let you do one ear" he said, "and if that's better, sure I'll let you do the other". So I syringed out one ear, and had my first experience of an ethical dilemma. Should I do the other ear? I decided, no, but I was left with a slightly uneasy feeling that Hippocrates might have disapproved.

For the next fifteen or sixteen days, I met him daily on the main street. Seeing me, he would if necessary cross to the other side, pull the cap down further over his eyes, and pass me by, no doubt certain that I would not recognise him. I never heard what happened to his second ear, but he will remain for ever in my memory as the first patient to pay me a private fee.

Incidentally, and to leave the subject of Killenaule for a moment, my first fee when I commenced consultation practice was earned in October 1950, just after I had returned to St. Vincent's Hospital. I was sharing the first floor return room at Bill Doolin's house at 2 Fitzwilliam Square with Oliver McCullen. A farmer arrived in from Tipperary and as he was leaving, he said to me "I'm afraid I would not have enough to pay you. Would it be alright if you sent me the bill?" I said "of course", being relieved that I did not have to bring up such an embarrassing subject. I saw him down the stairs and just as he got to the door, he said " Sure maybe I do have enough to pay you. What's your fee?"  I blurted out "Three guineas", being fearful that he would collapse with dismay and shock. "Ah, sure doctor, I have that and ten times over" and with that he takes out a huge bundle of notes and hands me three little green backs. I could detect that his opinion of me as an eminent Dublin specialist plummeted on the spot!

There was a tradition in those early years of giving your first fee to your mother. I might have done so if my financial circumstances were less precarious, and if the rumpled and dirty old red ten shilling note which I earned during my first week in Killenaule were more presentable.

In my second week in Killenaule I earned five pounds, although to say that I earned it is an exaggeration. It was customary in Ireland at that time for the doctor attending a confinement to receive a five pound note from the mother after the delivery was completed, whether she was a dispensary patient or not. I got an urgent call to attend a woman in a farm house some distance away from the village. When I arrived on my bicycle, I found that the woman had had her baby and that the handywoman present had supervised the entire event, so that the patient was comfortable and well settled down by the time I arrived. I went through the motions of feeling her pulse, pronounced her well, complimented the midwife on the successful outcome, and was about to leave the bedside when the patient took a five pound note out from under the pillow and handed it to me. While I was careful enough to take the money, I felt somewhat embarrassed accepting such a munificent fee when the midwife had done the work, and no doubt was paid a pittance for her trouble. I was to learn later that many of the fees received by doctors are at least partly earned by their nursing colleagues.

By the beginning of my third week the word had got around that there was a new doctor from London in the village. I collected twenty five pounds in fees during this last week, a quite respectable sum at that time. In my third week I also acquired a chauffeuse with a brand new land rover. My driver came down from Thurles every morning to take me on my calls. She was a Dwan from Thurles whose father owned a mineral water factory. Before Miss Dwan arrived on the scene, I had done my calls outside the village on the schoolmaster's bicycle. I felt a new sense of dignity and importance after her arrival, and these feelings must have been conveyed to my patients, because I found myself almost invariably invited to take a glass of wine after each domiciliary visit. The wine was by tradition Sandeman's port. It was probably the equivalent of the priest's bottle, which was a feature in many country homes in Ireland and which was invariably a glass of port or Irish whiskey.

When I was leaving Killenaule I was satisfied that a useful living could be made there in general practice, although whether success depended on having a handsome and comely maiden from Thurles as a chauffeuse is a moot point.

Cormack's Hotel is still extant, I believe, I was last there during the general election campaign of 1957 when a crowd of us used to go down to Tipperary every weekend to canvass for dad. It was to be his last election, so that a great cohort of Dublin people who were friendly with the family took part in the exercise, some of whom were not even supporters of his party. I am not sure that we did him any favour by participating in the campaign, although he was successful in being elected. I know that the locals were rather bemused by the arrival of this large body of young middle class professional types whom one householder contemptuously called college boys. I arrived at this man’s doorway with Donal O'Sullivan. I had a bow tie, a yellow tweed waistcoat designed and made by my sister Neilli, and a pair of immaculately creased flannels. When he opened the door, he stared at the two of us for a moment. After this unnatural pause, he turned and shouted to his wife who was somewhere at the back of the house "Mary, will ye come up and have a look at the college boys!"

There were a number of other bizarre confrontations between the city slickers and the country people which cannot have helped in the cause we were serving, and which was a reminder of the sharp social and cultural divide between the urban and rural populations at the time

We used to gather at Cormack's Hotel in Killenaule on the Sunday evenings after the
Killenaule in years gone by.
 weekend campaign was completed. We had a supper of sandwiches and Guinness on our first Sunday there. It was a very wet stormy night and, because Killenaule was off the beaten track, enquiries were made about the best way to Urlingford and the main Cork-Dublin road. We had a cavalcade of five or six cars. I explained that I had done a locum there in 1949 and that I knew the country intimately. I would lead the cavalcade to Urlingford by the safest and shortest route.

We set out about midnight having eaten and indulged adequately in the local black brew. We were a happy lot and were no restrictions on either quality or quantity of alcohol at that time. It was frightfully wet and stormy. I drove for some eight or ten miles, and after a while I began to feel a little uncertain of my bearings, particularly as driving conditions were so very bad. However, eventually we arrived at the outskirts of a village. It had a vaguely familiar look about it but it was not until I arrived at the centre of the main street that I realised that we were back in Killenaule! At first I thought in my panic that I would drive through without comment, hoping that my mistake might remain undetected in the storm, but on second thoughts I was sensible enough to realise that such a subterfuge would only add to my troubles and my embarrassment. This, more than any other event in my life, was to tarnish my reputation with family and friends for years to come. Subsequently, if I ever expressed a strong opinion about any subject in their presence, I would be reminded of my intimate knowledge of the topography of the County Tipperary.

Cormack's Hotel was a small commercial hotel run by Mrs Cormack who was a widow, and her son, Cormac, who attended mostly to the bar. They were a delightful and hospitable pair. Like the country people I used to know during my childhood in Kerry and later in County Wexford, they were the salt of the earth, honest, hardworking, uncomplaining, full of humour and humanity, generous, and entirely non-acquisitive. Some of my time was spent cycling around the countryside but many of my evenings were spent in the bar drinking an occasional glass of porter and talking to the locals, and particularly to Cormac and to a Kerryman by the name of O'Shea, who was resident in the Hotel and who was the local schoolteacher. Cormac was a raconteur of some merit, and used keep us amused by his stories, but O'Shea was a mine of information about the county and about the social background and people of Killenaule. He was entirely uninhibited in his comments about the local scene, and had, thanks to his many years as a national school teacher there, an intimate insight into the circumstances and customs of the people.

Killenaule church in more recent times.
Killenaule was not the worst village I had known in Ireland, but even in the context of those times, it was unkempt, featureless and lacking in architectural merit or amenities. On the Cashel road there had been about a dozen cottages, some of which, although occupied until recently, were semi derelict or in almost total ruin. On the other side of the village on the Ballingarry road there were six modern two storey houses. 

Apparently the occupants of the worst of the cottages had been moved to the new houses which had been built at the beginning of the war. This was an error of judgement on the part of the County Council, for these families were the most irresponsible and improvident, and therefore the least house proud. By 1949 the new houses were in a sad dilapidated state, with the gardens unkempt and full of rubbish, the boundaries broken and a general air of neglect and untidiness. According to O'Shea the baths were used for storage and there was hardly one stick of decent furniture in any of the houses. And, not surprisingly, there were many unkempt children to be seen. Louise and I passed through Killenaule two years ago visiting a book fair. I can assure you that much has changed for the better. It is a reminder of the huge benefits we in Ireland have received by the Tidy Towns campaign