I'm from a long line of GPs going to 1770 - but what's changed?
- Credit: Supplied by Stephen Gillam
Dr Stephen Gillam, from Holt, comes from a line of Norfolk apothecaries and general practitioners stretching back eight generations. In this column, the 65-year-old writes about his heritage and how medicine has changed over the years.
Eight generations of doctors from Norfolk – a record?
I was 47-years-old when I discovered, almost by accident, that I was last in a line of generalist doctors dating back to 1770. It was a shock.
We like to believe we exercise free will over our life choices. Mine, it seemed, had been determined two centuries earlier. I was left pondering my ancestors: their lives and livelihoods and how they had influenced mine.
My family’s origins were humble. The surgeon-apothecary William Skrimshire (the Older) (1739-1814) practised around Wisbech.
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In those days, malaria and other marsh fevers were still a scourge. His son, William (the Younger) (1766-1829), was the first to qualify as a doctor but his passion was entomology.
He was the first to write of the use of roasted iris seeds as a coffee substitute and was entrepreneurial too. He concocted a product called ‘British Salop...one of the most nutritious preparations ever offered to the public...’
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The Apothecaries Act of 1815 defined training requirements for the emerging GP. It did not, however, outlaw the mass of untrained ‘irregulars’ or travelling quacks.
In 1841 William’s son, George (1802-77), moved to Holt, and the house where I live now. GPs’ status and income were beginning to rise but his wife Lavinia lamented ‘a very poor first year; hardly any illness at all.’
The second half of the 19th century saw the emergence of the ‘family doctor’. He was expected to sit patiently at the bedside through long hours and to deal with any emergency at any time of day or night.
Poverty, competition, the costs of education and establishing a practice were recurrent concerns for GPs.
The otherwise successful career of my great great grandfather, John Truscott Skrimshire (1835-1912), was blighted by tragedy.
His wife Lizzie developed schizophrenia at an early age and was committed to an asylum. Prone to bouts of depression, John Truscott took his own life in late age with strychnine.
Mental illness, and what we nowadays call ‘stress’, have always been common among doctors.
Marital disharmony and divorce are the accompaniments. Their suicide rates are among the highest of all professions.
The vocation was perilous in other ways, too. My great grandfather, Joseph Gillam (1868-1911), joined John Truscott as an assistant in the partnership.
He married his boss’s daughter in 1891 but died aged only 42 of pneumonia contracted from one of his patients.
Major developments in the public funding of health care were to take place over my great great uncle Harry Skrimshire’s lifetime.
The National Health Insurance Act of 1911 established a system of free health care financed from employers and the state. My grandfather’s generation worked either side of the establishment of the NHS.
Improvements to training and working conditions helped to enhance the popularity of general practice in the 1970s but my working life has seen a steady decline in the status of generalists, despite advances.
A succession of well intentioned policies introduced to improve access and efficiency have often yielded perverse consequences.
I try to imagine practising without agreed qualifications and training standards, extended teams, managers and regulation, let alone guaranteed pay and effective remedies.
Yet while many aspects of practice have greatly changed, it is more striking how little this is reflected in the day-to-day of general practice. The main business of front-line work is, as it always was, managing mental health and acute as well as chronic illness.
Many of the rhythms and rituals of today’s consultations would therefore be recognizable to my great-great-great-great-great grandfather working more than 200 years ago.
Covid-19 has accelerated pre-existing trends. Certainly, the rapid transformation of practice to remote consulting has been astonishing. These transactions are satisfactory but they are inevitably less personal.
For though the cliché is well worn, clinical decision-making remains art as well as science.
*Stephen’s book, Of Patient Bearing – A History of General Practice in Eight Generations, interweaves medical history with family biographies, and is available from Amazon. Proceeds from the book, which has won the Rose Prize for medical history, are going to charity.