This book is not for the squeamish, the religiose or the prudish. Surprising perhaps, seeing that it is the autobiography of a physician; but then Geoffrey Dean is no ordinary physician. Brought up in Liverpool in a family with Irish ancestry, he seemed set on a standard medical career, but not liking the scramble for places on the professional ladder in Britain after the war, he went to seek his fortune in South Africa, leaving a newly wed wife with her parents. The gods, it is said, help those who help themselves and this has seldom been illustrated more clearly...

My father, Richard Dean, known as Dick, was born in 1887 at the Manor House near the village of Upholland in Lancashire, where his father, John, lived the life of a prosperous squire. The Dean family had lived in the area for many generations and the name comes from the nearby village of Dean; it means a valley or dell. John Dean’s eldest child, Ellen, aged sixteen, was accidentally shot by a gamekeeper in 1894 and died a few days later. The gamekeeper did not recover from the accident and died shortly afterwards. At the end of the Boer War,...

When I was five I attended La Sagesse, a convent school run by French Sisters, a few hundred yards from the bank. We would start each day with the greeting, ‘Bonjour, Bonne Mère’. This was a happy time of my life, although on one occasion my friend Kenneth Smith and I decided to run away and live, like the Red Indians, in a nearby wood. We stole tins of food and matches, settled under a tree and lit a fire. It started to pour with rain and we decided to give our parents one more chance. The next day we...

In 1936, at the age of seventeen, I started my life as a medical student at Liverpool University. In the first year we took four subjects: chemistry, physics, botany and zoology. In physics we had to work in pairs and I found myself with Sam (John) Bradshaw, an ex-Saint Francis Xavier school Liverpool boy who had won a rarely given state scholarship to university.

One of my memories of my first year as a medical student was the difficulty we had in getting our electrical experiments to work. At the time we did not know the reason for the problems...

In August 1943 I received my call-up papers to join the Royal Air Force as a medical officer with the rank of flying officer. This rank was equivalent to that of a first lieutenant in the army. The newly recruited doctors first reported to a training centre where there were about ten other doctors who had been conscripted at the same time. We were given a week’s preliminary training: how to salute, how to march reasonably in step and the structure of the RAF. Since I had been in the Officer Training Corps at Ample-forth, this was straightforward.

After a...

On returning to Liverpool in September 1945 I found life very dreary; it was a great anti-climax after the excitement of Water-beach and Bomber Command. Rationing had become worse; even bread was rationed. Nonie was pregnant again. We found a first-floor flat at 29 Ullet Road, near Sefton Park, and I bought a 1939 Morris 8 from Nonie’s brother Brian for £120. There had been remarkably little inflation during the war because of the government’s tight control of prices and wages. Nevertheless, great social changes had occurred. The poor people in Liverpool were better fed than they had been before...

The view of Cape Town nestling under Table Mountain when I arrived on thePriamon 24 June 1947 confirmed the words of Francis Drake. At that time, Cape Town was a relatively liberal city. Jan Smuts was the Prime Minister of South Africa and the leader of the United Party, which mainly represented the English-speaking white population, descendants of British settlers. The opposition Nationalist Party represented the Afrikaner white community, who predominated in the rural areas, but Afrikaners had also moved into the cities. Descendants of the Boers, they spoke Afrikaans, a dialect of Dutch. In 1947, the white...

Nonie and I returned to Port Elizabeth and stayed at the Grand Hotel. I was now accredited by the South African Medical Council as a consultant physician, but still had no practice. I was able to rent a consulting room and shared a waiting room at Elizabeth House and a secretary with Dr Gace. In South Africa, every consultant physician had an electrocardiograph, and most patients, at least those over fifty, were expected to have an electrocardiogram (ECG) with their consultation. Heart attack rates among the white and Indian South Africans were the highest in the world, although the rates...

Patricia’s death devastated me. Before this I had been a good Catholic, firmly believing that God was looking after His children. What was His purpose in allowing Patricia to drown? She was a girl of exceptional intelligence. She gave everyone the impression that she had lived this life before, she had such understanding and sympathy. I found it dreadful when people said how sorry they were. Nonie took Patricia’s death much better than I did, or perhaps one’s own pain always feels to be the worst. John, who was seven and loved playing with Patricia, missed her very much. There...

On 2 November 1955, I got a telephone call from Dr Le Roux of Knysna, a town about halfway between Port Elizabeth and Cape Town. He asked me if I would look after a patient, John Wiles, the son of a well-known South African painter. Dr Le Roux told me that the patient was already in an ambulance on the way to Port Elizabeth and asked me to arrange for his urgent admission to hospital because he was desperately ill with bilateral pneumonia.

John Wiles has given me permission to relate his story. He was employed by the Rhodesian Geological...

Since the end of the Second World War, cancer of the bronchus of the lung had become the commonest cancer to cause death in men in Britain and the United States. Doll and Hill in the United Kingdom and Hammond, Horn, Wynder and Graham in the United States have shown that the risk of developing lung cancer was proportionate to the number of cigarettes smoked, and that the non-smoker has a very small risk. In South Africa, cigarettes were, and still are, cheap. Most white South African men were heavier cigarette smokers than men in Britain. Yet I was seeing...

In 1955, Dr Cihad Çam, a dermatologist in Diyarbakir in eastern Turkey, saw a large number of children with sores and blisters on their faces and on the backs of their hands. They had dark pigmented skins and great hairiness on their arms, hands and faces. They were described by their neighbours in the villages as the ‘monkey children’ because of their hairiness. Their urine was a reddish-brown. When Dr Çam examined their urine in ultraviolet light, using a ‘Woods filter’ to block the white light, it showed a brilliant pink fluorescence. He realised then that these children’s symptoms had...

In January 1961 when Nonie changed her mind and would not agree to a divorce, I asked Maria, who had quite sufficient money at this time, if she would return to Paris, and I left for Port Elizabeth where I stayed at the Beach Hotel. Maria sold most of the furniture from the Johannesburg flat and put the three Chinese carpets into storage, and then followed me to Port Elizabeth where she soon made a number of women friends. She asked a lawyer, Marcus Jacobs, if he could further the divorce proceedings. I had no enthusiasm about this because I...

Whenever I saw a patient suffering fromporphyria variegata, I interviewed all the relatives I could find, examined them for porphyria and drew up a family tree. In this way I was able to find out from which side of the family porphyria had been inherited. All the families I studied came from Afrikaner, or Boer, stock. It was possible to trace the ancestors from the family bibles and from the baptismal records of the Dutch Reformed Church. The way the Afrikaners named their children was also a great help; the first son was always given the names of the...

On 8 January 1966, theBritish Medical Journalpublished a paper by Doctors Ida MacAlpine and her son, Richard Hunter, entitled ‘The Insanity of King George III: A Classic Case of Porphyria’. This dramatic paper claimed that the king had suffered from attacks of intermittent acute porphyria, the Swedish type. In their case history the MacAlpines described five attacks between 1765 and George III’s death in his 82nd year. A full account of the story is published in the second edition of my bookThe Porphyrias: A Story of Inheritance and Environment(1971). The MacAlpines were unable to find anyone...

I have already described how my interest in the cause of multiple sclerosis (MS) arose when I first emigrated to South Africa. MS is the most common disabling neurological disorder of young adults in the western world. It seldom occurs before the age of fifteen or sixteen and reaches its peak prevalence in persons in their early thirties. The disorder is more common in women than men, afflicting about three females for every two males, and it is typically a disease of exacerbations and remissions. The nineteenth-century neurologist Jean-Martin Charcot, of the Salpêtrière Hospital in Paris, first gave a good...

Every year I was seeing more and more patients suffering fromporphyria variegata. In 1963 I thought it might be a good idea to examine the records of patients who had died at the Provincial Hospital in Port Elizabeth (which at that time treated white patients only) to see if some of the deaths had been due to acute porphyria and that perhaps the correct diagnosis had been missed. There were 40 to 50 deaths at the hospital every year and a few deaths, in retrospect, were indeed attributable to acute porphyria, although the diagnosis had not been made at...

In 1965, after completing the study on lung cancer and bronchitis in Northern Ireland, I was invited to report the results of the study at a joint meeting of the Ulster Medical Society and the British Medical Association at the Whitla Hall in Belfast. Before the meeting I was the guest of honour at a dinner attended by about 200 Irish and British doctors. Just before the dinner, Graham Bull, professor of medicine at Queen’s University, Belfast, announced without warning to the assembled guests: ‘Geoffrey Dean, our distinguished guest speaker, will now say grace for us in Afrikaans.’ Fortunately, when...

We flew to Dublin on 27 October 1968. Rooms had been booked at the Montrose Hotel, on the main road from Dublin to Stillorgan. Paddy Lynch met us there, and advised me to organise where I was going to live, to buy a car, get to know my way around Dublin and only then should I begin work. I bought a map of Dublin and an Opel Kadett and within a few days had found a house to rent in Woodbine Road, adjacent to the Montrose. Maria was fully occupied in looking after Gordon, now five, and Elizabeth, just two,...

Much of the research I have undertaken has occurred as a result of serendipity, ‘the faculty of making happy and unexpected discoveries by accident’. The word was first used by Horace Walpole in 1754 and was taken from the story of the three princes of Serendip, the old name for Sri Lanka. Serendipity in medicine has been beautifully discussed by Richard Asher in his bookTalking Sense.He defines it as an ability to recognise the Highest Common Factor, or HCF. McFarlane Burnett has remarked that recognition of the HCF involves what he describes as the ‘notebook and shoe leather...

From the inception of the Medico-Social Research Board, we carried out studies of drug taking, including cigarette smoking and alcohol, among children in primary and secondary schools. In the 1970 s there was no serious problem of illegal drug taking in Ireland, although about 10 per cent of school children had experimented with marijuana and an even smaller percentage, particularly in the inner city of Dublin, had used ‘uppers’, the amphetamine group of drugs, and ‘downers’, generally barbiturate sedatives. By far the commonest drug used by young people was alcohol, cider in particular. We organised a number of programmes to...

In 1975, I was asked to take part in an EEC symposium on multiple sclerosis at the CIBA Foundation, now the Novartis Foundation, named after a drug company, at 41 Portland Place, London. Four doors away, at number 49, I saw the Embassy of the People’s Republic of China. The idea suddenly came to me that I should call on the Chinese ambassador to see whether it would be possible to arrange for a visit of Irish doctors to China. I had long been fascinated by what I had read about the Chinese use of traditional and modern medicine, and...

Towards the end of 1985, when I was about to retire as director of the Medico-Social Research Board, I was asked by the medical adviser of the Agricultural Institute of Ireland, Dr Alan O’Grady, if I would undertake a study on the cause of death in men in the research and technical staff at the institute, because there appeared to be a high number of deaths from cancer among them before they reached retirement age.

The national agricultural research organisation, now renamed the Agriculture and Food Development Authority, has its headquarters in Dublin and has seven major centres. The research...

I am sometimes teased that I choose beautiful and interesting islands on which to undertake research. There is truth in this and one of the reasons is that island populations can be ascertained fairly accurately since they are relatively closed communities. In 1985 a letter arrived from Dr Ntinos Myrianthopoulos, an advisor to the National Institute of Heath in Bethesda, Maryland. He told me he was a Greek Cypriot and that he considered that Cyprus would be an ideal island in which to undertake a study on the prevalence of multiple sclerosis. He said that he was friendly with one...

In 1976 Dr Patricia Sheehan, a Dublin doctor, was talking to a mother who had a Down syndrome child. Down syndrome, a disorder in which there are three chromosomes number 21 instead of the usual two, is also called trisomy 21. It causes changes in appearance which gave the disorder its old name, ‘mongolism’, and usually causes mental retardation. The mother told Dr Sheehan that there were other girls who had attended her school, St Louis, in Dundalk, Co. Louth, in 1956/57 who also had Down syndrome babies and that the mothers were young when the babies were born.

Patricia...

In the account of my work after leaving South Africa, I have said very little about my private life. It is difficult to do so when immediate family and personal friends are alive. It is easy enough to praise and say good things about those we know, but not so easy to be objective. Nor is it easy to be dispassionate about the decisions I have made, good and bad, in my own life.

On coming to Ireland, Maria and I, Gordon and Elizabeth spent a year in a rented house and then, in 1970, bought a house in Donnybrook,...

After returning from Kenya in January 1992, where I had been visiting my sister Pauline, I noticed that I was unduly tired and my ankles were swollen. I dealt with a large backlog of letters and reports and then decided to complete a study I was undertaking to find out how many of the 202 young people injecting heroin in the central Dublin and Dun Laoghaire study in 1982/83 were positive for the AIDS virus.

On the afternoon of 5 February I went to the Virus Laboratory at University College, Dublin, in Belfield, to obtain reports on the blood tests...

Every year I go to South Africa to see my children and grandchildren. Perhaps this is the time to relate my own attitude towards relations between white and non-white South Africans. Over the years my perspective has changed considerably.

I grew up accepting, as did my parents, that the British settled throughout the world with the highest of motives, which were to ‘civilise’ the indigenous people of the lands where they settled. Canada, Australia, South Africa and New Zealand and, in my father’s time, Ireland, had a Viceroy but were largely independent in their home administration and many other countries...