The Road to Genetics

    Life at the Maudsley was all and more than all that I could possibly have hoped. We were quite a small body of doctors, in order of seniority Thomas Tennent, the Deputy Medical Superintendent; Aubrey Lewis; Edward Anderson; Louis Minski; Mildred Creak; Desmond Curran; William Hubert; and another young man who died quite soon after of bacterial endocarditis. Those who were not married and wishing to go home for lunch, sat down to a long table with the principal lab workers. This was one of the places where the art of conversation flourished, and not always about shop. Nevertheless, a good deal of shop was talked, also at dinner if one stayed in for an evening on duty, and also over a rather prolonged coffee break in the mornings. The day's routine ran: 10 A.M. into the wards, 11.15 knock off for coffee, 12.00 back to the wards, 1 P.M. knock off for lunch, 2 to 4.15 back to the wards, 4.15 to 5 tea, 5 to 6.30 or even later once more in the wards; and it was not unknown for the enthusiastic to stay on for dinner and after it return once again to the ward if he was wanting to study in depth a more than usually interesting patient. Many as the breaks were in the day's routine, the time they took was not wasted. I certainly learnt from my fellow students, only a year or two more advanced along the road than I was myself, during those interminable, fascinatedly interesting discussions, as much as from text books and papers.

    If most of us were keenly vocal, there can still be no disputing that Aubrey Lewis was the leading spirit. He had more than a touch of deviltry at this early stage in his career, and delighted in pulling the legs of anyone he could make a victim of. His supreme achievement in this line was to persuade a junior colleague that (despite his small and very slender physique) at one stage in his life, when practically down and out, he had earned his living as an all‑in wrestler. Hardly less noteworthy was his successful persuasion of a whole lunch table that, when he had been working as an anthropologist in the Australian outback, he had lived in a settlement fortified with a zareba against the raids of the black pygmies who surrounded them. In the same spirit he would from time to time flabbergast us with his learning. I remember one lunchtime when the conversation drifted haphazardly from one theme to another till it ended up with Queen Elizabeth, Mary Queen of Scots, and the complicated intrigues of their conflict. Lewis came out with fascinating items of history, and dazzled us with a breadth of knowledge and a grasp of recondite items of detail that might have done credit to an earnest student of the period. That, in fact, was what for a few short days he had actually been. At the very time of that conversation there was lying on the table of one of the residents' sitting rooms a library copy of a contemporary work on the subject. Edward Anderson, Lewis's fellow resident, who himself had been reading the same book, sat all the way through that lunch hour, never by a blink giving his colleague away. The same whimsical spirit led to a test of olfactory powers to which he subjected the rest of us. In half a dozen small phials he had a few drops of faintly discoloured water, one of them carrying a very faint smell of, say, lavender. We were asked to identify them, and it was left open to us to suggest to ourselves any odour we might care to think of. The test was, in fact, one of suggestibility. While some of us, in another environment, might have resented such an intrusion into our human failings, at the Maudsley we became trained to accept the role of S as well as E, and bear as well as we might the penetrating regard of those brown and beady eyes.

    Lewis was an adept in the art of disputation, and there were very few who could stand up to him. Bill Hubert was one of these few ‑ a man of consummate fantasy, cheated of his normal career at the Maudsley by his failure to pass a higher examina­tion, this itself being caused by landing himself with a never terminated training analysis at the hands of a lay analyst who later became psychotic. He was a genuine eccentric, who tried to do all too much with his life, psychiatry, and psychoanalysis, and marriage and children, and a very active bohemian social life on the fringe between artistic Chelsea and the "bright young things" of the social world of the glossies. His final end as a drug addict was one of dreadful tragedy. At the time at which I knew him he was finding it difficult to make ends meet (and, for instance, wore spats to cover up the fact that he had no socks), but was full of an abundant life and humour. He could keep Lewis in play by producing some bizarre quirk of fantasy at the critical moment of a keen debate, after which Lewis would dash with the enthusiasm of a hound at the doubling of a hare. My own fortune with Lewis was somewhat different. Though he was at times most stimulating, he exasperated me by his keenness to exact a precise definition of terms used as counters, by his deliberate mistaking my meaning to show the falsity of what I had actually said (rather than listening to what I had tried to say); this unprogressive toing and froing over the same bit of territory had the aim of defeating you in formal terms rather than advancing to a higher level of understanding. In debate with him I would become more and more excited. Automatically, my hand would reach into my pocket where I kept the medical officer's massive keys, in my case tied to a length of stout cord. These I would play with and swing as a pendulum to and fro. Eventually at the top of my excitement, when the keys were whirling round my head or whizzing through the air in a vertical circle at my side and threatening to fly off at high speed in an unpredictable direction, Lewis would begin to blench, to lose the current of his thought, to hesitate in utterance, and perhaps abandon the topic.

    Though an immensely hard‑working man, Lewis was not very productive. His creativity was in due course to be shown in the organisational field, and the present Institute of Psychiatry at the Maudsley Hospital is largely his creation. At that time (1932), his contribution to our thinking about psychiatry was essentially in giving us much needed criticism. He gave me to read his own thesis for a doctorate in the University of Adelaide, on the subject of melancholia, in two parts, one historical and one clinical. This has since become a classic and has been influential, I think, in a retrograde way. Needless to say when I read it as a newcomer to psychiatry I was immensely impressed and, in fact, devoured it. At the end I could not but feel a sense of disappointment; it seemed to me indeed that it did not end. He asked me what I thought. I told him how persuasive, how convincing I had found his argu­ments, and could quite see all the faults, the inconsistencies and insufficiencies of all the aetiological theories advanced by earlier psychiatrists. But I had found myself at a loss to see what his own theory was. He told me rather shortly that with such an abundance of theories in the field it was not necessary to find a new one or adopt one of the old. In course of time I came to consider this unwillingness to take a positive line, whether it arose from a reluctance to meet those critical weapons which he himself wielded with such skill, or merely from a lack of personal need to identify himself with a point of view, as a fault of character which was his greatest weakness as a scientific worker. The sceptical approach to psychiatry is not enough.

    However, in those days it was a wonderful aid to teaching. Lewis organised fortnightly evening meetings in his sitting‑room, where one of us would produce an essay based on some personal work. Quite early on it was my turn, and I had not the slightest idea what to tackle as a theme. Lewis offered me a subject ‑ hypnagogic hallucinations. I should read up what I could about the subject, and should think how I could investigate it clinically. I did so. For some weeks, as my turn to talk approached, I talked to the Maudsley outpatients, asking them whether they ever had such experiences, and what their attitude to them was. Many did, and the numbers had to be correlated with age and sex and educational background, intelli­gence and capacities for visual imagery, diagnosis, time relations to illness, etc. I am sure my report was not a good one, but it provided a good deal of new matter to the group, and it was essential discipline for me. This was Lewis's greatest contribution: teaching us to define our operational terms, to define problems so that they would be subject to empirical attack, to consider the tools necessary for such an attack, to proceed in an orderly and purposeful way. In clinical psychiatry we were taught to examine our patients, to look and listen and record accurately and without presup­positions, to resist interpretations that were not based on observational data. Al­though Lewis had received training at the hands of Adolf Meyer, much of what he passed on to us came from his earlier apprentice experiences in Heidelberg.

    In this benign environment I developed fast. Lewis suggested that I might like to attempt a parallel investigation of the incidence of mental disorders in Britain to complement and to contrast with the several studies which had already emerged from the Munich school. As a way of sampling the general population, arrangements were made for me to be able to visit the surgical wards of King's College Hospital, and ask the patients there about nervous and mental disorder in their first degree relatives. I soon discovered the disadvantages of this approach. To begin with, the sample was not an unbiased one. It was quite clear that a proportion of the patients had been admitted in part for psychiatric reasons; for example, patients there for the removal of a "chronic appendix" were rarely suffering the effects of any local pathology. The sample was unsatisfactory in age distribution, the propositi peaked in middle age and their children were not yet into the ages of greatest psychiatric risk. The information obtained was not only incomplete from ignorance or reluc­tance on the part of the informants, but was probably also both unreliable and biased by unwillingness to admit psychiatric morbidity. The informants were not a captive group, and I had no lever to use to extract information. I did not take very long to reach the conclusion that some other way of approach was necessary.

    I enquired whether the national statistics kept by the Board of Control might be made available. Mapother and Lewis received this request with understanding, and the necessary official contacts and consents were obtained. Now figures were made available to me which lacked nothing in objectivity and precision; the one big trouble was the antiquated diagnostic classification in which they were arranged. Another problem was the way in which risks from year to year and from age group to age group could be cumulated to give a life‑time risk. At this, I had the temerity to write to R. A. Fisher to ask for his help. He gave it at once, and in a completely satisfying way; and it was in his journal that my paper was eventually published. Fisher helped me on many occasions, in investigations I carried out in later years, and never grudged time or trouble. I came to have for him the greatest admiration and a strong affection.

    Looking back, it is interesting that after giving me a method of approach, Fisher did not trouble to see that I carried it out as exactly as I should have; and he accepted for publication two papers with logical errors. One of them was this paper about incidence. The risk of admission to a mental hospital was, as I worked it out, about 5 per cent by the end of a life time. This probability of 0.05 was the result of accumulating much smaller risks over a total of, say, fifty years. These year to year probabilities should have been turned into probabilities of survival from year to year without admission to hospital, and these survival probabilities multiplied together to give a total chance of escaping admission. What I did was to arithmetically sum each of these small probabilities; this was quite incorrect but probably made no differ­ence of any magnitude, and Fisher let me get away with it.

    Life was now something close to heaven. I liked psychiatry, I loved playing with numbers, and I revelled in the give and take, even the cut and thrust, of intellectual interchange. I was determined to stay at the Maudsley, and was prepared to go through some long and extremely impecunious months that winter when my holiday locum job ran out and I had to hang around as an unpaid voluntary worker, waiting for the vacancy for an additional medical officer caused by the opening of the "Villa," a small block in the Hospital garden for the nursing of disturbed and noisy patients.[2] I had taken a half share in a flat with an old school friend, and had begun to enjoy the social life available in London to a young man, provided he had enough to live on. This I had, once my position at the Maudsley was stabilised. Above all things the Maudsley was a "happy ship" and the team spirit was tremendous.

    Nothing was wanting to make for strong loyalties. Regarded by medical col­leagues in the better established specialties and general medicine with a good deal of derision, we had to face on the other side a variety of unorthodox practitioners that shaded off into quackery. Our institutional enemy (how absurd it seems now!) was the Tavistock Clinic whose workers, as we saw it, had abandoned the scientific approach entirely for a system of therapy derived from dogma and applied intui­tively. With these therapists, led by J. R. Rees and Ronnie Hargreaves, inter­pretations of the patient's behaviour would be made without basis in close clinical observation, and theories would be applied which had never been tested in open­ended enquiry. Our champion was Edward Mapother, and he it was who led us against the heathen. If the enemy had captured the Medical Section of the British Psychological Society, we had a firm grip on the Psychiatric Section of the Royal Society of Medicine. Neither group paid any attention to the effete and recumbent Royal Medico‑Psychological Association, which was regarded as just a club for medical superintendents!

    I do not think there was one of us who came under his influence who did not develop a passionate loyalty to Mapother. He was a man of great vision but at times incredibly wrong‑headed. Life under him was not easy. Not more than one of us was allowed to go away on holiday at the same time, so that juniors found themselves taking their holidays at very odd times in the year. Doctors off duty at public holiday weekends had to return for half an hour in the afternoon to meet any relatives of their patients who might want to see them. Men who came to the Maudsley accustomed to handle even dangerous emergencies in previous house appointments found themselves deprived of the discretion to take the simplest mea­sures without the approval of a senior. An intensely anxious man, Mapother could never have enough security. One of his whims was that the two hospital residents must be the two most senior, and not the two most junior, of the unmarried medical staff. When in the course of time I attained the seniority to be dragged from my delightful flat in the West End to a hospital bedroom and sitting room in the purlieus of Camberwell in south‑east London, I resented it very keenly. This was a fate that would presumably continue as long as I was unmarried, and I could find my way from one prison only by entering another.

    During those years there was one cloud that overshadowed all lives, mine as well as everyone else's. For the first time, and very much against the grain, we were being forced to think about politics. In the continent of Europe, unspeakable men had seized the levers of power in nation after nation, and the reaction of our own statesmen was to pay lip service to the collective security which, enthusiastically and realistically sought, would have given us the peace and security which they sought to buy by accommodations with the devil.

    The Germans in their mass hysteria began to expel the Jews. With characteristic liberality and vision, Mapother secured from the Rockefeller Foundation grants to support three of the most distinguished fugitives from oppression, Eric Guttmann, Willi Mayer‑Gross, and Alfred Meyer. Guttmann and Mayer‑Gross were the clini­cians, and the new insights into the reach of clinical observation and the application to concept building, diagnosis, and systcmatics which they brought with them were to some of us, to me at least, like a view into a new world.

    The Rockefeller Foundation had for long been generous to the Maudsley in other ways. Every year one travelling fellowship was made available to us, and Mapother's nomination (made always, I think, on Lewis's advice) was all that was required. Just as my turn had come for slavery as a resident, so now came my opportunity. I remember a discussion with Lewis about what my plan should be. Very sensibly he was against sending yet another man to study everyday psychiatry at the feet of Adolf Meyer. As he saw it, the clinician of the future who would hope to make a personal contribution to the advance of knowledge should have a training in another specialised field of enquiry which might serve psychiatry. There were, he thought, two fields that came in question, neuropathology and genetics. To which did I feel the greater attraction? There was no hesitation in my answer.

    I think they were rather disappointed, when I arrived that autumn of 1934 in Professor Rüdin's genealogical department of the Forschungsanstalt fur Psychiatric in Munich, to find that my command of spoken German was so poor when my letters from England had been not only faultless but even stylish. Of course it was my German friends, mainly Eric Guttmann,[3] who had aided and corrected my German, and they were not here now to help me. However, everyone was pleasant enough, and I was assigned to the care of Bruno Schulz, who would see that the facilities were made available for my proposed study into the genetics of manic­depressive disorder and would supervise my work. Bruno Schulz was not impressive to meet, but a delight to have the privilege of knowing. He was a tubby little man, his cheek bearing the scars of German‑style fencing, with a great fondness fos Munich lager, the wines of the Rhine and Pfalz, and evenings out with the colleagues from the department. From my point of view he was perfect, warm, friendly. endlessly helpful, acutely intelligent, hard‑working, with a fine sense of researcF discipline. These were the days before anyone thought of double‑blind diagnoses and the only way to scientific integrity was to set the standards of evidence for 2 firm diagnosis, and for a "probable" diagnosis, and try to abide by them con sistently, even when one saw the evidence going against the working hypothesis Schulz's political integrity was the equal of his scientific honesty. He could no stand the Nazi ideology and never compromised with it. This meant that there couk be no future for him other than static continuance in the job he held, where no on( would be likely to call on him for declarations of loyalty to the regime he detested It was not until after the war, when he had only a few years to live, that thi University gave him the titular rank of Professor. In fact, in that one job in Munici he stayed till the end of his days.

    Life in Munich was very strange. Schulz told me when I first appeared that h would not recommend me to arrive at the Institute before a quarter to eight in th morning, as up till that time the cleaners might still be about in the rooms. I wa aghast, since in the Maudsley I was not accustomed to starting work before tei o'clock. I compromised with arriving at work by about a quarter past nine, and rn recollection tells me, perhaps untruly, that I succeeded in keeping to about that time fairly consistently. Nevertheless, in the first few weeks it seemed very early, and breakfast, consisting of a couple of rolls, butter, honey and a cup of very weak coffee as provided in my "pension" or boarding house, had also to be taken in the chill of the early morning. On my first morning I was feeling hungry by ten, fam­ished by eleven, and in increasing danger of fainting with inanition as the hours of twelve, one and two succeeded one another. I had been told that I would be collected for lunch, and I wondered what on earth could have happened. However, at last, about half past two, Schulz did appear to conduct me upstairs to the "casino," a spacious room with great windows looking over the fields, where lunch was taken. This was cooked on the spot in the adjoining little kitchen by a Fräulein who served us schnitzels sizzling straight from the pan, Kartoffelsalat and, in fact, top quality home cooking. On the walls were pictures by Leonid Pasternak (father of the poet Boris), which had been lent by his daughter, Lydia, who was at that time working in the Institute as a research chemist. This was the lady I eventually married. Other research workers also drifted in as they finished the main part of the day's work, among them the Scheid brothers and Karl Stern. Karl eventually went to Canada to a chair in psychiatry, and in his book, The Pillar of Fire, he has given an account of life in the Institute at that time. Franz Kallmann was at the Institute for about a fortnight while I was there, getting help from Schulz in the statistical analysis of his great Berlin material which went into The Genetics of Schizophrenia. When I arrived, the Institute was full of talk of the engaging personality of the Swedish research fellow who had preceded me and had only just left, Erik Essen­-Möller, a man with whom I was eventually to develop the warmest friendship.

    We did not see very much of Professor Rüdin, our departmental head. In fact, apart from my original reception, I can remember meeting him in any kind of social interchange only on a single occasion ‑ the day, once a year, when the members of the department were invited to dinner in his home. We all arrived by arrangement together, one of our number carrying a large bouquet of flowers to be presented with a "Küss' die Hand, gnädige Frau" to the Frau Professor when she graciously received us. The dinner and the evening's conversation which followed were fitting to the somewhat ceremonial nature of the occasion.

    If I had known that one day I should be working with twins, I should have paid more attention to Conrad. He was a man of exceptional ability, and his twin inves­tigation into the genetics of epilepsy was methodologically by far the most advanced piece of twin work of its age. In many ways it has still not been equalled, and it is now most unworthily neglected. Conrad was an Austrian, and like a number of Austrians who were working about the Forschungsanstalt, an enthusiastic Nazi. For these expatriates Hitler represented a great hope for the future, when all Germanic peoples would be united. This it was that made it difficult for me to get to know him. His after‑history was a sad one. In the end he became disgusted with what demagogy had made of genetics, and he abandoned the subject for good. In the chair of psychiatry in Homburg, Saar, he turned his mind to the application of Gestalt theory to phenomenological and clinical analysis. Those who have studied his work have found it highly original and interesting; but it was in a field into which I could never penetrate. Here, too, he has not received the appreciation he has deserved.

    To the Scheid brothers I was especially indebted for a thorough‑going discussion of all my basic psychiatric concepts. What I brought to Germany from the Maudsley was a very loosely conceptualised and articulated psychiatric framework, mainly derived from Adolf Meyer's teaching which had been taken over by all the British teachers including David Henderson, R. D. Gillespie, Edward Mapother, Aubrey Lewis, and Desmond Curran. It did not prove strong enough to stand up to dissec­tion at the hands of K. F. Scheid, and bit by bit it was replaced by something much closer to the teaching of Kurt Schneider, who was the Institute's Professor of (clini­cal) Psychiatry. This proved a very much firmer basis on which to build an approach to the genetical aspects of psychiatry, but of course it has had its disadvantages. It always predisposed me to think that the distinctions we draw in our theories corre­spond to equally certain distinguishable "phenomenal appearances." It should be perfectly possible, for instance, to distinguish clinically between an "endogenous" and a "symptomatic" schizophrenia, something which I have been later led to doubt; and it strengthened a tendency to ascribe insufficient importance to psycho­logical and social causes of variation in the life histories of individuals. Nevertheless, every scientific worker has to work out his own scheme of things entire by which to guide himself, and all such schemes must have faults. One does well to choose a scheme which offers adequate ways of trying to understand the phenomena with which one is concerned, and to remember always that it may be wrong in ways not yet to be recognised which may be fatal.

    By Christmas time I was desperately homesick for England; but after a fort­night's leave returned to Germany and was not affected in that way again. This was despite the fact that the shadow of the Nazi Goliath was beginning to dim the light in the research institute. As the year wore on, guest workers in uniform began to appear, and imperceptibly "Grüss' Gott" came to be less heard than "Heil Hitler." By the time I had come back from a few months of travel towards the end of my fellowship, the old way of life had gone, the casino was invaded by brown‑shirted "scientists," and the Jewish pictures had been taken down from the walls. My last day there Theo Lang (known for his studies of the sex ratio in the sibs of male homosexuals) took me into the lift for a talk, and kept it moving from the top of the building to the bottom so as to be sure of speaking without being overheard.

    I wanted to see something more of Europe during my year, and applied to the Rockefeller Foundation for permission to visit Zurich and Vienna. This resulted in a lunch with the Rockefeller Foundation European representative, on his next visit, to check whether such expenditure could be allowed. Dr. O'Brien seemed rather doubt­ful of this, and thought that some further opinions were called for. I was accordingly instructed to take leave and given my expenses to visit experts in Scandinavia for their advice. No doubt the journeys involved seemed trifling to an American, but they were vast, romantic, and exciting to me. I went to see Jens Christian Smith (author of valuable genetical studies in mental subnormality and atypical psychoses) in Roskilde near Copenhagen; Professor Tage Kemp who was then building up from its foundations the Domus Biologiae Hereditariae Humanae Universitatis Hafniensis, which housed the national registration centre for hereditary defects in Copenhagen; and in Sweden Torsten Sjogren and other psychiatric workers at Gothenberg, Dahl­berg at Uppsala and Essen‑Möller at Lund. I did not meet Erik Strömgren at this time, although I did on many occasions after the war. Although temperamentally I think we are very different, in our intellectual approach we share much in common; in one bit of statistical methodology we both hit on the same idea independently.

    This was a wonderful trip. Apart from the delights of the journey and the wonders of strange lands, to cross the Nazi frontiers felt like coming out of an unventilated dark‑room into the air. Above all, in meeting these immensely able and distinguished men, I had the feeling of being welcomed as a neophyte into a body of dedicated people searching for the truth along paths I felt myself capable of follow­ing.

    The Scandinavian referees vindicated my desire to visit Zurich and Vienna,[4] and permission was given. Ironically enough, I got very little out of those visits. At Burghölzli, H. W. Maier was a capable but as far as I was concerned not an inspiring teacher. At Vienna, the greatest chance of getting some new ideas was given me when I attended the Professorial visit to the neurological‑psychiatric clinic. Here all the bums and roughs and prostitutes and alcoholics who had been picked up by the police and thought in need of a psychiatric opinion were lined up on a bench, and very briefly interviewed for a decision on treatment and disposal. From that time, and also from my experience in an English "observation ward", it has always seemed that the case material that life itself throws up as a detritus on the psychiatric beach has much more instructive value for the young student than the carefully selected sample of "prognostically favourable cases" that came our way in the wards of the Maudsley Hospital.

    At that time Sakel was working at the Vienna clinic and had been given facilities to treat a limited number of schizophrenics with his insulin coma therapy. I am sorry to record the fact that I regarded this pioneer effort, in due time to be the thin end of a wedge which broke a way through an impassable barrier, as so much absurdity. I thought to myself, the Viennese have done it once, with the senseless but successful malarial treatment of G.P.I., and they think they can pull off just such another wild shot.

If my own ideas for improving myself did not bear much fruit, I continued to benefit from the wiser advice of others. My Scandinavian friends had warmly recom­mended that I should have some training, even if time was available only for the slightest, in general genetics. As a result, when most of my work was done in Munich, I went to Berlin‑Buch to the Institut fur Hirnforschung, with the aid of a three‑month extension to my year, to study genetics under Timoféeff‑Ressovsky. Here I was trained in breeding Drosophila, in practical work at the bench, and in genetical theory by reading very widely under instruction, and in many conversa­tions with Timoféeff. Timoféeff was a typical Slav, genial in both the English and the German sense, and became in turn a greatly admired teacher, a loved friend, and eventually godfather to one of my sons. He was one of the earliest workers to explore gene interactions and to show that the manifest effects of a gene could be greatly modified by other non‑specific genes, the "genotypic milieu." This was an idea that I carried away with me, and used it to show that with its help the intractable non‑Mendelian proportions of affected and unaffected in psychiatric sibships could be reduced to some kind of order ‑ all too easily, as the critics of monogenic theories would say.

    The end of that story was tragic. Timoféeff received an offer from the U.S.A. to go there to work, an offer attractive in every way except that it would mean uprooting his family and settling down in a new world, the language of which he only poorly understood. He was not a Jew, and so in no danger from the Nazis, but he was a man of liberal principles and should have heeded the warning they might have given ‑ that from that detestable ideology evil must come. He preferred to stay in Berlin and, as I have heard, was in the fullness of time overrun by the Russian occupation. To the Russians he was suspect as an emigré, and later no doubt doubly so, after the disgrace of Vavilov, as an adherent of the condemned Darwinism­-Mendelism. However, he and his family did survive, though he never reappeared as one of the leaders of thought in genetics.

    At the end of 1935 I returned to England, bringing with me Lydia Pasternak who was now my fiancée; she stayed in my parents' house until we were married at Christmas time. It was not so long afterwards that her elderly parents gave up their home in Berlin and followed; and again not so very much later that her cousin Frederick Pasternak, who had married her sister Josephine, brought his family to England to make a new home there. It was a source of peculiar satisfaction to me to be showing what I thought of Nazi Rassenhygiene by marrying a jewess, a member of an inferior race by their standards, a lady of the highest genetical aristocracy by mine.

    It was always foreseen that, after the generous training I had been given, I should continue with research; and in due course I was given a personal research grant by the Medical Research Council to carry out an investigation based on psychiatric patients, born one of a pair of twins, and with the twin surviving into an age of psychiatric risk. For this research I was given leave from my appointment as an assistant medical officer of the Maudsley Hospital, and for two years spent my days at one or another of the London County Council's mental hospitals. This proved to be a valuable experience at the clinical level. Once again, as previously in Derbyshire, I was brought into contact with patients showing the effects of ears of mental illness, but this time with a background of knowledge and experience, as well as with a number of fundamental questions in my mind, which gave me the attitude and some of the understanding which the experience needed. I also got to know a considerable number of psychiatric colleagues working in the slow moving and often melancholy world of the outlying mental hospital, and to appreciate their ambitions and frustrations. When I eventually got back to the Maudsley I often thought, in conversation with the luckier colleagues there, that work in chronic wards was a piece of training that every psychiatrist should have, and that without it a real picture of the long‑term development of the psychoses could not be obtained.

    At that stage in the investigation I had only a clerk to help me, who sat in the hospital office and sent off cards to relatives to ask whether the patient had been born a twin or no. I had to do all the field work myself; and going round and calling at people's homes was something new and difficult, which I never learned to like. In Munich I had indeed done a little of it; but there, the well trained population could be expected to present themselves at the research institute for interview if called on to do so by an official letter an attitude different indeed from the one I met in the relatives of British schizophrenics.

    During those years the shadow of the German armed colossus spread and deepened across Europe, which seemed to be sliding into a pit at its feet. For me the bottom of the pit was reached with the Munich agreement of 1938, when I felt my country was eternally disgraced. I was always glad and grateful that my father died before that compact with the devil was made, a death that also put an end to a long and debilitating illness. In fact, the deaths of both my parents have shown me death in the form of a friend and a deliverer, and since then I have ceased to feel, as I did in my youth, an uneasy sympathy with the poet's "Timor mortis conturbat me."

    My personal grant from the M.R.C. ran out, and I returned to clinical duties at the Maudsley, trying to keep the investigation going in my spare hours. It was not so easy. As acting deputy medical superintendent I was asked to carry out functions for which I had no natural gift; and when it became necessary to make far‑reaching plans for the welfare of hospital patients in the event of air‑raids and for the emergency evacuation of the hospital, I felt this was something someone else would do much better. At my suggestion Mapother gave these duties into the capable hands of Aldwyn Stokes. The evacuation of my own family to Oxford took place in good time before the war, and the evacuation of the Maudsley Hospital was carried out the day before the declaration. The official view was that immediately after the outbreak of war there would be intensive air‑raids on London, and that psychiatric casualties would be running up to tens of thousands a day; the civilian population, in fact, was expected to go half‑mad. All our patients were sent home, or into outlying hospitals, and our medical and nursing staff divided into two teams, going severally into emergency hospitals at Sutton in Surrey and Mill Hill at the northern fringe of London. Lewis was to be "Clinical Director" at Mill Hill, and I at Sutton, these being clinical and research appointments rather than administrative ones. For the actual running of these hospitals, Mapother brought in Louis Minski and Walter Maclay, both of them ex‑Maudsley men no longer on the staff. However, Lewis and I picked the two teams, turn by turn, like two captains on a children's playground, each of us using his own criteria of desirability. This resulted in two groups of doctors widely different from each other in team personality and team spirit. With our group at Sutton, under Minski we had an exceedingly happy ship, since he let us ward workers run our own affairs, but saw that we got what we needed administra­tively, and protected us against too much interference from the hierarchy of officials that towered above us, tier upon tier, to its apex at the War Cabinet.

    The last morning of peace, a lovely Saturday morning in early autumn, saw the charabancs gathering in the drive in front of the Hospital and, watching them fill and drive off, Mapother in his wheel‑chair, a man broken in health who had now himself pulled down the great structure he had built. The next morning I was one of a party sent from Sutton to pick up equipment left behind which could be rescued. And as we fetched and carried, through the sparkling blue air came the sound of the air‑raid warning. War had been declared.

That was thirty years ago.


London, 1969.




[1] The reader may be surprised at so much preoccupation with examinations. In fact, for a great part of my life, say from 13 until my M.D. at 36, they constituted most of the major challenges. Of those that have been or could have been critical I can remember 25: 4 public examinations in general education, 12 medical, 7 for scholarships, and 2 for prizes. Despite some facility kind of test, I do not much respect it: those who markedly lack the special ability which is needed to cope are at a great and unfair disadvantage in the pursuit of a professional career.

[2] Methods of treatment in those days were extremely limited. Apart from such standby drugs as paraldehyde, the main nursing treatment was by keeping the patient continuously in a luke­warm bath. The din and the antics and the cascades of water that one might meet on the morning round added some light relief to the predominantly depressing task of trying to treat illnesses that obstinately responded only to their own occult intrinsic laws. The preoccupation with exact observation and description was also, of course, in part a rncthocl of preserving one's own equi­poise when surrounded by such hopelessness.

[3] Eric's kindness and patience were endless. He it was who touched up all the German papers wrote about this stage in my career.

[4] I also visited Frankfurt am Main and spent a couple of weeks in Kleist's clinic there, seeing also von Verschuer's research institute which was occupied with a large twin sample from the general population. A short visit to Prague was also fitted in, with tragic memories later: I did not see or hear again from the Dr. Sekia I met then until the Rome Genetics Congress of 1961. While in Berlin I visited Curtius, who was more of a neurological than a psychiatric geneticist. I also visited Kallmann in his large Berlin mental hospital, an occasion heavily overcast with tragedy. Shortly he would have to emigrate to no such settled and welcoming home as was offered to our Maudsley refugees, and of all his savings allowed to take with him only ten marks for himself, ten for his wife.