Malcolm Almond describes the work he carried out during his National Service years
When I first qualified as a pharmacist, I was immediately thrust into a position of responsibility as a locum with a major multiple. From working under supervision, I had to make an overnight transition to having complete control of a pharmacy. However, this increase in responsibility was nothing compared to the change I encountered over the two years during my National Service.
I was called for National Service in April, 1960, and served until April, 1962. After 12 months in the army, I was given one of the plum jobs available to National Servicemen: I was to join the permanent military staff on board the SS Oxfordshire, transporting military personnel and their families around the world either to or from Britain. The ship's hospital was staffed by a doctor, two qualified nursing sisters, a pharmacist, one administrator and four male nursing orderlies. The male nursing orderlies were National Servicemen from all walks of life who had received eight weeks' training in first aid and eight weeks' training in nursing. With this training under their belts they were expected to carry out nursing duties, including the administration of injections. They were responsible to the two qualified nursing sisters, who were members of the Queen Alexandra Royal Army Nursing Corps. My duties were to provide dispensing services for the military personnel and their families and also to act as radiographer and laboratory technician.
I was, of course, given training for my new duties. While awaiting a position on board, I was based at the Royal Victoria hospital, Netley, Southampton, which was a military mental hospital. My radiography training was received at this hospital but whereas the hospital did mainly skull X-rays on decent equipment, I was going into a position which called for arm and leg X-rays on outdated field equipment. My training lasted about a week and was very basic. However, I would have a brief manual explaining my regular machine. I never had any problems in my short radiography career. The X-rays invariably turned out with incredible clarity and the highlight was my first fracture. It would not have been a happy time for the soldier concerned but it was exciting for a novice radiographer.
RVH Netley did not have the right laboratory facilities to train me so my training was one day at Cambridge Military hospital, in Aldershot. Here I was taught how to use stains on microscope slides for use in diagnosing malaria and venereal diseases. Once more I was provided with a short manual to help me. After such a brief training period, I was surprised to be given the responsibility for diagnosing from the slides. Suspected cases of venereal disease were sent by the doctor to a nursing orderly who took the relevant sample. I stained the sample with reagent, diagnosed and sent the patient back to the nursing orderly for the relevant treatment. The treatment was usually one megaunit of intramuscular penicillin and the patient would only return to the doctor if the injection did not clear up the problem. Predictably, cases of venereal disease surfaced about 48 hours after shore leave in our regular ports of call, notably Gibraltar and Aden.
Cases of malaria were not common but the patients were usually returning to the United Kingdom from overseas and had not taken their proguanil. Again, I was expected to diagnose and initiate treatment with quinine sulphate, the doctor only being involved in monitoring the patient to ensure that he responded to treatment. Only once did the patient not respond and this caused some concern. The patient had not been diagnosed from a blood sample but showed all the symptoms of malaria. Several slides did not reveal malaria but treatment was initiated with quinine and the patient did not respond. The patient was put ashore at the first opportunity and the shore based hospital diagnosed black water fever. This was the only case in my year at sea that caused real concern. Unfortunately, none of the ship's hospital staff, including the doctor, had received training on tropical diseases.
Dispensing for passengers was very straightforward. Families of lower ranks were accommodated in cabins for four around or below the water line. This meant that they could not open the portholes and they did not have air conditioning. The most common medical complaints were diarrhoea and prickly heat. Diarrhoea in children was treated with kaolin paediatric mixture and in adults with kaolin and morphine mixture. Prickly heat was treated with a "magic" potion, the formula for which had been passed down over the years on board the ship. The lotion contained menthol, zinc oxide, methylated spirit and water. It was not pharmaceutically elegant, settling out in seconds, but it was very effective.
The lower ranked troops were accommodated in dormitories, in bunks stacked two or three high with no opening porthole and no air conditioning. Prickly heat was again a problem. Sea sickness was not common but there were certain black spots where it could be prevalent. The most common area for sea-sickness was the Bay of Biscay; less sea-sickness occurred in the Indian Ocean and the South China Sea.
The range of drugs carried was limited and was considered out of date even for the 1960s. Illnesses were invariably acute cases. There were few oral antibiotics around in those days and we did not carry paracetamol. The analgesic of choice for all ages was aspirin.
On two of my trips, the medical staff carried out clinical trials for drugs used to treat sea sickness prophylactically. Volunteers in the services were never hard to come by and sea-sickness outside the clinical trials was not going to be treated sympathetically. The trials were conducted on a cross over basis with a placebo. The doctor supervised the clinical side while I undertook general management of the operation with help from a nursing orderly.
Service personnel and their families who contracted tuberculosis abroad were brought back to Britain by sea as it was not considered advisable to fly them home. They would spend the voyage in isolation in a ward at the stern of the ship with access to lots of fresh air. Treatment would usually be with streptomycin injections.
The ship's crew were merchant navy personnel and their medical needs were looked after by the ship's surgeon. The ship's surgeon was a dispensing doctor with his own limited range of drugs. He had no pharmacist and no laboratory or radiography facilities. It was not unusual for me to help him when I had access to facilities that he lacked. As a pharmacist, I held the rank of staff-sergeant, a rank that carried reasonable status on board ship. However, my status among the merchant navy crew was greatly enhanced by the fact that I was a fixture in the ship's cricket team. My knowledge and expertise in matters pharmaceutical were secondary to my ability to score a few runs and take a few wickets in our afternoon tussles with teams made up of various groups of passengers.
In spite of the fact that National Servicemen resented being in the Army, the experience enabled me to see the world, particularly the Northern hemisphere. My two years in the army also taught me to take responsibility, to improvise and to communicate with superiors and subordinates alike. The roles I undertook would not be acceptable in civilian life nowadays with the threat of litigation hanging over every move. I was succeeded by an army dispenser who was not a pharmacist but had been trained to technician level. I believe that most dispensers in the services nowadays are trained to this level. Pharmacy has changed in the intervening years and, while I would not claim that the 1960s were the good old days, I do not like the increasing attempts to achieve uniformity which seem to have crept into the profession.
Malcolm Almond is a writer and community pharmacy locum from Huddersfield, West Yorkshire