The Conferring address was given by Dr Michael Hyland, Consultant Geriatrician (attached).

Conferring Address by Dr Michael Hyland, Consultant Geriatrician, December 12th 2008

President Murphy, Vice Presidents, Head of College, Heads of Schools, new graduates, family and friends; I am honoured to be asked to address you today as a medical graduate of University College Cork 1957 and a retired consultant physician in geriatric medicine at Cork University Hospital and my beloved St Finbarr’s Hospital and a clinical teacher for 30 years until my retirement in 1998.  I congratulate you on your success.  Today is a milestone and a celebration of your achievement.  I realise the hard work and sacrifice involved and the support you receive from your family and friends.  I wish you every success in your future.  

You are starting your careers at a time of economic recession.  When I qualified in 1957 we were also in recession and the chance of my ending up with a post in Cork seemed remote.  Fifteen years later, after my postgraduate training in the UK, I was appointed to a consultant post in Cork.  A period abroad widens the horizons and allows you to identify new opportunities.  

I would like to present to you today the story of two founders of medical specialities, both female.  Both started out after graduation unsure of their future role in medicine and kind of post they would achieve.  The important feature of both ladies was their ability to “think outside the box”.  

Firstly, I will talk about Dame Cicely Saunders who founded the speciality of Palliative Care in the hospice.  She trained as a nurse but was very concerned about the care of the dying.  Early on, she decided that she was going to devote her life to the care of the dying.  She saw the future as a holistic approach to the dying patient as an individual human being rather than a condition or a collection of symptoms.  She was concerned about too much power in the hands of doctors – their focus was on medical technology, on cure rather than care – and the needs and rights of dying patients had been neglected.  What was needed was a coalition of doctors, nurses, patients and their families.  

As a nurse she knew that she would require more experience to gain these objectives.  She became a medical student and qualified as a doctor in London.  In 1967 she founded the world’s first modern hospice – St Christopher’s Hospice in Sydenham in South East London which has been internationally acclaimed.  It is a place of pilgrimage for doctors, nurses and others who wished to see the ideal care of the dying patient.  Once established she was invited to lecture in Yale in the US, and made a great impression.  A US nurse, Florence Wald, was most impressed and a year later arranged to become a nurse in St Christopher’s Hospice.  In 1972 Florence Wald returned to the US and founded the first modern American hospice, The Connecticut Hospice.  This model was widely followed in the US and there are now 3200 hospices, which are covered by Medicaid National Health Scheme.  I first visited St Christopher’s in 1969, where a UCC graduate, Dr Michael Kearney, was Registrar.  He showed me round the hospice and introduced me to Cicely.  I met Cicely again a few years later and at that time we discussed the appointment of a Palliative Care Physician to St Patricks Hospital in Cork, formerly known as “The Incurable”.    Permission was granted for the appointment of a Consultant in Palliative Care and in 1987 Dr Tony O’Brien took over as medical director and was later joined by Dr Marie Murphy.  Dame Cicely Saunders died in 2005.   A new state of the art hospice is currently under construction on the Bandon Road with the generous assistance of Atlantic Philanthropies.  

Dr Marjory Warren is widely recognised as the “mother of geriatrics”.  She was born in London in 1897 and qualified at the Royal Free Hospital in 1923.  After house appointments she became an assistant Medical Officer in 1926 in the West Middlesex County Hospital, where her primary interest was surgery.  In 1931 she became Deputy Medical Superintendant.  In 1935 her career took a turning point when the nearby Poor Law Infirmary was annexed into the West Middlesex Hospital and she was given the medical responsibility for 714 patients who were chronically ill and mostly elderly, labelled as “incurable”.  She attributed the high number of bed ridden patients in the Infirmary to poor diagnosis, lack of medical supervision, insufficient treatment, a lack of multi-disciplinary team work and the absence of rehabilitation.  She accepted the new challenge by creating the first geriatric unit in the United Kingdom, based on comprehensive assessment and early rehabilitation of the patients by a multi disciplinary team.  Her work led to the publication of the British Medical Association Report in 1947 and the initiation of a comprehensive geriatric medical service in the UK in 1948.  She was appointed as one of the first Geriatricians in 1949.  She died in 1960.  I spent the last two years of my specialist training in geriatrics in the West Middlesex Hospital where she was still revered.  

Complementary and alternative therapies have become increasingly popular.  They should always be remembered in taking a history as patients are often reluctant to inform health professionals that they are taking these therapies.  They include Acupuncture, Aromatherapy, Herbal Medicine, Homeopathy, Hydro Therapy, Massage, Nutritional Therapy, Osteopathy, Reiki and Reflexology.  

I will finish with a couple of quotations:
This quote from Rudyard Kipling is useful in taking a history:
‘I keep six honest serving men
They taught me all I know
Their names are What and Why and When
And How and Where and Whom.’

Secondly on the dangers of bed rest by Richard Asher:
‘Teach us to live that we may dread
Unnecessary time in bed.
Get people up and we may save
Our patients from early grave.’

931MMcS

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