William Pickles (medical doctor)

Pickles was influenced by the physician-epidemiologist William Budd, and the cardiologist and general practitioner James Mackenzie, who argued that it was the GP as family physician who had the true insight into disease. He later advised all young doctors and medical students to read McNair Wilson's biography of Mackenzie The Beloved Physician.[2]

He held several locum positions in his early career and became an assistant to Dr Horsfall and Dr Eddison of Bedale in the North Riding of Yorkshire, doing his rounds by bicycle, assisting in operations and performing most of the midwifery. An incident involving a sick gypsy and a defective water pump led him to make correlations with an outbreak of typhoid. As John Snow had done with the Broad Street pump in 1866, Pickles ended the typhoid epidemic by having the water pump closed, which stirred his first interest in epidemiology [2]

In 1912 he visited Aysgarth for the first time, as a locum for Dr Edward Hime. Later that year he served as a ship's doctor on voyage to Calcutta and, on his return to England, resumed working for Dr Hime as a second assistant.[1] In 1913, Dr Hime left Wensleydale and sold the practice to Pickles and Dr Dean Dunbar for £3,000. Dunbar, assumed the position of Medical Officer for Health at the workhouse and was also on the Board of Guardians of the workhouse at Bainbridge. Pickles was the second assistant to Dunbar. At the time, the practice in Aysgarth served eight villages and a population of more than 4,000.[2]

Pickles served as surgeon-lieutenant in the Royal Naval Reserve during the First World War[1] where he observed and wrote about sailors with poor oral hygiene that predisposed them to Vincent's disease.[2] The Royal Naval Medical Journal published his work in 1918.[1]

In an article in the British Medical Journal in 1930[1] "Epidemic catarrhal jaundice: An Outbreak in Yorkshire", and in another in 1933, "Bornholm Disease: Account of a Yorkshire Outbreak", Pickles showed the opportunities available to GPs for epidemiological observation. His observations reached a wider audience in his 1939 book Epidemiology in Country Practice, in which he described an unusually severe epidemic of catarrhal jaundice in the Dale that had occurred in 1929. It was later discovered to be Hepatitis A and many school children were affected. Through his observational studies, he was able to prove that the incubation period was 26–35 days. He also traced one case to the relationship between an affected maid and a man who sneaked through the door to help her "wash up".[2] For Pickles, it was "great fun when we could exercise Sherlock Holmes tactics and nail the culprits".[4]

In 1933, Pickles was the first person to describe Bornholm disease in detail in Britain. Without any known cure, one response to his findings was that suffers could be “safely left to the care of the physician”. Pickles was said to remark on his view of the hazard being “that on some occasions it would come under the care of the surgeon”. The condition is now known to be caused by Coxsackie B virus.[2]

In 1935 Pickles spoke to the Epidemiology Section of the Royal Society of Medicine on measles, the incubation period of which was thought to be between 7 and 18 days. He used an example of a farm boy who transmitted the measles to his aunt who sat in the aerially connected room below, to demonstrate an incubation period of 12 days.[2]

His period of service in Wensleydale eventually covered more than 50 years, half of which time he spent recording his observations. Once, as he looked down upon Wensleydale from the top of a hill, he realised that he knew everyone in the village and most on a first name basis. His success lay in showing that the rural general practitioner had opportunities for making observations on disease.[2][5] This was as a result of Pickles's close acquaintance with the eight villages he looked after.[6] His wife Gertie, was deeply involved in keeping the charts up to date and in order.[3]