The Surgery at Mountain Ash

“It was an agreeable and easy-going life, but after a few months I realised that I was being starved of experience … it became obvious that if I wanted to better myself, I should have to find a post where there was more to do.” (p14, The Surgery at Aberffrwd)

In 1908, a young doctor named Francis Maylett Smith gave up a post in an English country practice to work in a colliery town in the heart of the South Wales coalfield. He spent several years at a busy practice in the town, a time recounted in the book, The Surgery at Aberffrwd, edited by his nephew, Denis Hayes Crofton, and which was published in 1981 by Volturna Press.

Mr Crofton places the location of Aberffrwd – which is not the name of the actual town – “somewhere in the triangle between Hirwaun, Pontypridd and Merthyr Tydfil.” Names of individuals have also been changed.

Reading the book with a local eye, it is evident to me that the colliery town of “Aberffrwd” is Mountain Ash in the Cynon Valley. I have collated some census and other evidence relating to the surgery during the time of Dr Smith’s memoir that helps to identify the town and some of the individuals mentioned. I shall use the “Aberffrwd” names for the purpose of considering the book, with the actual names, and supporting documentation, at the end of this post. 

Dr Francis Maylett SmithAberffrwd Surgeryphototitle

Dr Smith obtained his medical qualifications in 1907 at the age of 30. His path to this achievement had not been smooth, his earlier studies having been interrupted by his becoming deaf. Feeling that he was unable to progress in the profession, he went to South Africa where he studied agriculture. Finding his skills were of more use as a doctor than a farmer, he resumed his medical studies despite the difficulties he faced.

Aberffrwd was not his intended destination. He had obtained a post at a practice in Wiltshire and it was while waiting to take up the post that he came to South Wales to work for 2 weeks as a locum at a busy practice in the industrial town of “Dyffrynmaur”. There he met Dr Prichard, a man who came to impress him greatly and who wanted him to take up a post in his busy practice rather than the countryside: “A mere country practice! You will learn nothing there and probably take to booze!” (p5)

While not taking to booze, Dr Smith did not take to life in a country practice either. Unfortunately, by the time he contacted Dr Prichard, it was too late: the post had been filled. Dr Prichard was able to help, though, by directing Dr Smith to a post in another colliery town – Aberffrwd.

 The Surgery at Aberffrwd

When Dr Smith arrived in Aberffrwd, he was already wondering if he had made a mistake: night had fallen and the town seemed uninviting. The practice owner, the genial Dr Williams, was waiting at the station to accompany him to the practice, only a few yards away in Merthyr Street, in the heart of the town. There, Dr Smith met his fellow assistants: Dr Arthur Rees, of whom there is much to say, and Dr Fiztherbert, with whom Dr Smith would share lodgings at the practice itself.

From Dr Fitzherbert, Dr Smith learned that Dr Williams left the work of the practice to his assistants, particularly Dr Rees. “He sees all the difficult cases, runs the hospital, does the operations and confinements, sets the fractures and pulls out the teeth.” (p19) The patients called him Dr Arthur and had little regard for any other doctor.

This is exemplified at Dr Smith’s first morning surgery when Dr Fitzherbert approaches the queuing patients – who crowded in the draughty corridor while waiting to be seen – to ask if he could attend to them.

“‘I want to see Dr Arthur,’ was the reply of a miner of rather truculent appearance. ‘And what about you?’ Dr Fitzherbert asked a woman standing at the miner’s side. ‘I want to see Dr Arthur,’ she answered. Further enquiries elicited that Dr Arthur was the preference of everyone, at least of those in the leading files, while those in the middle and the rear of the column seemed inaccessible to human aid.” (p21)

Dr Smith and Dr Fitzgerald were left with those patients who either did not mind being seen by a doctor other than Dr Arthur, or who were too diffident to say so.

In those days, the practice did not allow for privacy for the patients. There was no waiting room, with patients having to stand in the corridor while they waited to be seen, nor a consulting room. When settled in, Dr Smith gives this account of the procedure at the surgery for assessing patients.

“In the surgery we make most of our diagnoses in what some might think a most perfunctory manner, with a quick look at the patient’s general appearance as he stood in the queue, and a few brisk questions about his symptoms. “Any vomiting? Bowels open?” he would be asked, if it seemed something to do with his abdomen; “Let’s see your mouth … Put out your tongue … Does that hurt?” – this last with a prod over his stomach and appendix. This brief catechism was usually enough to decide if there was anything serious the matter. If there was not, a bottle of medicine would be instantly made up to some well-tried prescription, with not too much nicety in measuring the ingredients, but with a turn of speed that would have left any pharmacist standing.” (p73)

The speed was necessary given the workload: in seeking experience, Dr Smith had found it.SurgeryAberffrwdcontents

Gwynfa Terrace

“. . . as one who often had to visit it in the course of professional duty, I am bound to stress that the conditions prevailing there were grossly insanitary and that the toll of sickness was therefore exceptionally high.” (p32)

In recalling his patients, Dr Smith focuses on Gwynfa Terrace (chapter 3, p26). It is situated, he tells us, on the other side of the river from the surgery, in a small district to be found by turning right after crossing the town bridge and walking along Cardiff Road by the canal. He describes four streets, with Gwynfa Terrace a cul-de-sac that “climbs at an angle up the face of the mountain.” (p30)

Dr Smith’s view of the housing stock in the area is that it is ugly and primitive, in keeping with a 19thC idea of suitable housing for workers.

His comments on the layout of the town are of interest, though his views on the people – their circumstances, behaviour, and attitudes – are more interesting given his social status relative to his patients. Though he forms a clear impression of the residents of Gwynfa Terrace, he appears to do so with empathy, and a desire to be fair.

Patients

Several chapters are devoted to patients, with Dr Smith providing not only the details of their lives as he saw them, but what amounts to short biographies. In these accounts, his view – though marked by social and professional distance – tends to the sympathetic, with genuine regard for the welfare of his patients. The challenge of treating some patients is discussed, but in the main his recollections of his patients are notable for the warmth, humour, and circumstances with which doctor and patient had to deal.

Whether he is telling us of Mrs Roper, who maintains an air of happiness despite trying circumstances, or Mr Simpkins, whose ill-health is inexplicable apart from his not wanting to work, Dr Smith takes us into his patients’ houses to stay awhile.

Keep your hat on

The disparity in social status is made apparent after Dr Smith’s first morning surgery, when he accompanied Dr Rees on his rounds.

Dr Smith notes that Dr Rees never took his hat off when he entered – without knocking – a patient’s home. The explanation was that to remove one’s hat would indicate diffidence or subservience to the occupants of the house. Such an error was to be avoided. (p24)

The importance of social status reflected in the raising of a hat is again referred to in his comments on the Tuppers of Gwynfa Terrace. He notes that the daughter, Miss Tupper, was educated and working for a solicitor, thus belonging to the higher walks of Aberffrwd society. He further notes that, “It was rare for a doctor to raise his hat to a woman on the streets of Aberffrwd, and not even Mrs Tupper could stir his sense of chivalry, but the approach of Miss Tupper always reminded him of his duty.” (p156)

Mrs Tupper, he thinks, would not expect such a politeness as she knew her place as a collier’s wife.

Pulling teeth

“It’ll have to come out.”

Words to cause a slight loss of composure even today. In Dr Smith’s day, it seems that even doctors like himself would feel a lack of appetite for the process, especially given a difficult extraction from a struggling and screaming patient: “an unsuccessful attempt . . . was almost as painful to me as to the principal sufferer,” (p76)

Anaesthetic? Not the practice, though it seems that the doctor as much as the patient would have appreciated it.

At least Dr Smith would have a try before admitting defeat in the teeth, ahem, of the recalcitrant molar. Dr Fitzherbert, he says, found the whole thing so distasteful that he would make up a pain-killing powder on the basis that the tooth was either too good or too rotten to be removed, to the delight of the “timid and weak-minded”. (p76)

The other doctors at the practice were not so squeamish.

Dr Rees, as might be expected, was the person to whom the doctors and patients looked, though the thought of his “steely determination” in such circumstances makes me wince. That said, Dr Smith observes that such commitment in “one so merciful and kind, must have called forth a considerable effort of will.” (p77)

The burden of the patient, then, was not only sorrow for one’s own suffering but also for the suffering one is causing one’s beloved doctor. Except…

“The ruthlessness with which he persevered with a difficult case filled the onlooker with wonder, pity and awe. However much the patient might struggle with both hands to escape . . .” (p77)

The patient “left the surgery chastened by suffering, but with no hard feelings. Dr Arthur, it was generally believed, was cruel only to be kind.”

The owner of the practice, Dr Williams, is perhaps most notable for his absence, and the duties he left to Dr Rees. However, in the extraction of teeth he seems to have found a measure of satisfaction and enjoyment.

“His method of extraction was peculiar to himself. The patient would have to stand and Dr Williams would secure his head under his left armpit. When Dr Williams introduced the forceps into his gum, the patient would step backwards and withdraw still further as the operation proceeded, so that before the tooth came out, he and Dr Williams had performed a kind of waltz round the room. Our surgery being small, the rest of us had to give way to allow the couple to pass.” (p77)

Night shift at the mines

I rather like this description of the miners going on night shift.

“At night, when the byways seemed deserted, the streets would suddenly come to life and resound with the clatter of miners’ boots as the night shift hurried to work. They would come pouring down Merthyr Street, past the surgery, in their ragged working clothes, whistling as they went, seasoned men and larking boys filling the street with their shouts and laughter of irrepressible youth, miners and surface workers hastening together. Here and there you might see one with the mark of a permanent injury suffered at the coal face, a heavy limp or even a wooden leg, It was as if an army, ready for the fray, had burst upon the silent streets, Over the bridge they would surge, and make for the pitheads. There the miners would be swallowed up, plying their dangerous trade, until with blackened faces they emerged to toil wearily up the same precipitous streets and byways to bath and breakfast,” (p26)

Death of a young miner

“Late though the hour was, the neighbours were awake and standing in groups at their open doors. The men looked grave and some of the women were weeping, but even if they had not been, the fact that they had been roused made me fear the worst. Then came the chilling sound of wailing from the house to which I had been called. A doctor has to harden himself to the sight of human anguish or he would lose his nerve altogether, but here it was not easy to steel oneself, for the bright young lad I had been called to see had only lately followed the family tradition and became a miner. And now he had been crushed beneath a fall of rock, and before I could reach him he was dead. As he lay there, his mother sat beside him, her eyes empty of tears but clouded by the agonies of grief as she continued to moan distractedly. The neighbours, kindly folk, tried to console her by speaking of the joys of Heaven into which her son had been received, but she did not seem to hear. All that she understood was that the form of her son beside her was lifeless. The time for medical skill had passed, and the time for sympathy that could be of the slightest avail had not yet come, so I left the house with a heavy heart and made my way home through the night, down the steep hill and across the moor in the moonlight. The peace and magic had fled from the streams and the woods, and as I passed downward through the glen, my mind was full of the bitter wailing of women.” (p112)

Fancies

There are some observations made by Dr Smith that have me shaking my head in disbelief.

He states that there “were Christmas Evanses by the thousands in the valleys” but never a Christmas Thomas, or Christmas Williams, or whatever (p63). Amusing but, as someone who has spent some time seeking family history sources in the valleys, not a trend I have even seen in the baptism records. I have seen one or two Christmases in families – not Evanses – but that arises from a family surname being passed on to a child as a middle name, rather than an appreciation of the time of year. (I will return to this in “The surgery at Mountain Ash?” at the end of this article.)

“You would often hear a miner say that he would never let water touch his spine or he would get a weak back.” (p45) This is mentioned to explain why the three young men in the Potts household have a dirty streak down their backs after bathing. This is not something I have heard before – it seems rather an effort to try and avoid such wetting – but there might have been one or two who believed in such a superstition, in much the same way people believe in homeopathy, or god, or whatever.

There are several slight-but-amusing stories provided by Dr Smith in the context of the provision of medical supplies to patients. Such provisions were part of the contract system but it had its limits. One story concerns a miner who called at the surgery to ask for brimstone (sulphur) for his wife and was “told that he would have to go to hell for it” (p75), an incident that a journalist turned into a story for the “Aberffrwd Times”. (I reference the story at the end of this article.)

Dr Arthur Rees

Of all that Dr Smith has to say about his colleagues, whether in other practices or visiting surgeons from Cardiff, it is Dr Arthur Rees who emerges as the most significant figure, not so much for his status in the town – a prominent Liberal, active politically and socially – but for his hard work and the confidence his patients had in him.

“His personality was genial and sympathetic, quite devoid of any air of superiority, so that in half-an-hour it seemed that we were already old friends. His way with the patients in their homes was, in complete contrast to the rather abrupt manner, which, under pressure, he had adopted in the surgery, always kind and considerate; he would examine them with thoroughness and still find time for a chat and a joke. In each house we visited, he knew all the inmates, young and old, and had all their peculiarities at his finger tips. It was easy to see that they thought the world of him, and gave him their complete trust. I know understood why many of them wanted no-one but Dr Arthur and were ready to wait till he was free to see them.” (p24)

It is fitting that, with Dr Williams failing in health, Dr Rees became a partner, officially taking over the running of the surgery, and he did so at a time of change with the introduction of the Health Insurance Act. The birth pangs of the Act must have been especially difficult for a man used to the respect of his patients, and who  had to balance his politics with his role running a practice: he was a supporter of the Act while his profession was fighting it.

“Swine! Blackleg” (p104)

The cries above do not arise in the course of an industrial dispute but at a meeting of the South Wales branch of the British Medical Association, held to consider the Act.

This meeting, attended by Dr Smith, was to consider the concern that the practice owners feared the diminishing of the “lucrative system of running large practices through low-paid assistants.” (p104) At the meeting, the practice owners did most of the talking. (That practice owners were using their assistants in this way was told to Dr Smith by Dr Fitzherbert on his very first evening at the surgery. p19)

One or two members, including Dr Rees, spoke in favour of the Act but stressed that they would support the will of the majority: their qualified loyalty was afforded a cold reception.

The shouts of “Swine! Blackleg!” were reserved for two speakers, both owners of one-man practices, who stated that they would sit on the panel created by the Act, whether the meeting was in favour or not.

The meeting ended in near-unanimous commitment to refuse to co-operate with the Act.

The odd thing about all this girding of loins, according to Dr Smith, was that the BMA withdrew their objections at the last moment and urged all doctors to sign up without delay: they had apparently discovered that the Act would not have the deleterious effect on their lucrative practices that they had feared.

As for Dr Smith, he refused to sign, not because he did not support the Act but because he wanted to disassociate himself from the “ludicrous volte-face” of the leaders of his profession.

He notes that he had, as an assistant to an empanelled doctor, nothing to lose by such a refusal.

The doctors’ halfpenny strike

Prior to the Act, the colliery companies deducted “threepence in the pound” from each man’s wages, with the GP practice contracted to provide the miner and their families with medical treatment, and a variety of items for home treatment – bandages, cotton wool, pink lint and so on. (p74)

With the introduction of the Act, the amount to be deducted for the medical care of the miners’ families was up for negotiation. In Aberffrwd, the miners suggested one and a half pence in the pound, while the doctors wanted two pence. The difference led to the characterisation of the dispute as “the doctors’ halfpenny strike”. (p121)

These sort of discussions were going on elsewhere, but Dr Smith states that the dispute that arose was local to Aberffrwd, its miners, and its doctors.

The story of the strike, and its effects, is one that I think deserves some attention: I will write a separate post using Dr Smith’s account supplemented by contemporaneous reports in the local newspapers.

Medical records, desks and somewhere to sit

The Act created a new bureaucracy of prescriptions and medical records for which the surgery at Aberffrwd was unprepared. Doctors could no longer spend most of their practice hours on their feet. Now that they needed to write prescriptions rather than make up their own medications, they needed a desk, and somewhere to sit: they needed a consulting room. (p106)

The need to compile medical records was seen as red-tape and ignored, as there was no point in recording easily treated minor complaints. This seemed reasonable until the surgery was asked to send their patient records to Cardiff for assessment, leading to the three doctors getting together to try and make up the records from memory. Their efforts were queried when it turned out that they only provided a tenth of the expected number of records.

Fortunately, a fire in Cardiff put paid to all the records. (p107)

 The death of Dr Williams

During this time of change, Dr Williams died. As his partner, the surgery now belonged to Dr Rees.

“It was sad to see one who had enjoyed life as he had suffering so in his last days. His home and family, good company and the pleasure of hospitality, music and singing and days in the hills with his horses and dogs had shed a genial warmth upon his life, and he was a forlorn figure as he entered the valley of the shadow. Though he bore himself without complaint, there was grief in his eyes at the thought of all he was leaving, unrelieved, I think,by any confident hope of better things to come.” (p107)

Leaving Aberffrwd

During the introduction of the Act, probably in 1913, Dr Smith began to loosen his ties with Aberffrwd. He left the surgery for a while and then found that he could not return as, after the halfpenny strike, the workload at the surgery had fallen such that the vacancy created by his leaving did not need be filled.

When Dr Fitzherbert left, Dr Smith returned for a short while before saying farewell to Aberfrrwd in 1915.

The Surgery at Mountain Ash?

I have already noted that Mr Crofton offers the observation that Aberffrwd “lies somewhere in the triangle between Hirwaun, Pontypridd and Merthyr Tydfil”.

Dr Smith’s description of the town, Chapter 3, p26, is suggestive of Mountain Ash but it is his description of crossing the bridge, then turning right down Cardiff Road, that seems particular to the point of identification. His description of his destination – “Gwynfa Terrace” – matches that of Strand Street, Newtown. (p29)

Further evidence is offered by his observation of a building known locally as the “barracks” on Cardiff Road. (p60)

Local knowledge of this building is supplemented by census returns such as Class: RG13; Piece: 5006; Folio: 106; Page: 11, and Joseph Keating’s memoir, My Struggle For Life.

Taking the particular and the general into account, his description of arriving in “Aberffrwd” and his short journey from the station to the surgery leads to the thought that the surgery was based in Pryce Street, leading upwards from the main street and with the “Oddfellows club” opposite. (pp 16, 20, 21)

Looking through census returns provides the following for 5 Pryce Street, opposite the Hibernian Club.
1911Census-RG14-32-2-91-32291_0113_06
Denis Fitzgerald, aged 46, Surgeon and physician, 5 Pryce Street.

Arthur Thomas Jones is to be found at 19 Richmond Road, Mountain Ash.
1911Census-RG14-32-2-84-32284_0427_06
Arthur Thomas Jones, Physician Surgeon, aged 37, born Wrexham, Denbighshire, 19 Richmond Road, Mountain Ash.

That Dr Jones has a relationship to the surgery at 5 Pryce Street is supported by the 1901 census that shows him with his brother at 5 Pryce Street, Mountain Ash.
Source Citation: Class RG13; Piece 5005; Folio 60: Page: 1
Arthur Thomas Jones, 27, born Wrexham, Denbighshire
And his brother, Trevor Christmas Jones, 24.

All of this is consistent with there being a surgery at 5 Pryce Street, Mountain Ash, and that this was the surgery in which Dr Smith worked as an assistant between 1908 and 1915.

The “aliasing” of the names appears to be fairly simple. “Dr Arthur Rees” was actually Dr Arthur Jones. “Dr Fitzherbert” was actually Dr Fitzgerald.

Recalling Dr Smith’s wonder at the “thousands” of “Christmases” among the population, it is interesting to see Dr Jones’s brother, also born in Wrexham, having the name “Christmas”, no doubt a family surname.

Newspaper reports are a useful resource, though at the time of writing the online Welsh newspaper resource provided by the National Library of Wales does not include the Aberdare Leader for 1911 and 1912.

The specific references that can be linked without question to Dr Smith’s “Aberffrwd” are limited but include the “brimstone” story referred to above. That story appears in the Aberdare Leader of 22 August 1908 under Mountain Ash Jottings. http://welshnewspapers.llgc.org.uk/en/page/view/3577918/ART109

The “doctors’ halfpenny strike”, which Dr Smith describes as local to “Aberffrwd”, is mentioned many times in the Aberdare Leader with reference to Mountain Ash. A letter from Dr Arthur Jones to the paper published on 5 April 1913 refers to Dr Evans’ surgery in connection with an allegation of failure to treat an injured man due to the strike. http://welshnewspapers.llgc.org.uk/en/page/view/3578665/ART120

The death of a local practice owner, Dr Edward Pritchard Evans, is recorded in the papers in 1913, http://welshnewspapers.llgc.org.uk/en/page/view/3578742/ART43 and http://welshnewspapers.llgc.org.uk/en/page/view/3578751/ART28, the former mentioning that he was attended by his partner, Dr Arthur T Jones.

Taking all the information together, I think it can safely be said, in considering  “the Surgery at Aberffrwd” with a hundred years’ distance, that “Aberffrwd” is Mountain Ash, that the surgery was located at 5 Pryce Street (“Merthyr Street”), that the practice owner was Dr E. P. Evans (“Williams”), with assistants Dr Arthur Jones (“Rees”) and Dr Fitzgerald (“Fitzherbert”). “Gwynfa Terrace” is “Strand Street, Newtown, Mountain Ash”.

In his valuable book Mountain Ash & Penrhiwceiber Remembered in Pictures, Bernard Baldwin includes photographs of a Dr A T Jones, photo 124, and a Dr E P Evans, photo 151: it seems very likely that these are the doctors referred to above.

The Surgery at Aberffrwd is not just an entertaining book of reminiscences by a humane and capable doctor, though it is surely that, but it is also an important document in the local history of the town of Mountain Ash, and more generally of the medical profession at that time. One man’s view, to be sure, and an outsider at that, but valuable and worthy of consideration in accounts of the history of the town.

The Surgery at Aberffrwd by Dr Francis Maylett Smith, edited by his nephew Denis Hayes Crofton and published in 1981 by Volturna Press, ISBN 0 85606 151 4. Availability is via second-hand resellers such as abebooks.co.uk.

SurgeryAberffrwdcover

 

Postscript

The death of Dr Smith is mentioned in The Times (London, England), Tuesday, Jan 30, 1945; pg. 1; Issue 50054

“SMITH – On Jan 27, 1945, suddenly, at Dawley, Dr Francis Maylett Smith, late of Quarry Bank, Church Stretton, and Battle, eldest son of the Rev. G Furness Smith.”

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