William Norman Pickles CBE (6 March 1885 – 2 March 1969) was a British physician who worked as a general practitioner and was the first president of the Royal College of General Practitioners in 1953.
He showed the opportunities available to GPs for epidemiological observation in two British Medical Journal (BMJ) articles in 1930, on 'catarrhal jaundice' and in 1933, on Bornholm disease. His observations reached a wider audience in his book, Epidemiology in Country Practice (1939). This contained pioneering work on the incubation periods of common infectious diseases of the time and earned him the reputation of one of the world's leading epidemiologists.
He was in practice in Wensleydale for more than 50 years, half of which time he spent recording his observations, thus proving that the rural general practitioner had great opportunities to make observations on disease.
Early life
Pickles was born in Camp Road, Leeds, on 6 March 1885 to the general practitioner, John Jagger Pickles and his Quaker wife Lucy Pickles. His grandfather was a local pharmacist. He was one of six sons, all of whom went into medicine and four of whom also became GPs.
He attended Leeds Grammar School and then Leeds Medical School (Yorkshire College) in 1902. In his third year, he proceeded with his clinical studies at the Leeds General Infirmary, qualifying as a licentiate of the Society of Apothecaries (LSA) in 1909. He served as the resident obstetric officer at the Infirmary, after which he held a series of temporary jobs and locum positions. He graduated MB BS from the University of London in 1910 and MD in 1918.
In 1917, he married Gertrude Adelaide Tunstill, daughter of Harry Tunstill, a wealthy mill owner from Burnley, Lancashire.
Medical career
Influences
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.
Early medical career
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
Aysgarth
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. 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.
First World War
Pickles served as surgeon-lieutenant in the Royal Naval Reserve during the First World War where he observed and wrote about sailors with poor oral hygiene that predisposed them to Vincent's disease. The Royal Naval Medical Journal published his work in 1918.
Epidemiology
In an article in the British Medical Journal in 1930 "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". For Pickles, it was "great fun when we could exercise Sherlock Holmes tactics and nail the culprits".