Dr Ian Macdonald

Some of Dr. Halliday Sutherland’s best writing concerns the deaths of close relatives (such as his father) and of patients (example here and here). In A Time To Keep (1934) he wrote about the death of his cousin, Dr. Ian Macdonald, on 14 September 1932. Dr. Macdonald established the Mackay and Macdonald clinic in Huelva, Spain with his (and Halliday’s) uncle, Dr. William Alexander Mackay.

Forty-three years later Ian Macdonald, M.D. of Edinburgh and Paris, member of learned societies in Europe and America, and pioneer of abdominal surgery in Southern Spain, could have retired in comfort. He and his wife were in London at the Welbeck Palace Hotel, and there I dined with them on the eve of their return to Spain. A first-class diagnostician and a skilled operator, he always spent a week of his annual holiday in Paris, London, Leeds and Edinburgh or Glasgow—to see other surgeons at work, and so improve his own technique. He was never much of a talker, but a shrewd listener who never mistook glitter for gold. In manner he was serious, courteous, and formal, but my imitations could make him laugh until the tears came. It was a pleasant, albeit early dinner, because he and his wife were going to a theatre, and he told me of his intention to sell the practice in Spain and retire. On the doorstep of the hotel we parted, and Wellbeck Street heard out farewells.

“Hasta luego.” (Until we meet.)

“Salu y pesetas.”

Salu y pesetas! Health and money. The two things men most desire. These he wished me. The next morning he telephoned from his room in the hotel. In the theatre there had been a beastly draught which made him shiver, and now he was feeling rather queer. I found him in bed. On the floor was his luggage ready for the train, but I told him that he was unfit to travel, and was in for pneumonia. He accepted the diagnosis, but I insisted on a second opinion. The diagnosis was confirmed. He and his wife took it for granted that I was going to look after him. It is unusual and inadvisable for a doctor to attend to his relatives, and I did my best to get out of it, but nothing would please them. He promised to observe my wishes as he would those of a stranger. This was at once put to the test when he demurred over going into a nursing home. I reminded him that in pneumonia skilled nursing was more than half the battle. Nurses could be brought to the hotel? In that case I would walk straight out, and he could get someone else. That settled it. He was moved to a nursing home where I saw him three times a day.

All went well until the morning of the fifth day when the disease began to affect the sound lung, and pulse pressure ratio was no longer satisfactory. After giving a hypodermic I was looking out of the window and thinking how strange it was that he and I, who had known each other for a long time, had never once discussed out beliefs or unbeliefs in what comes after death. Yet what did it matter? He had led led one of the cleanest lives I had known. My thoughts were interrupted by his question: “You think I’m going to get better, don’t you?”

I turned to him. “Up to now you are doing all right, and we’ll soon see the results of the hypodermic. Remember every day counts.”

He nodded.

Before leaving the room I asked him a question. “About what you asked me just now, if ever you thought you weren’t going to get better would you like me to tell you?”

He paused for a moment or two. “Yes I think I would. You see, I would like to have time to consider it.”

“All right. But see that you get a nurse trained in Edinburgh, You see, we were both at Edinburgh, and so we should have an Edinburgh nurse.”

“I’ll do my very best.”

Fortunately in the home there was an Edinburgh girl. She had been on day duty, and when I explained why she was being asked to forego a night’s sleep her eyes became moist. “Poor man, it’s little I can do for him.”

“In one way you’ll be doing a great deal,” I said, and she went on duty.

From the home I went to the neighbouring hotel where my cousin’s wife was staying. As I told her I was going to sit there for an hour, and then make another visit. At ten I would let her know definitely. That at least prepared her for what I feared was coming.

At ten he was asleep, but I told the matron to telephone for his wife. For an hour she and I sat in the sitting-room listening to the ticking of the clock. Soon after eleven the nurse entered the room. My cousin’s wife rose, but the nurse shook her head and looked at me. “It’s his cousin he’s asking to see.”

He was wide awake, and breathing more easily. “You sent for me?” I said.

He nodded. “Put the nurse outside.”

As soon as the door closed he opened the conversation. “There are just one or two thing I wanted to say. First of all I agree with the treatment: It’s all right. But there is one thing I want. We’ve know each other for a long time, and I just want that you and I should discuss the case right up to—the finish.”

These last two words were spoen in a voice that was firm: yes, even defiant. Here was the clinical instinct, strong even in death. So strong that it sustained us both, and I found myself speaking as though he and I were discussing, as we often had before, some problem in relation medicine extraneous to ourselves.

“Of course I will.”

“Very well. Now this heart failure to-day Man, it’s come on very suddenly, and none of the drugs is acting. What do you make of it?”

“Well, you remember that X-ray, when you saw me three months ago?”

He nodded, and I continued: “My idea is that the old adhesions have bound down the heart that there’s not room for it to adapt itself to the present strain.”

“Yes, I think that’s it. Now, there’s another thing. You remember what you said about these new anæsthetics?”

“What did I say?”

“You said that when a drug was in the blood-stream no power on God’s earth could get it out.”

We both smiled, and he continued: “I just want you to see that I get no hypodermics unless you order them.”

“Of course. Now I’ll give you one myself…. Well, I must be going. Your wife will be here to see you. She’ll be wondering why I’ve been here so long.”

“All right.”

“Good night, Ian.”

“Good night, Hallie.”

I went home, and soon after midnight the telephone rang. His breathing had become worse. The matron had held the oxygen mouthpiece to his face. He was quite conscious, and said: “I can hold that myself.” He raised his hand, and fell back dead.

The next day I saw him for the last time. It is difficult to read the faces of the dead, but I thought there was a faint smile, the slightly sardonic smile of achievement. They took him north to the graveyard at Kildary, where four of those who once made holiday at Salen now rest.

From A Time to Keep (1934) by Dr. Halliday Sutherland.

Dr. Macdonald’s papers are stored in the Edinburgh University Library Special Collection. The Archives Hub website includes this brief biography:

Ian MacDonald was born in 1873. He was educated at the Royal High School, Edinburgh, and he studied at Edinburgh University where he was awarded the degrees of M.B., C.M. in 1894, and M.D. in 1898. After graduation he spent his early professional years in Edinburgh and in London (West Ham) before going to the British Hertford Hospital in Paris and working in Laveran’s Laboratory where he contributed to Ronald Ross’s Prevention of malaria. He then proceeded to Spain as surgeon to the Rio Tinto Mines Company where he investigated the spread of malaria spread by the mosquito. In 1901 he obtained the degree of M.D. from the University of Paris on the presentation of a thesis on the subject of malaria. In 1903 he joined Dr. W. A. MacKay – an Edinburgh graduate, and his uncle – in Huelva, Spain, where he built up a surgical practice. In 1923 he was made a freeman of Huelva, and he was elected as a Corresponding member of the Society of Surgeons of Paris. Dr. Ian MacDonald died in London on 14 September 1932.

There are some photographs of the house that used to be occupied by Dr. Macdonald in Huelva here.