Oxford Medicine December 2005

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THE NEWSLETTER OF THE OXFORD MEDICAL ALUMNI OXFORD MEDICINE

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NOVEMBER 2005

Letter from the President Just after the last issue of Oxford Medicine was posted to you, we learned of the death of Richard Doll and thereby the loss of one of OMA’s staunchest, loyal and enthusiastic supporters. Indeed, I do not recall a single event, since John Ledingham arranged the emergence of OMA from the embers of the Oxford Medical Graduates Club some five years ago, that he did not attend and support. As Ken Fleming, the Dean, remarked during his report on the state of the medical school at the last annual meeting of OMA in September, the rightly extensive obituaries that appeared in the broadsheets said little of Richard Doll’s massive and sustained influence and contribution to the success of Oxford medicine during his time as Regius Professor, and then as the founding Warden and indeed creator of Green College. These years were not free from controversy, and he did not always get his way, as some of you will recall, but his studious care in securing outstanding appointments to the Nuffield chairs of medicine and surgery and his nurturing of Richard Peto and others stand testimony of his ability to recognise potential and to pick people of the highest order. On the NHS side his friendship and respect for Rosemary Rue, Regional Medical Officer during the early seventies, and another strong supporter of OMA, sadly also missing from this year’s events led to enormous dividends.

The September meeting to mark 100 years since William Osler came to Oxford from Johns Hopkins,

superbly organised by Jayne Todd, the Alumnus Officer, went off splendidly. Terence Ryan’s seminar at 13 Norham Gardens arranged for Osler enthusiasts started the weekend, and was followed by a reception (with food this time!) in the Museum of the History of Science, a last minute move to accommodate the large numbers. The highlight of the Saturday meeting was the Oxford Medical Society lecture given by Michael Bliss, author of the highly acclaimed Osler biography, on Osler’s contributions to Oxford. This preceded an excellent series of short papers by past and present members of the Oxford medical school on Osler’s diseases then and now delivered to entertain as well as educate, which straddled a leisurely luncheon deemed by Richard Turner-Warwick as the best hospital lunch ever…. Finally, Christ Church, Osler’s old college and the college of Regius Professors provided a very good dinner indeed to a full hall with heavy representation from the 1980 and 1995 qualifiers and entertainment provided by David Weatherall, who proposed the toast to the medical school and Basil Shepstone who replied.

Do note in your diary the date of the Oxford Osler lecture on 26 April when Professor Christine Lee will be looking at Haematology and also the 2006 meeting on 16 September when we will be paying particular attention to Oxford's contribution to neuroscience.

J M Holt

Head of Division newsletter Michaelmas Term In my last newsletter, I briefly discussed the two Green Papers (on Academic Strategy and on Governance) which had been released for consultation within the collegiate university and which are of vital importance to our future. These certainly stimulated great debate and controversy. Indeed, there has been a debate in Congregation, which resulted in a clear rejection of the

proposals in the draft Academic Strategy for regular mandatory review of an individual’s contribution to the collegiate university, which could be linked to terms and conditions of employment. A significant factor in the rejection was some of the actions taken by this Division and the Life and Environmental Division as part of preparation for the 2007 RAE. However, as it is

Contents

Letter from the President . . . . . . . . . . . . . . . . .1 Division news from Dr Kenneth Fleming . . . . .1 Obituary Professor Richard Doll . .3 Worldwide Alumni Groups . . . . . . . . . . . . . . . . . . .3 The Oxford Medical Society . . . . . . . . . . . . . . . . . . . .3 Professor Alastair Buchan

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Sir William Osler

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Oxford Osler Centenary 2005 . . . . . . . . . . . . . . . . . . . . . .8 OMA Events Diary 2005–2007 . . . . . . . . . . . . . .9 Obituaries

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vitally important to optimise our research strength ahead of the RAE, we shall need to consider carefully how best to proceed.

…the broad thrust of both these Green Papers is vital for the long term health of the Division…

Aside from this issue, many of the Academic Strategy proposals were generally welcomed and Council will be deciding how best to take these forward over the coming months. In addition, Council has recognised the considerable concerns expressed about the governance proposals and has just brought forward further options, for wide consultation, which incorporate the range of views it received. The intention is to have a debate in Congregation on these matters towards the end of 2005. In my view, while it is crucial to get the details right and take the time appropriate for general agreement, much of the broad thrust of both these Green Papers is vital for the long-term health of the Division and collegiate university.

In the education arena, a strategy group, under Richard Boyd’s leadership, produced a report for consideration by the Board for subsequent wide consultation. The Report addresses issues such as student numbers and provision of training and supervision of graduate students. It also highlights the opportunities for clinical academic recruitment and training presented by the changes in post-graduate medical education (PGME) arising out of the Modernising Medical Careers proposals of the NHS. These latter are amongst the most radical changes to PGME for many years, with a two year Foundation programme, incorporating the old Pre-Registration House Officer (PRHO) and first Senior House Officer (SHO) year, and a 5-year programme of specialty training.

The opportunity to use these changes to reverse the calamitous decline in numbers of clinical academics (around 13% decline since 2000), comes from the recent Walport Report, which proposes creating a more structured career pathway for trainee clinical academics. The Walport Group’s recommendations have largely been accepted. There is to be a national competition for these academic programmes and we are actively preparing for this.

Most recently, the review of much of our educational activities (excluding Experimental Psychology) was carried out by the University’s Education and Policy and Strategy Committee, with predominantly external reviewers. The written report is not yet ready, but the immediate views were very positive, indicating that our educational activities bear very strong comparison with the rest of the UK (and the USA). This result is a great tribute to the enormous amount of work, talent and dedication of our staff and, of course, of our students. It is also timely in view of the upcoming RAE, since it will be vital to ensure that this great strength in Education is not compromised by preparations for the RAE.

On the research front, the next month or so will provide major opportunities in clinical research. First, the Medical Research Council has announced that it has assigned £15m per year for competitive proposals for experimental (translational) medicine, while (second) the Wellcome Trust, the Wolfson Foundation and the Department of Health have asked for bids for Clinical Research Facilities (£80m). Given our intention to build on our pre-existing strengths in clinical research (especially in experimental (translational) medicine); it is vital that we are appropriately successful in these various competitions.

We have submitted an outline bid for a Vascular Research Facility which will be dedicated to acute stroke and which will be led by Alastair Buchan, our recently recruited Professor of Geratology. This unit will link strongly to our cardiovascular clinical research facility which is finally going ahead and which is led

by Hugh Watkins, Field Marshal Alexander Professor of Cardiovascular Medicine. A vital component of these units is the close and full involvement of the NHS. As we have several other geographically dispersed clinical research facilities (vaccine development, cancer, diabetes), we are also planning how best to integrate all these activities, to optimise our resources and expertise. In particular, given the increasing complexity and demands of the regulatory environment, we need to ensure a co-ordinated, efficient and effective approach to clinical and research governance. We also need to optimise training opportunities for staff and students and ideally to provide a single expert point of contact for both insiders and outsiders, especially commercial.

Generally, our research continues to be very successful across the broad range of our activities, with over £100m of external peer-reviewed funding awarded in 2004 – 05, (an increase of 15% on 2003-04) and an average success rate of applications of around 55%.

In addition, there are a few specific achievements.

First, Wellcome Trust Principal Research Fellowships (their highest awards) were re-awarded for Professors Hill and Monaco and a new Fellowship was awarded to Professor King in Cardiovascular Physiology. These three awards were 30% of the total awarded nationally.

Second, Professors Hill and Kwiatkowski received a Gates Millennium Award each. Professor Dominic Kwiatkowski, was selected for a grant of £16.4m from the NIH to support his work on MalariaGEN. Professor Hill was selected for a grant of £10m from the NIH to support his work on improving technologies for potential vaccines for HIV, tuberculosis and malaria.

Finally, Professor McMichael is a partner in the consortium of four universities which was awarded the NIH AIDS vaccine programme ($300m over 7 years), after an international competition. Well done!

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Trinity Term saw the second of the Oxford Medical Seminars, hosted by Green College and the Medical Sciences Division, and supported by GE Healthcare.

There was a lively discussion on “Personalised Medicine: what is its true role?” and we enjoyed excellent speakers in Professor John Bell, Professor Sir Michael Marmot and Dr. Russell Hamilton, all carefully chaired by Dr. Geoff Watts. Of course, a lively audience contributed to a very successful event.

Our congratulations and thanks to Dr. Paul Dennis on his re-appointment as Director of the Post-graduate Entry Course (Medicine) and to Dr. Richard Harrington, who will take up the post as his deputy in November 2005.

Thanks also go to Professor David Smith and Professor Richard Mayou for their invaluable help on the divisional board since its inception in 2000. David chaired the MSD Appointments Committee and was deputy Head of Division and Richard chaired the division’s Library/IT Committee. He also fought the hard battles in the University’s Library and Buildings Committees, as well as being very supportive in many other areas of the division. We wish Richard a very enjoyable retirement and every success to David as he continues with his research in the Department of Physiology.

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OBITUARY Professor Sir Richard Doll 25th July 2005 (1912 – 2005) How can one write in a few words what Richard has brought to our lives, not just here at the University, but also, through the benefits of his remarkable research over so many years, with benefits to whole nations?

Not only was he very instrumental in promoting Medicine in Oxford to the world during his incumbency as Regius, but on his “retirement” he then went on to become the first Warden of Green College. He has been an inspiration to many people. We shall all miss him tremendously, not least because, although he was a very busy person, he still found time to talk and meet with us professionally and socially on diverse subjects.

Our thoughts are with his family.

Kenneth Fleming Head, Medical Sciences Division Michaelmas Term 2005

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The Oxford Medical Society Earlier in the year, the officers of the Oxford Medical Society, founded in 1895 and strongly supported by William Osler in it’s early days, came to us to explain that changing practice and fashion had taken their toll, attendance at meetings had fallen to embarrassingly low levels, with a request to amalgamate with OMA. This has now happened and as a consequence we have named the lecture to be given at the annual

www medsci ox ac uk/contact

September meeting the Oxford Medical Society Lecture. It is intended that the lecturer will wear the very fine seal presented to the President of the OMS at it’s inception by the founding members, and the residual funds are such that a small honorarium can be paid to the lecturer.

J.M.Holt

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Professor Alastair Buchan Professor of Clinical Geratology and Honorary Consultant Neurologist Nuffield Department of Clinical Medicine John Radcliffe Hospital Oxford Alastair Buchan is the newly appointed Professor of Clinical Geratology following the retirement of Professor Sir John Grimley Evans. He is a Neurologist at the John Radcliffe Hospital and heads up the Acute Stroke Programme for the Nuffield Department of Medicine.

Brain imaging has transformed Neurology from being a primarily diagnostic specialty to one which offers a huge array of treatments

His training in research began at Cambridge. While at Oxford, he was the President of the Osler House Club at the time of the move to the John Radcliffe Hospital.

Following house jobs in Oxford and SHO jobs in Oxford and London, he emigrated to London, Ontario where he was a Neurology Resident for Henry Barnett at the University of Western Ontario. There was a period of research training at Harvard in the Neurology Department and, subsequently, he spent two years as an MRC Centennial Fellow in the laboratory of cerebral ischaemia at Cornell University in New York. He was also a Neurology Fellow at the New York Hospital. In 1995, he became a Professor of Stroke Neurology in Calgary and led the Calgary Stroke Programme. In Calgary, he was the first to use thrombolysis for acute stroke in Canada and, following the publication of the pivotal trials, established a comprehensive stroke programme for Calgary where over 500 patients have now been treated with thrombolysis. He continues to have a laboratory which has been involved in cell death and apoptosis and an understanding of preconditioning in the hope that neurprotectants can be devised to add to thrombolysis.

Wh y d i d y o u b e c o m e a N e u ro l o g i s t ?

Brain imaging has transformed Neurology from being a primarily diagnostic specialty to one which offers a huge array of treatments. Much of what we do is best done early and imaging gives us the confidence to make diagnoses quickly and the freedom to deliver treatment in a rapid emergency room style. While at Oxford and later at the Hammersmith and at Harvard, I was much taken with what was happening with Cardiology and the advent or coronary care units, thrombolysis, and angioplasty. The same things are now possible in stroke as a result of the imaging revolution.

Wh o h a s i n s p i re d y o u ?

I have always been interested in transferring knowledge from basic science into clinical therapy. Understanding the biology of disease and taking those observations into a clinical setting is the challenge of experimental medicine. When I was a medical student, David

Weatherall and Peter Morris were stellar examples of caring physicians and surgeons who brought a depth of knowledge to the bedside because of their strong research activity. In Canada, I was inspired by Henry Barnett who brought the clinical trial science, much of it derived from the Doll/Peto school, into the clinical arena to answer questions about interventions in Neurology and Neurosurgery.

Wh a t l e d t o y o u g o i n g t o C a n a d a ?

There were a number of reasons but I remember vividly standing outside the Hammersmith after an MRCP exam and John Bell asking me where I was going to study Neurology. He told me that I should get interested in stroke and the best place to go was to join Henry Barnett in London, Ontario. It would have been easier if Henry Barnett had accepted the Neurology Consultancy he was offered at the Radcliffe Infirmary in the 1960s!

Residency training was particularly helpful. You could be in once place for five years and get not only basic specialty training, but also research experience in a plan that led to speciality certification. At the end of residency, it was possible to get away on a research fellowship and have an opportunity to experience basic science research without this interfering with progression to a consultant appointment.

N e u ro l o g y R e s e a rc h

Imaging patients with CT and now MR has become very accessible in an Emergency Department setting. The clarity is improving all the time but the real opportunity is to link the basic science to the clinic. Observations at the molecular and cellular level can now be imaged using clever probes such as paramagnetic labels linked to ligands that recognize selectins, cell death pathways, or even stem cells. We can now image pathology as it happens in experimental models and the hope is that we will be able to to it in an analogous way in patients. For instance, we might be able to actually visualize where a TIA (transient ischaemic attack) struck. This will help take the mystery out of neurology. The gift of imaging is the de-mythologizing of neurology, turning it into a therapeutic specialty.

Wh a t i s t h e b i g g e s t c h a l l e n g e ?

Keeping going at an experimental level, working in the laboratory at the same time as trying to be a good clinician.

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Wh a t a re y o u r o b s e r v a t i o n s o n c o m i n g b a c k t o O x f o r d a f t e r 2 0 y e a r s?

As a student at the Radcliffe Infirmary, there were only 50 to 60 of us in a year. Jim Holt had handed over to John Ledingham as Director of Clinical Studies and we enjoyed a rather gentile life at Osler House, venturing out as we needed to to the wilds of the Radcliffe Infirmary. Osler House provided a very secure compartment and we all knew each other incredibly well. It was possible to do locum house officer jobs as a student and when we did we got enormous support from not only the Junior Doctors but the Consultants and the Professors. The move to the John Radcliffe changed all that. One of the worst things that happened was that while Acute Medicine and Surgery moved to the John Radcliffe, much of the Neurosciences remained at the RI. It was as if the head and neck had become disconnected from the body.

Twenty years on, as they complete the build of the new west wing, there is the opportunity to reintegrate neurosciences and bring the care of the elderly into a very close integration with the John Radcliffe.

W h a t d o e s t h e f u t u re h a v e i n s t o re?

With Richard Doll and George Pickering and, more recently, Richard Peto, our understanding about high blood pressure, smoking, and hyperlipidemia has given

us a measure of understanding of the risk factors in vascular disease. But despite their work, we still do not have any real clue as to what actually causes vascular disease and triggers events. We need to use imaging and focus on these acute events in the John Radcliffe.

Many of the strong research groups have now moved out into purpose-built institutes such as the Weatherall and the Wellcome and there is the opportunity of redeveloping some of the ‘inner-city’ research space in the JR2. My hope is that by getting acute stroke up and running, developing the clinical and research imaging, and hopefully bringing some research-based molecular imaging into the Emergency Department of the Hospital, it will allow new developments for experimental medicine that will help us with our patients, with our research, and critically, improve the training environment of academic training. Closing the Radcliffe Infirmary opportunity is not just an opportunity to reconnect the head and neck to the body, but to bring clinical research into the centre of the Hospital. It was the research environment that made the old Radcliffe exciting 25 years ago and it is what I hope will happen to the John Radcliffe Hospital when it restructures to cope with the closure of the Radcliffe Infirmary over the next 25 years.

I very much look forward to the next 25 years!

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NOVEMBER 2005 / 5

…there is the opportunity to reintegrate neurosciences and

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bring the care of the elderly into a very close integration with the John Radcliffe

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ore than 600 doctors and medical researchers gathered in Oxford over the weekend to carry out “a rigorous analysis” of research. Many were from leading hospitals and laboratories in North America, Australia and Africa but, in a way, they were all united by a historic debt.

Most were alumni of Oxford University’s School of Medicine, the great centre of teaching that has had an impact on world health over decades, while benefiting millions of people for generations to come.

But it was an altogether less obvious bond that brought them all back to Oxford, for a late September weekend – shared gratitude to a heavily moustachioed medic, who none could possibly have known.

For the weekend of lectures, scientific meetings and a grand reunion dinner at Christ Church was all organised to celebrate the life and work of Sir William Osler, one of the most influential physicians in history, who died in 1919.

The event was not to recognise the anniversary of Osler’s birth, death or even any notable scientific discovery or publication. It was to mark Osler’s arrival in Oxford from his native Canada 100 years ago to become Regius Professor of Medicine. It was an appointment that was to change not only Oxford’s approach to treating sick people, but the world’s.

The man who had the prescription for doctors ■ Gathering...the former Regius Professor, Sir David Weatherall, left, with Dr Jim Holt, president of Oxford Medical Alumni

■ Pioneer…Sir William Osler, Oxford’s Regius Professor of Medicine, who was to become one of the most influential physicians in history

Physicians from around the world gathered in Oxford to celebrate the life of the medical pioneer William Osler ■ Heart of the problem…Osler at a mortuary in 1886

A glance down the list of lectures by Oxford professors over the weekend certainly points to the scale of his achievements: Hugh Watkins spoke on “Osler and heart disease”, George Ebers on “Osler, the true father of neurosurgery”, John Wass on “Osler the pioneer in thyroid replacement”, while Nick White tackled “Osler’s favourite fevers: malaria and typhoid”.

■ Research…Osler’s study in Norham Gardens as it still looks today

He also revolutionised the treatment of tuberculosis, establishing a control clinic in Oxford, and effectively laid the foundations of the Oxford Medical School that was to be formally established at the outbreak of the Second World War by Farquhar Buzzard and one of Osler’s pupils, Alec Cooke.

Yet he was to say: “I desire no other epitaph than that I taught medical students in the wards.”

In many respects, the ward round witnessed daily in hospitals around the world, can be put down to Osler, whose approach to patients was quite revolutionary at a time when physicians tended to conduct their teaching rounds in frock coats, pinstripe trousers and wearing top hats, and attached little importance to communicating with those whom they were treating.

The Oslerian method of teaching, depending on careful bedside observation and clinical knowledge, was best summed up as: “Begin with the patient, continue with the patient and end with the patient.”

As one of his students remembered: “He taught us that the treatment of the patient was the most important element in the treatment of disease and that the patient not the disease, was the entity.”

The present Regius Professor of Medicine, John Bell, who, like Osler, is Canadian-born, said: “Osler produced the last great revolution in diagnosis, based on a combination of bedside skills, using your senses, sight and touch and smell and tastes.”

He, like other Oxford Regius Professors of Medicine over many years continues to wear Osler’s old red Doctor of Medicine robe at formal occasions, a robe which features in a story about Osler, which offers insight into his famed bedside manner.

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nce, on his way to a lecture, he was called to the bedside of a child sick with whooping cough. He treated the youngster in his red gown and, despite initial fears, the child was to make a good recovery. Osler, thereafter, was to make a point of wearing his red gown to the bedside on each visit during the child’s long convalescence.

On another-occasion as he was leaving a family home after attending a child who was dying, he was asked why he was whistling. He replied: “If I did not whistle, I should be in tears.”

He would frequently refer to his North Oxford house as “the hotel”. To thousands of the guests from all over the world who visited the house, including Rudyard Kipling and Mark Twain, it was known as the ‘Open Arms’.

At the weekend, once more internationally renowned medics were beating a path to the large house at 13, Norham Gardens.

The house had been originally built for the Public Orator as University teachers first began to live with their families outside colleges. When the Oslers bought it, the house had only one bathroom but Lady Osler (Grace), who continued to live at the house for ten years after her husband’s death, insisted on an extension and extra bedrooms.

In 1956, Sir George Pickering became the first Regius professor to occupy the house after Osler, when its ownership was transferred to the university from Christ Church.

Later it was to be come home to Sir Richard Doll, the celebrated professor who died earlier this year, and the property is now owned by Green College.

But the house is something of a place of pilgrimage, remaining much as it was during Osler’s lifetime, with even the fireplace as he designed it. In the professor’s old study, documents and artefacts relating to his work are on display, while the house contains many of the hundreds of books he collected.

A great bibliophile, who once risked his wife’s wrath by putting up yards of extra book shelves when she was safely away, he was instrumental in

obtaining funding for the underground storage of the the Bodleian Library. (They have lasted the best part of a century, with the university only now having to examine improving its entire library service, at a cost of £100m).

Osler was born in 1849 in Bond Head, Ontario, one of an Anglican clergyman’s eight children, He studied at the University of Toronto and Montreal’s McGill University, becoming a full professor at the age of 25, teaching physiology and microscopic anatomy.

In Canada, he was the first to study blood platelets and the malaria parasite in the swamps of the Great Lakes.

His great work, The Systems of Medicine, comprised seven volumes and became a standard textbook in its field for 30 years, introducing a novel method to medical education.

Yet his appointment to Oxford only came about because of a lack of worthy British candidates, or at least any willing to undertake what was a comparatively poorly paid position.

His experiences in North America meant he well understood the threat of tuberculosis in cities and, after coming to Oxford, he was approached by Miss Mabel Price, of Headington, who had organised a society to help the poor and needy.

The meeting was to result in the creation of the Oxfordshire branch of the National Association of the Prevention of Tuberculosis, with clinics created at the Radcliffe and in the villages.

His determination to create a hospital for TB patients was to be instrumental in the eventual construction of the John Radcliffe Hospital.

For, early in 1919, when the Headington Manor Estate came on the market, he encouraged the Rev G. B. Cronshaw, the treasurer of the infirmary, to buy the site as it would not only provide grounds for a sanatorium but also give the infirmary much needed room for expansion.

A public appeal was launched and much of the purchase price came from the British Red Cross as part of the winding-up of monies raised during the First World War.

‘With the advances of modern science, it is possible for science to appear divorced from the bedside. The example that Osler set was to bring the science and the clinical practices together.

Osler’s abiding legacy is the importance of taking science to the bedside and putting the patient first.’

■ Place of pilgrimage …the Osler’s house in Norham Gardens This article by Reg Little originally appeared in The Oxford Times, Friday, September 30, 2005. p14.

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Osler did not live to see his dream of a hospital for TB cases realised. He died of pneumonia in 1919 – one of the lectures examined whether he was a victim of the post-war influenza epidemic, which claimed more lives than the conflict – with the last months of his life clouded by the loss of his only son, Revere, who died on the Western Front in 1917.

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ady Osler was to lay the foundation stone of the Osler Pavilion in 1925 and the hospital in Headington opened 18 months later. The pavilion was demolished in 1969 when the site was cleared for the building of the John Radcliffe Hospital. But the great man’s name survives in nearby Osler Road, in William Osler House (a social club for medical staff) in the Osler Chest Unit at the Churchill Hospital and in the Osler Ward at the Radcliffe Infirmary.

But the real legacy is not in the bricks and buildings but in the Oxford Medical School itself, which today welcomes more than 150 students each year, with an annual budget for teaching and research in excess of £140m, accounting for over a quarter of the university’s total bill.

Osler’s ‘favourite’ diseases, such as malaria and TB, remain the focus, for the research stretches far beyond the confines of Oxford. The school has permanently staffed units in Thailand, Kenya, Vietnam and Laos.

The present Director of Clinical Studies, Dr Tim Lancaster, said the Osler approach has survived all the rapid advancements in medicine.

“What Osler very firmly did was to establish the importance of doctors learning from patients. That is something that has continued to be central to the mission of the Oxford Medical School ever since. With the advances of modern science, it is possible for science to appear divorced from the bedside. The example that Osler set was to bring the science and the clinical practices together.”

“His abiding legacy is the importance of taking science to the bedside and putting the patient first.”

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Oxford Osler Centenary The Osler Centenary Celebrations marked the end of the Oxford Osler Centenary year. The celebrations lasted for two days and took place at five venues throughout Oxford attracting graduates from 1938 to 2004, Regius Professors of Medicine from Oxford and Cambridge, alumni from throughout the world and representatives of many Oxford institutions.

Proceedings started with a seminar at 13 Norham Gardens, examining aspects of Sir William and Lady Osler’s life in Oxford. A Grand Reception held at the Museum for the History of Science followed where even more alumni gathered to set the scene for the rest of the weekend. Reunions between alumni who had not met since graduation were commonplace and there was much exchange of contact details: on paper for the older generations and of mobile numbers for the more recent graduates.

To book places at any part(s) of OMA events please contact Jayne Todd at Oxford Medical Alumni

The next day Professor Michael Bliss gave the Centenary Lecture which was received with great acclaim. This Lecture will be published in due course.

The Osler Symposium followed. Convened by Professor David Warrell and Dr JM Holt, Oxford alumni spoke on themes associated with Osler and his favourite diseases.

Comparison was drawn between the great man’s ideas then and current practice today showing how his influence extends into medical life even one hundred years later with innovative thinking, excellent practice and on going research.

The Centenary Banquet closed the celebrations in grand style. The historic Great Hall at Christ Church, traditionally the home of the Regius Professors of Medicine at Oxford, provided a marvelous backdrop for three hundred alumni and friends. An excellent dinner and sparkling, witty speeches from two of Oxford’s most eminent medical teachers demonstrated the continuing warmth of feeling clearly felt by all those who have studied medicine at Oxford.

It was a memorable occasion for Oxford medical alumni.

Museum for the History of Science

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Oxford Medical Alumni Events Diary

3 1 s t M a rc h & 1 s t A p r i l 2 0 0 6 North American Reunion 2006 Waldorf Astoria, New York.

Oxford Medicine holds a special reception for their North American based Old Members every other year.

This event is part of the North American Reunion, run biennially by the University of Oxford in New York.

The next Reunion will be attended by many Oxford academics and clinicians. More information on the Reunion will be available soon.

2nd A p r i l , 2006 O x f o rd v C a m b r i d g e B o a t R a c e Join the Oxford University Society to watch the 2006 Boat Race the Fulham Football Club at Craven Cottage. Fulham's splendid new conference facilities offer plasma screen televisions for when the boats are out of sight, and outdoor space on the river for when they are in view. If you require further information, please contact Cathy Tennent at the Oxford University Society telephone 01865 288087 or e m a i l : c a t h y.tennent@ousoc.ox.ac.uk

22 September 2006 G ra n d R e c e p t i o n Radcliffe Infirmary Boardroom 23 September 2006 6th A n n u a l O x f o rd M e e t i n g Medical Sciences Teaching Centre, Oxford Neurosciences O M S s p e a ke r P ro f e s s o r C o l i n B l a ke m o re 23 September 2006 6 t h O M A G ra n d R e u n i o n D i n n e r at Pembroke College, Oxford Reunion for ALL our alumni and their guests, but especially those who graduated in 1981 and 1986.

27 A p r i l 2 0 0 7 O x f o rd O s l e r L e c t u re to be given by P ro f e s s o r Pe t e r R a t c l i f f e Nuffield Professor of Clinical Medicine 27 A p r i l 2 0 0 7 A n n u a l O x f o rd O s l e r D i n n e r 7.30pm, Rhodes House, Oxford 28 September 2007 7 t h G ra n d R e c e p t i o n

26 A p r i l 2 0 0 6 O x f o rd O s l e r L e c t u re to be given by P ro f e s s o r C h r i s t i n e L e e Professor of Haemophilia, Director & Consultant Haematologist Royal Free Hospital, London

29 September 2007 7th A n n u a l O x f o rd M e e t i n g Medical Sciences Teaching Centre, Oxford Cancer This meeting is being convened by P ro f e s s o r A d r i a n H i l l O M S s p e a ke r S i r Paul Nurs e

26 A p r i l 2 0 0 6 A n n u a l O x f o rd O s l e r D i n n e r 7.30pm, Rhodes House, Oxford Reunion for graduates of 1964 to 1968

29 September 2007 7 t h O M A G ra n d R e u n i o n D i n n e r Reunion for ALL our alumni and their guests, but especially those who graduated in 1982 and 1987.

Contacting OMA A d d re s s : Oxford Medical Alumni Medical Sciences Office John Radcliffe Hospital Oxford OX3 9DU Email: jayne.todd@medsci.ox.ac.uk We b s i t e : www.medsci.ox.ac.uk/oma Enquiries: 01865 221690 Fax: 01865 750750

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Obituaries Dr Philippe Shubik

Charles Kent Unexpected Oxford Medicine Newsletter Today with Sudden sadness rucked up from the past Big man died Strong heart Medical love Always stopped For two words He cared Strong legs Crashing strength On the ruby field Even with the very Amateur amateurs Right there in our team Losing drinking We enjoying his Spotlight of fame on the International Field Scored against my Scottish Team Still stopped to talk For two words Doctor in learning Husband father Gentleman Gentle man Galloping headlong in Unrestrained control Crashing to your Untimely death No three quarters respect From all who were Fortunate to Have been met By you You are Remembered in Completeness (The author of this poem wishes to remain anonymous)

A connection with Green College brought Phillipe Shubik back to Oxford after a career spent in cancer research in North America.

Philippe, born in London on 28 April 1921, was educated at University College, Oxford and University College Hospital, London.

His college year included Bryan Matthews, subsequently our Professor of Neurology.

Phillipe obtained his Oxford BM in 1943 and served in the RAMC in Scotland and India.

The war over, Phillipe entered the Dunn School of Pathology in Oxford directed by Sir Howard (later Lord) Florey. He worked on experimental cancer with Isaac Berenblum, his supervisor to a DPhil and their important papers on the experimental production of cancer determined Philippe's career.

His move to North America arose from the tragic death of his first wife, Nancy. He was briefly in New York, but rose to eminence in cancer research in Chicago. His wife and three of his four children died in a house fire, from which he and his daughter Anna escaped. He married Valerie in 1963 and in 1968, they moved to Omaha, Nebraska. There under Philippe's direction, the Eppley Institute for Cancer Research became a leading centre for cancer research in North America.

In 1981 Phillipe returned to Oxford to a fellowship at Green College and, for some years, an appointment with the UK Health and Safety Executive. In cancer research, Philippe was the author or co-author of hundreds of papers, served on many committees and editorial boards and was the editor of two journals. In 1976, he had founded the Toxicology Forum, which brought together the food and drugs industries, academics, and government bodies, at annual meetings in Washington DC, the second home of Philippe and Valerie, and in Aspen, Colorado. His many Oxford medical acquaintances were always pressed to participate in these meetings and in others in Europe and to assist with the editorial work of his cancer journals.

Philippe and Valerie when in Oxford, were gracious hosts in their several homes to a wide circle, who miss Philippe and extend their sympathy to a brother and sister, to Valerie and her children and to Anna.

Dr J.T. Hughes (Retired Oxford Consultant Neuropathologist)

Dennis Gath

When the BMJ arranged an exhibition of photographs of leading British doctors, they had good reasons to choose Dennis Gath to represent psychiatry. They photographed him on the bridge outside Wolfson, no doubt to reflect his achievements in linking psychiatry with the rest of the Oxford Medical School and Medicine with the other faculties of the university.

and was president of its debating society.

Gradually his interests turned to medicine and, after graduating, spent a year as a teacher Switzerland earning money to help pay for the Oxford pre-clinical course during which he acquired two skills that were to be useful throughout his life: he became fluent in French and he learnt how to teach.

Born in 1930 Dennis excelled at school in classics, played first team cricket, and was a versatile actor. He read classics at Cambridge but after National Service, transferred to philosophy and psychology. He won good reports from his tutors, rowed and played cricket for the college,

Dennis completed his preclinical studies at St Catz and his clinical training at the Radcliffe Infirmary. Like many others who trained in Oxford, he was much influenced by the teaching and professional example of Alec Cooke and John Badenoch. Thinking of a career in hospital

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medicine, he followed house jobs at the Radcliffe Infirmary with senior house officer and registrar posts under Professor Leslie Witts and Dr (later Professor) Ritchie Russell. This experience gave Dennis a broad knowledge of medicine and a deep and lasting understanding of the role and responsibilities of a doctor.

After he obtained the MRCP, his increasing interest in the personal side of medicine led him to psychiatry, and to the Maudsley Hospital.

At the Maudsley, Dennis Gath trained under Sir Aubrey Lewis, an eminent psychiatrist who insisted that his trainees should be as well informed about the lives and personalities of their patients, as they had to be about the scientific basis of their illnesses and their treatment.

The approach fitted Dennis’ interests and training in both the humanities and science, and underpinned all his subsequent practice and teaching. Sir Aubrey demanded great intellectual rigour from his trainees, some of whom found the approach rather daunting.

Dennis thrived on it and, when his post-graduate training was complete, Sir Aubrey enabled him to carry out an important epidemiological study of childhood delinquency for which he was awarded the DM. In 1969, Dennis Gath moved to Oxford with Ann, his first wife, and their young family, to join the newly established University Department of Psychiatry. He remained in the department until he retired in 1996 and played a key role in developing its research, teaching, and postgraduate training. One of his greatest contributions was in linking psychiatry with other departments of the medical school through his clinical practice and research.

The latter had two main themes. One concerned psychiatric disorder arising in the course of physical illness and its treatment. When he began, most studies of this problem were either inconclusive or misleading because of faulty design and method. Dennis Gath began by studying gynaecological disorders using reliable methods of case identification and measurement, and an epidemiological framework. His findings overturned many previous conclusions, for example, that hysterectomy was a cause of depression. Dennis showed that the depression occuring after the operation had usually been present before the surgery, although undetected by clinicians, and he went on to formulate simple but effective methods of pre-operative assessment. Other research topics included depression after childbirth, psychiatric consequences of termination of pregnancy, and premenstrual symptoms.

With the growth of community care, Dennis Gath developed a second line of enquiry concerned with the care of

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psychiatric disorders in primary care. Working closely with general practitioners, he and his research team showed that many patients with these disorders recovered without the medication, which, at that time was generally prescribed.

He went on to show that most of the rest could be treated with a simple form of counselling which general practitioners and practice nurses could provide effectively. Subsequent studies concerned the care of patients with severe and chronic psychiatric disorders, including the homeless mentally ill. Like the earlier ones, these studies led to recommendations to improve practice.

Dennis was universally respected by his medical colleagues for his clear and helpful clinical opinions, his wide knowledge of medicine, his skills as a psychiatrist, and his unfailing care and concern for his patients. He took a leading part in developing undergraduate and postgraduate teaching of psychiatry, and many of the Oxford students who chose a career in psychiatry, did so because of Dennis’ example.

His scholarship and the exceptional clarity of his writing were major reasons for the success of the Oxford Textbook of Psychiatry which reached its 5th edition in the year of his death.

Dennis’ reputation extended far outside the medical school. He was respected throughout the University for his scholarship and wise judgement and he served on the General Board and other important committees.

Elsewhere, his advice was sought by the MRC, the Department of Health, and the Royal College of Psychiatrist, as well as in the United States.

Dennis Gath was cultured, widely read, and sociable.

He enjoyed music, the theatre, and long walks in the countryside, especially in France. He was interested in and concerned for his many friends and colleagues. From 1973, he was a Fellow of Wolfson College where he played a full part in the intellectual and social life of the college despite his many clinical and other commitments.

When he retired from his university post in 1996, he looked forward to a greater involvement in college life and in the many cultural activities of Oxford. The onset and relentless progression of Alzheimer’s disease prevented him from enjoying these things and, towards the end, even from taking a full part in the life of the family of which he was so proud. He was cared for until the final few weeks of his life by his second wife, Eileen. He is survived by Eileen, his first wife Ann, three children from their marriage, and two step-children.

Michael Gelder

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Sir Richard Doll Regius Professor of Medicine

The death of Richard Doll on 24.7.05 ends a career in epidemiology, the exceptional merits of which have been analysed in several obituaries. His role in the founding of Green College is also described elsewhere.

Here we review his productive ten years as Regius Professor of Medicine.

Doll was at the centre of three

George Pickering, Doll's predecessor, and Paul Beeson, the Nuffield Professor of Medicine had begun the enlargement and transformation of the Oxford Medical School and the Oxford Hospitals. New chairs had been founded, new consultant posts created and, on Headington Hill, the John Radcliffe Hospital had been built and was being commissioned. The medical school curriculum was being extensively altered to reflect the expansion of the school of clinical medicine.

changes in the Medical School: the creation of the Clinical Medicine Board the offering of reciprocal honorary appointments and the granting of MA status to all senior medical staff

The Regius Professor – an ex officio member – was a central figure on the Board, which position Doll used to great effect.

The Oxford University professors, readers and lecturers had differed from the more numerous NHS Consultants in their access to the Nuffield Committee but also in that many of them enjoyed college fellowships. Now, all NHS consultants were offered clinical lectureships in medicine and senior academic staff were given honorary consultant appointments. The membership of the Clinical Medicine Board from its inception was mixed, a harmony of medical staff not seen hitherto.

When Richard Doll came to Oxford, the Medical School was in the mould created by the Nuffield chairs dating from 1937. The Nuffield Committee distributed the funds of the Nuffield endowment and, in effect, ran the medical school which, otherwise, had little contact with the University.

MA status gave powers and privileges previously accorded to those with an Oxford MA and was now conferred routinely on those senior medical staff, who had not attended an Oxbridge University, an introduction championed by Richard Doll, himself a product of a London teaching hospital. Before this innovation, which was welcomed in other faculties, an Oxford DPhil or even an Oxford DSc gave no academic rights in Oxford.

Doll was at the centre of three changes in the Medical School: the creation of the Clinical Medicine Board, the offering of reciprocal honorary appointments, and the granting of MA status to all senior medical staff.

Additionally, his role in founding Green College gave college fellowships to senior medical staff, an example followed by other colleges.

The period of 1969-1979 with Doll as Regius Professor saw great changes in Oxford medicine. We remember his skilful advocacy at the Clinical Medicine Board but also his invitations to 13 Norham Gardens – the Open Arms – where informal advice would be offered together with 'food and conversation'. His recreations listed in Who's Who.

The Clinical Medicine Board, chaired by the ViceChancellor, replaced the Nuffield Committee and rapidly assumed the administrative tasks of the medical school.

J.T. Hughes

O M A re c o rd s w i t h s a d n e s s t h e n a m e s o f o t h e r c o l l e a g u e s a n d a l u m n i w h o h a v e re c e n t l y d i e d : Mr Justin RW Blathwayt Dr John B Booth Dr Laurence J Cawley Dr S Vanessa Lloyd-Davies Dr Peter GM Gaffikin Dr William W Gooddy Dr William D Hayley

Dr Ivor S Levy Dr David C Lyon Dr Colin P McEvedy Lady Jean Medawar Dr Christopher A Pallis Dr Dennis Parker Dame Cicely Saunders

Dr ML Sutton Dr Brian DM Williams Mr Ian W Young If you would like to contribute an obituary or to write a tribute then please contact Jayne Todd

Oxford Medicine is produced by the Medical Informatics Unit, NDCLS, University of Oxford. Telephone +44 (0)1865 222746.

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