b.3 April 1912 d.25 April 1969
MRCS LRCP(1935) MB BS Lond(1936) MRCP(1942) MD(1946) FRCP(1952)
Son of the Rev. Felix Asher of Brighton, who could not resist a good book, Richard Asher had a violinist and a ’cellist as aunt and uncle. He was born at Brighton, educated at Lancing College and the London Hospital, qualified in 1935 and was then house physician to Donald Hunter. He became assistant medical officer at the West Middlesex Hospital in 1936 and physician to the Central Middlesex Hospital in 1943. In the next two decades this hospital was to gain an international reputation and Asher was one of those who brought this about.
A notable diagnostician with an exceptional memory for previous cases, his special interests were in haematology, endocrinology, and physical factors in mental disorder. He was asked to take charge of the hospital’s mental observation ward and one result of this was his paper on Myxoedematous Madness in 1949. Psychoses with myxoedema had often been reported, but his telling account of fourteen cases ensured that far more would now be recognised and treated. When, in 1951, he described as Munchausen’s syndrome the condition in which people go from hospital to hospital with spurious signs and symptoms, his colleagues thanked him for a useful addition to the medical vocabulary.
With his eye for what matters, Asher was a pathfinder. Today ‘early ambulation’ is the rule, but it was his 1947 paper on The dangers of going to bed that jolted the profession here into reconsidering its time honoured habit of prescribing rest. And it was Asher who persuaded manufacturers to make clinical thermometers which would register hypothermia.
With his scientific curiosity went a real concern for patients. The way the doctor deals with them and, especially, how he talks to them, is, he said ‘about the most important part of our trade’. Himself inconspicuous and unassertive, he wrote ‘It is a greater medical triumph to leave the patient feeling better but thinking little of the doctor than to leave him worse but deeply impressed.’ To admit therapeutic bankruptcy is, he felt, unkind and ‘a little credulity makes us better doctors, though worse research workers’. He was indignant at the incarceration of lonely old people in big institutions where they acquire the ‘institutional neurosis’. Indeed, he mistrusted institutions in general and he deplored the epidemic spread of committees.
The precision of thought that marked his clinical work was reflected in his pleas for simplicity and clarity in medical writing. Obscurity is bad, not only because it hinders understanding but because it is confused with profundity, ‘just as a shallow muddy pool may look deep’. Names, of course, are needed, ‘a rose without a name may smell as sweet but it has far less chance of being smelt’. But unsuitable medical names can do a lot of harm, ‘they perpetuate illness, syndromes and signs whose existence is doubtful, they deny recognition to others whose existence is beyond question and, moreover, they distort text book descriptions to conform to the chosen word’. He insisted that to name a thing by its supposed cause is always a mistake. For instance, subdural haematoma was formerly called pachymeningitis interna haemorrhagica and the assumption that it was inflammatory delayed the discovery that it follows head injury and is curable by operation.
In the course of time Asher had a teaching unit at the Central Middlesex, which was part of the Middlesex Hospital Medical School, and posts on it were sought after. As a lecturer he was sure to be original, clear and witty; and his three Lettsomian lectures to the Medical Society of London in 1959 were a brilliant example. With other outstanding papers they were published posthumously in 1972 as a book called Richard Asher talking sense. His fame spread to the United States were he had ‘a triumphant procession’. At home he had become President of the Clinical Section of the Royal Society of Medicine when, in 1964, authority decreed that his mental observation ward should be taken over by a psychiatrist. Deeply affronted, Asher resigned all his posts and virtually abandoned Medicine, almost overnight.
When younger he had had a gastrectomy and his last years brought much misery and further operations. But wherever possible he made a joke of illness. In medical work his imagination had been channelled by his intelligence and only strong self-discipline, with accuracy and industry, could have produced his lectures. But his way of working was an artist’s. "I work fitfully. I break to empty the wastepaper basket into the dustbin and am diverted to do some photography when I reach the basement, or to play a duet with one of my children ... I rarely go to bed before 2 am’. Perhaps his greatest enjoyment was in playing wind instruments and the piano, but he seemed to be able to do anything he chose. At hospital, reacting to administrative delay, he would set about reglazing a window or cementing a floor. Raising his tenor voice in song, or leaning over Sister’s desk to sign a form by writing upside down, he was a master of the unexpected. Few could be dull in his company. ‘Although a friend of mine for twenty-five years’, wrote Lord Rosenheim, ‘I find it difficult to draw an adequate picture of this remarkable man. He was an eccentric in a world that was becoming increasingly uniform; he revelled in the clinical paradox and the unusual; delighted in poking fun at authority and pomposity; a modem Don Quixote’.
Asher married, in 1943, a musician — Margaret, daughter of Edward Eliot, a London solicitor. His family gave him great support and pleasure. His son is a former singer; his elder daugher is Jane Asher, the actress; and his younger daughter has been a teacher. He died in London.
Sir Theodore Fox
Sir Gordon Wolstenholme
[Brit.med.J., 1969, 1, 388; Lancet, 1969, 1, 988; Times, 3 April 1969]
(Volume VI, page 16)
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