Lives of the fellows

Richard Anderson Hickling

b.6 December 1900 d.30 October 1984
BA Cantab( 1922) MRCS LRCP(1924) MB BChir(1925) MRCP(1925) MD(1929) FRCP(1932)

Richard Anderson (Andy) Hickling was the son of a clergyman of the same name and was born in the mission field at Bangaloor in India. This close association with the church in his early years clearly played a large part in forming his character.

He was at Taunton School during the first world war and played for the first rugby and cricket teams. He also gained an open scholarship at Sydney Sussex College in 1919. He played rugby, soccer and cricket for his College, and obtained his BA with first class honours in the natural sciences tripos. For 20 years he was secretary and later president of the Cambridge Graduates Medical Club. A university scholarship took him from Cambridge to the Westminster Hospital medical school in 1922.

In August 1923 the Westminster Hospital medical school was closed for renovation and all its students were transferred to Charing Cross Hospital. He would never have imagined that 60 years later the two schools would amalgamate, nor would he have approved of the changes that have taken place in the London teaching hospitals.

Hickling played cricket and rugby for his new hospital and in his last year as a student he was asked to captain the First XV. It was typical of his modesty, a characteristic that he never lost, to decline the honour - saying that it should go to a Charing Cross student. He played regularly for Rosslyn Park, which was a leading London rugby club at that time. He qualified in 1924 and was house physician to W J Fenton [Munk's Roll, Vol.V, p. 127] and W J Adie [Munk's Roll, Vol.IV, p.596]. He then became resident obstetric officer to C Lockyer [Munk's Roll, Vol.V, p.245] and J B Banister [Munk's Roll,Vol.IV p.21] and, later, a demonstrator of pathology in the medical school. He was elected to the fellowship of the College in 1932. In later years he served on the Council of the College, and he was a member of the Association of Physicians for many years.

Hickling worked for a short time with Salzmann at Graz in Austria, before spending two years in the USA. The first year, in New York, was devoted to pathology and in the second year he was resident physician in the Cornell division of the Bellevue Hospital, where he worked with Eugene Dubois in the metabolic ward.

On his return from the USA he became a medical registrar at the Westminster Hospital and on Fenton’s retirement in 1929 he was appointed assistant physician at Charing Cross Hospital; he was only 28 years old. He made it clear for the rest of his life that he considered it a great honour to be appointed to the teaching staff of the hospital, and it was his great pleasure and duty to devote himself to the hospital and medical school. If there was a clash between private and hospital work, it was always the hospital work that came first. He did an enormous amount of clinical work and was equally active in all aspects of hospital and medical school life. When he was senior physician he performed the hat trick at cricket in the annual match against the students. He was appointed dean of the medical school during the 1939-45 war and with his characteristic enthusiasm undertook the combined duties of warden, tutor and dean. He was intolerant of the endless discussions which bedevilled proceedings in hospital committees, and was equally outspoken in his views on the needless investigations that he felt were done to patients in hospital.

Much of my knowledge of Hickling’s earlier career stems from N S Plummer [Munk's Roll, Vol. VII,p.474], who knew him in his younger years and who, like Hickling, was a great general physician and teacher with a special research interest. It was difficult to find out much of Hickling’s attainments from himself because he was modest almost to a fault. This modesty and his forthright manner probably prevented him being appreciated fully outside Charing Cross Hospital itself. His modesty was such that each year he always kept it a secret when he went as external examiner to Singapore University, in case he was thought boastful.

In his later years he was probably less popular with some of his students because of his attitude with patients; he was always extremely polite and kind to all his patients, but if he found one exasperating he might make a caustic comment after the patient had departed. This was sometimes interpreted as hypocrisy by some students when, in fact, it was the reverse. He felt it was his professional duty to be kind to the patient, but made no pretence about his true feelings for the sake of the students.

He was a great proponent of the apprenticeship system of teaching. He viewed with abhorrence the German model of so-called ‘scientific’ medicine with its emphasis on the laboratory. Before Peter’s principle was propounded about promotion to levels of incompetence, he believed that the pyramid of the professorial unit would result in research being done to obtain promotion, whereas with the plateau system of the part-time London teaching hospital consultants of his day research was done for its own sake. He would have been delighted to learn of the recent appointment of the chairman of Daimler Benz as a part-time professor at the local university, and the most popular teacher in his department. It would have seemed to Hickling that the world had moved full circle.

Hickling did research work throughout his busy life as a practising consultant. He had a small room at Charing Cross, with a bench and a microscope, where he worked without the aid of a technician. For nearly 40 years he himself examined the blood and histological sections of spleen and marrow of the cases referred to him. He would travel any distance to follow up these patients, and must have had the longest follow-up of the largest number of cases of splenomegaly in this country if not in the world.

Hickling will always be remembered for his original observations on the life history, diagnosis and treatment of myelosclerosis. His paper on chronic non-leukaemic myelosis in the Quarterly Journal of Medicine in 1937 was a landmark. He first reported the association, in the Lancel in 1953, of gout with leukaemia and polycythaemia. He showed that it was: ‘much more common in patients with myeloid metaplasia involving erythroblasts, leucoblasts and megakaryocytes than in patients with typical myeloid leukaemia or with typical primary polycythaemia.’ He continued his work for years after he left Charing Cross Hospital, as a result of facilities offered him by wise and courteous colleagues at the Royal Free Hospital. Again, his extraordinary modesty about his research meant that it was not fully appreciated by his colleagues at Charing Cross Hospital nor, one suspects, by the haematologists who met together in diverse places, as is now the rule in most specialties. He rarely spoke at, or even attended, meetings since his time was so fully occupied in Charing Cross Hospital treating, teaching and doing research.

He was a man of great courage. Two years before he died, he collapsed at a convivial Charing Cross Hospital dinner, with severe chest pain. It was almost certainly a heart attack but he would not allow a cardiogram to be done. He was taken home, and on his own insistence left to fend for himself. Two days later he wrote an uncharacteristically testy letter complaining of the unnecessary fuss that had been made.

He was a man who inspired many young men, students, housemen and registrars, and he helped them greatly in their careers. He was also a very warm family man. He and his wife were a devoted couple and he never completely recovered from her death. They used to take their three sons to North Wales each year, where they were keen sailors. I suspect that they excelled in this sport but, again, they would give no hint of their own ability.

Hickling would be considered by some to be a reactionary influence in teaching hospital medicine. There are those who have seen the change from apprenticeship teaching to so-called ‘academic’ teaching, and who realize that we shall not see again such physicians as Andy Hickling who, through a combination of humanity, honesty and wisdom, made British medicine famous.

PBS Fowler

[Lancet, 1984,2,1287; Charing Cross Hosp.Gaz., Winter 1966-67,64,(3), 137-139]

(Volume VIII, page 221)

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