Lives of the fellows

Ralph Coburn (Sir) Jackson

b.22 June 1914 d.1 November 1992
KBE(1973) CB(1963) MRCS LRCP(1937) MRCPE(1950) MRCP(1968) FRCPE(1960) FRCP(1972)

Ralph Jackson was born at Whitley Bay, Northumberland, where his father was a bank manager. He was educated at Ascham House, Gosport, and Oakmount School, Arnside, before entering Guy’s Hospital medical school, London, where he qualified in medicine. After a series of house appointments at Guy’s and the probability of another war with Germany, he decided to join the RAF as a medical officer. It was a choice he never regretted for he loved Service life and it was obvious that ‘Jacko’, as he was known, was exactly the right type to be a doctor to the enthusiastic young men who were then joining the rapidly expanding Air Force. He married Joan Crowley in December 1939; they had four children, two sons and two daughters, and in a well known Churchillian phrase ‘lived happily ever after’.

From the start Ralph Jackson had an adventurous war. He went to France with the Advanced Air Striking Force and 18 months after his return from that disastrous campaign he was posted to what turned out to be a unique task as the senior medical officer to 151 Wing, consisting of two Hurricane fighter squadrons, which were sent by the first Arctic convoy to a base near Murmansk as support for the Russians in the critical days of the 1941 winter. There he found he was expected to advise not only on how to cope with the effects of extreme arctic conditions on health and hygiene but also on the problems associated with life in a foreign environment. It was typical of the man that his good humour and enthusiasm made for excellent liaison with the Russians, which solved many problems. As an example of the unexpected, he quoted the hilarious effect on young airmen who found that their sauna baths, arranged as a hygienic treat, were to be supervised by ancient Russian ladies who plied birch twigs on the nearest naked bodies.

After his return from Russia, the Air Ministry’s typical reaction was to send him to the opposite climatic extreme -West Africa. There his hard work earned him two mentions in despatches in the next two years. In 1944, when he eventually returned to England, it was to another exacting task as senior medical officer to 46 Group of Transport Command, which was largely responsible for the air evacuation, from Europe to Britain, of no less than 76,000 British casualties.

At the end of the war Ralph Jackson decided to remain in the RAF and elected for specialist clinical training as a physician. He obtained his MRCPE and served in various hospitals at home and abroad until 1957 when he was appointed clinical head of medicine at Princess Mary’s RAF Hospital, Halton. At that time the RAF medical directorate was considering the Korean war experience of acute renal failure as a frequent result of severe wounds and burns and had decided to set up a unit to assess the Kolff twin coil artificial kidney as a therapeutic process. Jackson was invited to direct this unit at Halton. It was only the third artificial kidney to be established in Britain and he seized this opportunity with enthusiasm, assembling a team of young clinicians and pathologists with whom he worked tirelessly to acquire and improve techniques and equipment that were then untried in the UK.

The first dialysis was performed at Halton in June 1957 on an NHS patient in renal failure due to multiple injuries. It needed all the facilities of the nearby RAF Institute of Pathology to perform the continuous load of biochemical laboratory work that was so labour intensive in those days. The renal unit diaries show that 19 patients were dialysed in the first year, the majority being NHS patients - a trend that has continued to the present day. It was a remarkable contribution at a time when such resources were scarce and treatment of renal failure by haemodialysis was not available in the majority of areas. A unique aspect of the RAF renal unit was the creation of a mobile dialysis team with specially modified equipment. It was originally established to provide treatment for servicemen, ill or injured anywhere in the world, but it soon became a valued contribution to the NHS when used to treat cases of acute renal failure at the hospital where they occurred, should transfer to Halton appear to be an unjustifiable risk.

Haemodialysis was then a novel therapy and experience gained at Halton was disseminated by frequent publication of scientific papers. In addition, there was a demand for presentations at both national and international medical meetings. Ralph Jackson described the management of traumatic and obstetric causes of renal failure and gave the first accounts of haemodialysis as a successful therapy for blackwater fever and accidental poisoning complicated by renal failure. Directing the renal unit was exacting and involved considerable emotional stress, not only because of the high mortality rate at that early stage of technology but also because so many calls for help had to be refused when the unit was already overstretched.

Ralph also acted as host to endless visitors to the unit which involved many hours of explanation and discussion with those interested in setting up dialysis centres. Jackson’s reputation grew as the organizing genius of the unit and he made many friends who were to influence his career. It also had an extraordinary effect on the peace-time reputation of the RAF medical branch and undoubtedly encouraged the recruitment of many high quality young doctors and specialists who joined the Service in those years. Jackson’s work was recognized by the award of the Lady Cade medal of the Royal College of Surgeons and election to the fellowship of the RCP Edinburgh in 1960. He became Companion of the Bath in 1963, at the young age of 49.

In 1964, Jackson finally left the renal unit, by which time he had established a group of experienced young physicians to continue both the work and research. As an interim respite before promotion to a new task, he went to the RAF hospital in Germany. But while there he had his first myocardial infarction which at that time was so often accepted as the end of a career. Yet Ralph, with the unstinting support of his wife, made an excellent recovery and went back to work with unabated enthusiasm and energy. Two years later he was rewarded with the top job in RAF clinical medicine, being appointed consultant adviser in medicine. He was also appointed honorary physician to the Queen in 1969 and elected a Fellow of the College in 1970.

From that time his professional career began to change towards an increasing commitment to administration and organization. He both enjoyed and was particularly good at them both. In 1971 he became senior consultant RAF, almost wholly organizational work, and subsequently became the first chairman of the Defence Medical Services Postgraduate Council, with a seat on the council for postgraduate medical education and on the committee of postgraduate deans. As well as his administrative ability he had the advantage of professional contacts and earlier friendships which helped him to understand the position of various academic bodies involved in particular problems affecting postgraduate education in the medical branches of the Armed Forces. As official recognition of his work he was created KBE in 1973. By the time he retired in 1975, when he was 61, he had constructed a recognized position in the Service from which his successors could operate successfully.

In retirement he continued as honorary civil consultant to the RAF and added a number of consultant and referee appointments with insurance companies. His continuing loyalty to the Service was apparent in his work for the RAF Benevolent Fund where he became a member of the main grants committee as well as honorary consultant. He was also appointed a director of and medical adviser to the French Hospital, Rochester. His hobbies included genealogy, bird watching and the history of the City of London. Of the latter he was a Freeman and a member of the Society of Apothecaries. His full life was rounded by his abiding joy and interest in his children and their families.

Ralph Jackson was a good man to work for because he was considerate, fair, well organized, a great enthusiast and genuinely interested in the performance and career of his subordinates. His juniors liked and trusted him and the pioneering work in management of acute renal failure was the result of good relationships. The RAF medical branch gained a great deal both from this early work and the later fruits of his service for he himself always put the requirements of the Service first, before his own advancement.

J N C Cooke

[Daily Telegraph, 7 Nov 1991,1 Feb 1992; The Times, 1 Feb 1992; Proc.roy.Coll.Physns.Edin., v.22,no.3,July 1922]

(Volume IX, page 262)

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