b.20 September 1917 d.11 April 1997
BSc Lond(1938) MRCS LRCP(1942) MB BS(1947) DPM(1947) MRCP(1949) MD(1950) FRANZCP(1966) FRCP(1967) FRACP(1977)
As foundation professor of psychiatry at the University of New South Wales, Leslie Kiloh’s empirical approach and advocacy of biological psychiatry had a major impact on the specialty in Sydney and in Australia as a whole.
Born in London, he was educated at Battersea Grammar School and then went to London University and King’s College Hospital to study medicine. After graduating he joined the Army, serving principally in the Middle East. On his return to England Eric Cunningham Dax organized a psychiatric position for him at Netherne Hospital in Surrey. It was while working here that Kiloh completed his DPM. He then left the Army, and returned to King’s, based in the neurological unit and working with some of the leading British neurologists of the period.
After completing his training he moved to Newcastle, and after a brief stint with Alexander Kennedy [Munk’s Roll, Vol.V, p.226], he spent three years in a large psychiatric hospital to ensure he gained extensive clinical experience. When Martin Roth took up the chair at the University of Durham Kiloh joined the department and, in collaboration with others, produced a series of classic papers on the sub-typing and treatment of depression. Kiloh argued the binary view on the basis of a number of elegant statistical studies and from a strong clinical ‘feel’ - although he never made the mistake of basing his argument on the latter.
After ten years at Durham he went to Australia in 1962, initially to consider two available chairs. He elected to join the new medical school at the University of New South Wales as academic head of the school of psychiatry and director of psychiatry, based at the Prince Henry Hospital. He arrived without staff, facilities or patients, but while travelling to Australia on the Oriana he designed a 50-bed psychiatric unit for the general hospital. He subsequently developed a 40-bed psychiatry unit at the Prince of Wales Hospital and arranged for the relocation of the Psychiatric Research Unit (PRU) to Prince Henry Hospital. With his clear leadership and superior medical skills he quickly earned the respect of the other clinical directors and senior hospital administrators and rapidly advanced the status of psychiatry in the hospital.
Kiloh brought a British Army style to administration. It was hierarchical, the structure and rules were clear, focused on ensuring that the job got done, whether it was teaching or delivering the best available care. He was an excellent clinician, skilled in neurology and with a facility in internal medicine, bringing consummate diagnostic skills into play during his clinical assessments. His influence as a role model cannot be overestimated. His influence on the PRU in the late sixties and early seventies ensured the development of neuro-psychiatry as a sub-discipline. There he chaired case conferences that were attended by neurosurgeons and neurologists from around Sydney, as well as numerous psychiatrists, trainees and other staff, consolidating a base to promote biological psychiatry.
Though he was the senior author of a definitive book on electro-encephalography (Clinical electroencephalography, London, Butterworths, 1961) and had other signal distinctions in neuropsychiatry, Kiloh never made reference to his accomplishments, being above a need for such trappings.
He prioritised teaching above all activities and this was the component he most missed on retirement. He did not embarrass or humiliate the foolish (but enjoyed a rapier verbal interchange with less vulnerable colleagues) and had great patience in his teaching and mentoring, both at undergraduate and postgraduate levels.
His clear prioritising of a biological psychiatric approach was strong and authoritative. It was not surprising then that he would focus on and defend procedures such as ECT and psychosurgery which, following the advance of the anti-psychiatry movement in the 1970s, might well have disappeared from the psychiatric armoury without his strong and uncompromising advocacy. His development of an ECT machine and his long-standing interest in ECT moved that procedure from one where it was, at times, cavalierly administered to again being used according to more empirically based principles.
His research interests expanded into a number of other areas when he was appointed to Sydney. While maintaining his interests in biological psychiatry, he also developed a number of transcultural studies.
As an academic head he felt no need to develop a school marked by ‘intellectual incest’ or to promote acolytes. Kiloh sought to recruit academics from whatever persuasion who would be self-starters, presumably believing (for he never detailed his strategies) that their disparate interests would create a synergy in the school and its research. He rarely gave them a distinct plan or ‘job description’. Staff were expected to ‘get on with the job’ - be it academic, clinical or administrative. To those who required ‘spoonfeeding’, the lack of feedback could be sufficient to create a developmental crisis. To those who did not have such ‘needs’, his respect for autonomy provided an opportunity for creativity and to move forward untrammelled.
Kiloh would appear seemingly indifferent to the successes of school members, taking them as a given. His scepticism (‘Good God - I hope you don’t believe that’) was as educational as his reasoned and informed arguments. Understand the motivations and you could understand Kiloh and his unusual model of leadership. His integrity resided in his being free from the need to be loved or admired, leading to true respect. Often shy, he rejected all attempts to provide some recognition of his outstanding contributions to the hospital and university.
He had many skills outside medicine and psychiatry; he had a long-standing interest in gliding and was a keen sailor, bush walker and naturalist, getting to know the Australian outback better than most born there. He married his wife Marjorie - whose warmth and generosity was experienced by all school members - in 1947 and they had three sons.
[Australian Psychiatry Vol.5, No.5, Oct 1997]
(Volume XI, page 317)
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