Lives of the fellows

George White (Sir) Pickering

b.26 June 1904 d.3 September 1980
Kt(1957) FRS(1960) MRCS LRCP(1928) MA MB Cantab(1930) MRCP(1930) FRCP(1938) MD(1955) Hon FACP(1955) Hon FRCPI(1965) FRCPE(1967) Hon MD Ghent(1948) Siena(1965) Univ W Austral(1965) Hon DSc Durh(1957) Dubl(1962) Hon LLD Manch(1964)†

George Pickering was born in Whalton, Northumberland, into a family with very strong farming traditions. He was always proud of his Northumbrian origins and liked to return to those wide rolling landscapes with broad horizons that reminded him of his youth. His father was a schoolteacher, who unfortunately died at an early age, and George was brought up, together with his sister, by his mother, who was responsible for their early education up to the age of seven. They lived in Newcastle and while George could not claim to be a true Geordie, he certainly had a wide range of Tyneside songs which were produced at suitable times, and often enlivened the somewhat staid proceedings of international conferences. He attended the Newcastle Grammar School from the age of nine and he soon showed his independence of spirit as well as his assessment of what was best for him by persuading his mother to send him far away to school at Dulwich College, where he was an exceptional student. At Cambridge he sat an examination for a scholarship in science, intending to do a degree in agriculture. With that good fortune that often seems to favour the exceptionally talented, he met Rudolph Peters, who persuaded him to change his aim to biochemistry or physiology. He was subsequently awarded a scholarship at Pembroke College. At Cambridge his mind turned to physiology, where he was obviously stimulated by the research and views of, among others, Barcroft, Rideal and Adrian. The step from physiology to medicine seemed natural and he was given an entrance scholarship to St Thomas’s. He qualified in 1928 and became house physician to Sir Maurice Cassidy, a cardiologist of originality and who was the first to associate carcinoid tumours with valvular lesions on the right side of the heart. By a fortunate chance, which owed a lot to Pickering’s friendship with Henry Barcroft, who was together with him at Cambridge, his wish to pursue clinical science was met when Sir Joseph Barcroft suggested he tried to work with Sir Thomas Lewis at UCH. Good fortune once more favoured him and a vacancy which had arisen by what would be delicately called temperamental incompatibility, was offered to Pickering, and here began perhaps the most important formative period in his life in clinical science. A different sort of union also occurred at this time, since he then married Dr Carola Seward, daughter of the professor of botany and master of Downing College, Cambridge, and this was one of the best decisions he ever made in his life. There were a son and three daughters of the marriage.

At University College he entered what was the leading medical centre for the pursuit of scientific knowledge, and there was a collection of original minds which has not been equalled since. In Lewis’s department there were Wayne and Grant, and a succession of eminent overseas research fellows. The department of medicine, directed by TR Elliott, who was the original proponent of the ‘adrenaline hypothesis of sympathetic nerve action’ when working with Langley in Cambridge, contained Himsworth, Smirk and McMichael, and all the other departments had their luminaries. One whose company Pickering particularly enjoyed was Wilfred Trotter, a neurosurgeon, whose philosophical approach he admired and whose essays he often quoted. Pickering was with Lewis for eight years, and during this time his interest in the control of the circulation was firmly established. It was there that he did his early studies on blood flow, and finally in 1938, together with Prinzmetal, he re-discovered renin, which had been patiently waiting since its original discovery in 1898 by Tigerstedt and Bergman. His period of apprenticeship was now over. He owed a great deal to the example of Lewis, who had the same critical spirit of enquiry that he himself always showed. His move to St Mary’s Hospital Medical School in October 1939 was the beginning of his most important contributions to medical research. He was brought there through the clear appreciation of his merit by Sir Charles Wilson, later to be Lord Moran, who achieved great fame, firstly by rescuing the medical school in the early 1930s when it was threatened by closure, and secondly as Churchill’s doctor. It was no surprise, except perhaps to the more traditionally minded members of the medical staff of St Mary’s, when he chose the youngest star in an intellectual firmament to direct the medical unit. This coincided with the outbreak of the war, and while Pickering made extremely important contributions in a wide variety of clinical fields, such as constrictive pericarditis and the cause of pain in peptic ulcer, it was not until the medical school, which had been evacuated largely to Harefield Hospital among other country sites, returned to London that his research blossomed fully. By example in the laboratory and at the bedside he created an atmosphere of excitement and critical enquiry which spread to everyone. Even those who were frightened of his trenchant criticisms respected him, and his influence was instrumental in gradually making St Mary’s the place that people wanted to get to, both from abroad and at home, to work with George Pickering. He touched on many fields apart from hypertension, and so his interest in the pain of peptic ulcer led to a demonstration that it was the pH of the stomach contents that mattered rather than spasm of the stomach or duodenal wall. He took a keen interest in fever, so that work developed in search of the pyrogen that caused it in many clinical disorders as well as experimentally. This led to the setting up by the MRC of a body temperature research unit within the medical unit. However, his enduring fame will be in relation to hypertension. His initial work on renin led to further experiments which defined the role of the kidney in experimental renal clipping hypertension in the rabbit, and it was out of this interest that work on angiotensin, which led to its isolation and amino acid analysis, developed. Perhaps the most widely known work came when he decided to look at genetic and environmental factors and their part in blood pressure distribution in populations. He showed, together with his colleagues, that the sharp differentiation between normotension and hypertension was an artificial division and that blood pressure, like many other qualities, was distributed as a continuous variable. This led to the famous Platt/Pickering controversy, since Robert Platt believed that ‘hypertension’ was inherited as a dominant characteristic in families, and that the distribution of pressures within populations could be seen to be biphasic due to the occurrence of a truly hypertensive group that could be distinguished from the normotensive remainder. Since then all the evidence relating blood pressure to morbidity and mortality supports Pickering, since there is no obvious cut-off point, even though clearly at the very high levels of pressure morbidity and mortality increase markedly. The series of papers on this subject can be said to form the basis of the epidemiological approach to the study of blood pressure in populations, and to have brought numeracy into clinical thinking, since these considerations have had considerable impact on clinical practice.

Pickering was always more interested in causes and mechanisms of hypertension than in treatment. In fact he had stronger views on the treatment of bleeding peptic ulcer than on hypertension. His house physicians, who had to keep patients with bleeding peptic ulcers alive while up to forty pints of blood were transfused, sometimes wished that he had had less definite views on the place of surgery in these conditions. In the treatment of hypertension he was more content to watch the efforts of his young colleagues on the medical unit as they tried to master the art of giving ganglion blockers to patients with severe hypertension, to enable them to spend more time on their feet and less being picked up off the floor, to which the resultant hypotension had consigned them.

In 1956 he moved to Oxford as regius professor, where his task was to revive clinical research in a new department created for this special task. He threw himself into this with evident enjoyment and enormous energy, despite the fact that osteoarthritis of his hips, which was to cloud much of his activity with continuous pain, grew in severity. Once more he attracted young people to his cause and his two main interests at this stage led to fresh developments. The first was a reinvestigation of baroreceptor mechanisms, particularly the carotid sinus, a subject he had investigated in his youth; and the second, the general subject of vascular wall disease, in which he was attracted by the old ideas of Virchow, and the similar and somewhat later ones of Duguid. They both believed that fibrin deposition on the vessel wall led to its incorporation and appearance subsequently as plaques. He further believed that they were the source of platelet emboli, and their direct demonstration in retinal vessels always delighted him. This led him to disbelieve any hypothesis of transient loss of vision or of cerebral function based on vascular spasm, since he was so impressed by observations, both in patients and experimentally in animals, which showed how platelet thrombi and emboli could be formed and swept away with only temporary blockage of small vessels.

In 1960 his contributions to the scientific basis of medicine were recognized appropriately when he was elected a fellow of the Royal Society.

The busiest of men are always given the greatest and most numerous tasks, and his clarity of mind, his great energy, and his width of knowledge, led to him being asked to perform on a larger stage. He was a member of the Medical Research Council, and chaired the MRC working party which conducted one of the first large scale trials of anticoagulant treatment in coronary thrombosis. He was a member of the Council for Scientific Policy, which was the precursor of the present Advisory Board to the Research Councils. A task which he clearly enjoyed was chairing the committee which saw the new Medical School at Nottingham University through from its first consideration to its final accomplishment.

His greatest contribution has to be the influence he had on all those who came into intimate contact with him. Despite the temperamental differences, one could feel that the flame that was kindled for British medicine by Thomas Lewis was given perhaps extra power by Pickering’s patent enthusiasm, allied to his considerable intellect and his gusty sense of humour. This attracted young men from all parts of the world, who carried the same light with them, so that his influence was spread to countless others. He was not only a clinical scientist of the highest order but he was also a physician of great understanding, who taught everyone never to spare themselves either in the pursuit of knowledge or the care of their patients.

WS Peart

† The list of honorary degrees is too lengthy to include in entirety.

[, 1980, 281, 752, 878, 952, 1224, 1365; Lancet, 1980, 2, 599, 655; Times, 5 Sept 1980; Biog.Mem.Roy.Soc., 1982, 28, pp. 431-449; St. Mary's Hosp. Gaz., 1971, 77]

(Volume VII, page 464)

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