Lives of the fellows

Edward Johnson (Sir) Wayne

b.3 June 1902 d.19 August 1990
Kt(1964) BSc Leeds(1923) MSc(1924) PhD(1925) MB ChB(1929) MRCP(1932) FRCP(1937) MD(1938) FRCPE(1955) FRFPS Glas(1955) Hon DSc Sheffield(1967)

Edward Wayne was born in Leeds, where his father was a surveyor and his mother had been a teacher. His first encounter with medicine was at the age of 5 years when he had an attack of scarlet fever. He remembered vividly the strange delirious dreams, and even more impressive was the excitement of the arrival of the family doctor who came in a pony and trap. A curtain impregnated with carbolic was hung outside the bedroom door and after his recovery all his books were destroyed and the room was fumigated by burning sulphur candles. He recalled that he was not allowed to see his friends until his skin had desquamated.

From 1914-20 he attended Leeds Central High School and then entered Leeds University as Akroyd scholar, graduating with first class honours in chemistry in 1923. He was taught physical chemistry by a woman who had worked with Madame Curie, just after the latter had discovered radium. Following the award of the Sir Swire Smith fellowship, he worked in organic chemistry for a year, in Leeds, and then went to Manchester University for research on the intermediary metabolism of the fatty acids with H S Raper FRS [Munk's Roll, Vol.V, p.343], obtaining a PhD in 1925. It was at this point that all his instincts led him to medicine. In one of his many self-deprecating witticisms he joked that he had observed that clinical professors had bigger cars and better suits than the non-clinical ones.

During a post-doctorate year, continuing his research, he took classes in anatomy and physiology; returning to Leeds in 1926 to complete a course in medicine. He later commented on his course as a medical student: ‘. . . senior consultants at that time received large financial rewards from their practices, but no payment at all from their hospital work as honoraries. The hospital appointment conferred prestige and patients seen privately, often admitted ahead of those seen in the outpatient department. The honoraries often lived in large houses with a butler, a chauffeur, a gardener, a cook and a few maids.’ He considered himself fortunate to be a dresser to one of them - Sir Berkeley Moynihan, later Lord Moynihan. He found it ‘. . . a pleasure to watch him operate - only Wilfred Trotter at University College Hospital, London, was a surgeon with more elegant technique.’ Wayne graduated in 1929 with first class honours and was awarded the Hay gold medal as the most distinguished graduate of the year.

After his resident house jobs he was appointed a demonstrator in physiology in the University of Leeds, and in 1931 he became an assistant in the department of clinical research in University College Hospital, London, under the directorship of Sir Thomas Lewis FRS [Munks Roll, Vol.IV, p.531]. He learned much from Lewis, about whom he often spoke in reverential terms with an appropriate anecdote, e.g. Lewis would separate papers he read into three groups (1) important - few, (2) possibly important if true and (3) rubbish - many; a classification Wayne found useful. George Pickering, later Sir George [Munk’s Roll, Vol.VII, p.464], was also with Lewis at this time and Wayne and he struck up a lifelong friendship and wrote a paper together. Wayne carried out some of the earliest trials on digoxin as well as an investigation on angina, using the ‘2-step test’ for the first time. He was convinced that he was the first person to take a dose of digoxin and rated highly his conclusion that a large dose of digoxin was an important innovation in the acute treatment of cardiac failure since previously many patients had received inadequate amounts of tincture of digitalis.

In 1934, at the age of 32, he was appointed to the chair of pharmacology and therapeutics in the University of Sheffield and became an associate physician in Sheffield Royal Infirmary. He stayed there for 19 years and we are fortunate to have his comments on that period when ‘. . . there were few effective drugs but still a lot of disease.’ He remembered the smell of the outpatient department at the children’s hospital in which he was a physician. The children were ill-fed, inadequately clothed, dirty, verminous and sometimes barefoot. Some were ‘sewn in for the winter’. Rickets was rife. The death rate among the inpatients was appalling, in winter from bronchopneumonia and in summer from infantile diarrhoea and poliomyelitis.

In 1937 he was elected to the Fellowship of the College and obtained his MD a year later. That same year he appointed Hans Krebs, later Sir Hans Krebs, Nobel Laureate, [Munk's Roll, Vol.VII, p.325] to his only lectureship, giving him about half the laboratory space for his research. Krebs, a refugee from Nazi Germany, then completed and published his work on the citric acid cycle. Wayne modestly assessed his own previous work in Manchester on the intermediary metabolism of the fatty acids as producing ‘No papers of fundamental interest’ and even more modestly claimed to have dismissed Krebs out of hand when the latter first told him of the citric acid cycle. He tried to maintain his clinical work at this time with no department or assistant in the hospital but he was later appointed physician to the Children’s Hospital and to the Emergency Medical Service. In 1941 he took charge of the beds and consulting practice of Robert Platt, later Lord Platt [Munk’s Roll, Vol.VII, p.470], during the latter’s absence on military service. Later, in retrospect, he appreciated that for the first time he saw medical problems in the raw uncontaminated by the opinions of registrars and unaided by laboratory findings. He was able to enter the houses of rich and poor alike. He remembered treating a Duke in his baronial splendour with a butler and footman in full uniform. But he recalled, too, his experience with the poor; one such experience being carved starkly upon his memory. Some miners had a whip-round to pay for a specialist to see an ill fellow worker and Wayne went to see him. He found him in advanced cardiac failure and took him into hospital but he died in spite of digoxin and diuretics. Too late, alas. It was this sort of experience which made him a strong supporter of the National Health Service and the associated Social Services revolution after the war.

After the war he became once again a full-time professor of therapeutics and indeed - as he put it - had ‘. . . a ringside seat to observe progress in this field’, first as chairman of the joint formulary committee of the British Medical Association and Pharmaceutical Society and later as chairman of the British Pharmacopoeia. This gave him unrivalled experience in the assessment of drugs and at last his flair for directing clinical research was enabled to reach its full potential. He had obtained excellent training in chemistry and biochemistry in his early professional life and his years with Lewis had been fruitful.

Subsequently three able young men returned from the Forces to take up lectureships with Wayne. They were fortunate to be directed by a man whose career had ideally fitted him for this role. The men were Alastair Macgregor [Munk's Roll, Vol.VI, p.311], John F Goodwin and Graham Wilson [Munk's Roll, Vol.VII, p.612]. In collaboration with A G Macgregor, later to take the chair of therapeutics in Aberdeen, he began to use radioiodine in the diagnosis and treatment of thyroid disease, work which later led to the Bradshaw Lecture of 1953. Graham Wilson, the most distinguished graduate of his year in Edinburgh University, was also involved with disorders of the thyroid. Indeed, Wilson succeeded Wayne in his Sheffield and Glasgow chairs. With John Goodwin, Wayne returned to his research in cardiology, using the new techniques of angiography and cardiac catheterization. John Goodwin, later to become professor at Hammersmith, recalls this period: ‘When I joined Edward Wayne’s department in Sheffield in 1946 the medical scene was opening up like a desert flower at the onset of rain ... It was an exciting and challenging time, and no one better to exploit these changes than Edward Wayne ... He was a great leader and I owe him an enormous debt for the education and opportunities he gave me.’

In 1953 Wayne was appointed regius professor of the practice of medicine at Glasgow University in succession to Sir John McNee [Munk's Roll, Vol.VIII, p.317]. Before taking up his appointment he visited India for three months, inspecting the medical schools and lecturing - especially on thyroid disease. A few years later he visited Iran, giving advice on setting up medical schools.

The regius chair of the practice of medicine was founded in 1714 by Queen Anne and has a distinguished history. Sir John McNee had returned to Glasgow from University College, London, in 1936 attracted by the new Gardiner Institute of Medicine, a four-storey purpose built building attached to the professorial medical wards in the Western Infirmary. It housed laboratories, an animal house, offices, seminar room and library, and 12 beds for clinical investigation. All this in addition to the 50 beds in his adjoining wards. Wayne was determined to continue his successful run in Sheffield and the Gardiner Institute was the ideal vehicle for his ambitions. Like Wayne, McNee had been frustrated in his hopes for research by the war years and his commitment to the Navy. Nevertheless, important contributions had been made by him and his able assistants in the post war years, for example Basil Rennie, Hugh Conway, Tom Fraser [Munk's Roll, Vol.VII, p.196], Ian Simpson and Lawrence Scott.

Wayne came to Glasgow superbly equipped with the knowledge and experience of current technology, therapeutics and statistics, essential for clinical research. From 1953 until his retirement in 1967 he sparked off and encouraged research in a number of areas. First in his own field of thyroid disease, he was ably supported by James Crooks [Munk's Roll, Vol. VII, p.126], later to become professor of pharmacology and therapeutics in Dundee. A man of great maturity and drive he was the perfect partner for Wayne in their research. They used modern statistical techniques to devise clinical indices for the diagnosis of thyrotoxicosis and hypothyroidism (the diagnostic index). Wayne investigated various aspects of treatment of thyrotoxicosis with Crooks, Hashimoto’s disease with Watson Buchanan, iodine metabolism with Donald Alexander and Dmitri Koutras with whom he wrote a book, Clinical aspects of iodine metabolism, Oxford, Blackwell Scientific Publications, 1964. He continued his great interest in cardiovascular disease by supporting Alister J V Cameron with whom he laid the basis for the cardiac department in the Western Infirmary, which had been initiated by J D Olav Kerr [Munk's Roll, Vol.VIII, p.256]. He also fostered the work of B E C Nordin on osteoporosis. Nordin had worked at Hammersmith and had been attracted by a lectureship in Wayne’s department. There was a warm affinity between Wayne and Nordin, both sharing the same wavelength of wit and intellectual repartee.

Abe Goldberg returned to Glasgow as a lecturer with Wayne, after research into blood pigments and blood diseases with Rimington in University College London and with Wintrobe in Salt Lake City, Utah, USA. Wayne had stimulated the formation of an independent haematological service in the Western Infirmary and had also acquired a full-time physicist for the department, David Bluhm. Wayne’s example of radioiodine was a model for Goldberg’s use of radioiron and radiochromium in the investigation of blood diseases and he showed real interest in Goldberg’s laboratory studies on haem enzymes. On one occasion Hans Krebs visited the department at Wayne’s invitation, and took time to study and comment on the haem enzyme work - a much appreciated gesture.

All of these research areas proceeded with gusto and occasional friction induced by competing ambitions for limited resources. Very occasionally this would provoke in Wayne an irascibility, pardoned next day by an endearing apology. Above all he was a very active clinician, taking his share of receiving and post-receiving rounds. He was a stimulating bedside teacher and one always learned at least one important medical - and particularly therapeutic - principle from his comments. He took his full share of undergraduate clinical teaching and lecturing and edited a student booklet of notes on clinical methods.

Wayne was fascinated by the application of modern technology, such as tapes and slide tapes, to teaching and this intrigued his staff, particularly Ronald Harden who made a major contribution to medical education. He himself, with Crooks, made a programme on thyroid disease for Charles Fletcher’s TV series ‘Your life in their hands’.

Throughout this period Wayne fully integrated himself into the life of Scottish medicine. He was elected to the fellowships of the Royal College of Physicians of Edinburgh and the Faculty of Physicians and Surgeons of Glasgow, and was examiner for the membership of both Colleges. He adapted flexibly to the more formal teaching in Scotland and was a popular and effective lecturer. Initially he was somewhat critical of the Scottish methods and sometimes yearned for the easier ways of Sheffield but the following comment shows that he was prepared to change his mind: ‘The system of medical education in Scotland differs in several aspects from that of England. Instruction is much more formal and systematic. At first I did not like it, but eventually I decided it had advantages over the laissez-faire which had prevailed in Sheffield; but the systems in both countries are now more alike’ (1975).

In 1954 he became an honorary physician to HM The Queen in Scotland. He recorded later that he was never called to see the Queen herself but looked after some members of the household. In 1958 he became a member of the Medical Research Council and was chairman of its clinical research board until 1964. In 1959 he was appointed Sims commonwealth travelling fellow and, with his wife, visited most of the universities and medical schools in Canada, from Nova Scotia to British Columbia. This was a particularly rewarding experience for him. That same year he gave the Lumleian Lecture ‘Metabolic studies in thyroid disease’ at the College. He was knighted in 1964 and retired in 1967 to Chipping Campden, a lovely village in the Cotswolds where he and his wife adapted very well to life in the community.

The Birmingham regional hospital board perceived the opportunity in their midst and in 1968 appointed him to be an adviser on research projects. In that capacity he visited almost all the hospitals in the region, giving research and general advice. From 1967-69 he was chairman of the Government’s advisory committee on drug dependence but in 1974 he retired completely from medical work though continuing to read the BMJ and The Lancet. The only committee he remained on was the BMA committee on alcohol and road accidents, of which he had been chairman since 1948. That committee’s reports ‘Relation of alcohol to road accidents’ (1960) and ‘The drinking driver’ (1965) were accepted as the basis for the Road Safety Act of 1967, which introduced the olood alcohol limit of 80mg/100ml. Wayne used to say that he saved more lives by this part of his work than by all his clinical career.

He was awarded the Cruickshank lectureship and medal of the Faculty of Radiology in 1966 and was made an honorary DSc of the University of Sheffield in 1967.

After 14 years in Chipping Campden, he and his wife went to live with their son David, a consultant physician, and his daughter-in-law and their children, at Lingwood Lodge near Great Yarmouth. His son recorded the following observations of his latter years there: ‘He was a humorous man who laughed easily at quirky humour, such as the Goons. He enjoyed the density of feeling in short poems rather than those of longer narrative style - though he could recall much of those too. T S Eliot’s Four Quartets were particular favourites, especially in the recording read by the author. He had a great love of music and I remember regular family outings to John Barbarolli and the Hallé every fortnight during the war at Sheffield City Hall. On the whole he preferred chamber music, especially Mozart, Beethoven, and always Brahms; also German lieder. Wolf was the firm favourite but Schubert, Brahms and Schumann also. Music on compact disc became particularly important towards the end of his life as he became less and less mobile - that, and the better quality wines he now tended to purchase. He loved ‘blind tastings’ - ‘ ... the two of us testing each other.’

Edward Wayne was one of the new breed of full-time clinical scientific professors which evolved in the mid-20th century. His long life spanned the major part of that century. With his remarkable memory he recalled what medicine was like in the 1920s and 1930s and the dramatic effects of the introduction of insulin, liver and anti-infective drugs. His training as a young man in chemistry, biochemistry and clinical science, with Lewis; his early appointment at Sheffield and the various drug committees gave him a unique opportunity to perceive the therapeutic revolution. His drive and his ability to attract younger men of merit to work with him allowed him to make and superintend significant contributions to medicine.

As an individual he was dynamic and his movements were quick, matching his quick, enquiring mind. Like the dynamo he was he generated sparks, which always kept those around him on their toes, but he was usually sensitive to their feelings - employing his Yorkshire wit in the most effective way. He had a genuine compassion for his patients and his fellow men. His visits to India and Africa left an imprint on his mind reflecting the problems of the developing countries. He recorded: ‘I have seen women working in the paddy-fields of Patna with a haemoglobin of 4-5g per cent. Hookworm is endemic and rice contains no iron. About half the world’s population never sees a doctor or any person with a medical training.’ He himself was most grateful for the surgeon’s skill having lost his appendix in 1938, a kidney and prostate in 1975 and a branch of the vagus nerve and a peptic ulcer in 1976. He declared this at a meeting in his late 70s and typically capped it all by saying ‘What you see standing here is what is left.’ He married Honora Nancy Halloran in 1932. She had been a student at Westfield College, London, and head of classics at South Hampstead High School. They had a son and a daughter. She will be remembered as a woman of great character, charm and common sense who was a splendid support for, and foil to, her brilliant husband.

Sir Abraham Goldberg

[Brit.med.J., 1990,301,604;The Lancet, 1990 2,932; Times, 23 Aug 1990; The Independent, 28 Aug 1990; The Daily Telegraph, 22 Aug 1990; The Guardian, 22 Aug 1990; Proc.RCP Edin.,Jan 1991; Chemist & Druggist,21 Jan 1967; Glasgow Herald, 18 Apr 1953; The Scotsman, 18 Apr 1953]

(Volume IX, page 565)

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