Lives of the fellows

Alexander Russell

b.1914 d.4 March 2003
OBE MB BS Durham(1935) DPH(1937) DCH(1947) MRCP(1948) MD(1952) FRCP(1972)

Alexander Russell, who achieved eminence and international recognition for the two syndromes he described, actually began his career as a general practitioner. He spent his early years in Newcastle, and qualified at Durham. At that time paediatrics was something of an orphan specialty and the only resident job he obtained after qualification was at Newcastle General Hospital, as house physician to the doyen of British paediatrics, Sir James Spence [Munk's Roll, Vol.V, p.386]. Alex used to reflect on the early years and his time with Spence with pride.

The first years after his hospital job he spent in a busy general practice in mining villages in the north east. These were the hungry thirties, poverty was prevalent and social conditions were poor. Long hours were only infrequently interspersed by short holidays across the Penines.

His career in paediatrics was cut short by the Second World War. He was called up to the medical branch of the RAF and was at first a medical officer at an air force station. This was bombed and an air raid shelter was struck. A gas main leaked into the shelter and those who were trapped in it developed mild carbon monoxide poisoning. They became confused and were acting in an unusual manner when Alex was called to treat them.

He was then transferred to the psychiatric branch. Alex had no previous training or experience of psychiatry, but by some trick of fate the job he was given was to interview 'rear-gunner Charlies' who were being discharged from the service because they were said to be psychologically unsound. Most of these men had flown in the old Whitley bombers. The rear gunner sat in his turret some distance from the pilot's cockpit. Because of the intense cold during the flight, the turret was closed off. It had no alternative oxygen supply and the planes were not pressurised. Alex studied these men's stories carefully. They had become anxious, tense and excited after they fired off their Browning machine guns to test them inside the sealed turrets. He realised that carbon monoxide had been released into the closed space, and that its effects were exaggerated by a relative lack of oxygen. Using a spare turret at the RAF experimental research establishment at Farnborough, Alex proved his theory to be correct. Because of this work these men were re-enlisted, the turrets were properly heated, ventilated, and supplied with oxygen.

He was then sent to the Middle East as a roving investigator. He first looked into what was purported to be an outbreak of 'cerebral malaria' among the staff of an RAF station there. He observed a very high daily alcohol intake among the members of the officers' mess staff. He was thus able to rule out 'cerebral malaria' as being the cause of the apparent outbreak of their psychiatric and neurological symptoms.

He also looked into outbreaks of other tropical diseases in the Middle East. For this he was awarded the OBE and twice mentioned in despatches.

He always carried a much-thumbed textbook of paediatrics in his kit bag during his travels in the Middle East and claimed that this was his 'first love' in medicine.

After discharge, Alex returned to civilian life as a general practitioner. This was in the poor East London suburb of Whipps Cross. After such distinguished war time service general practice was something of a come down. Had Alex wished to resume a paediatric career immediately after discharge, he would have received a government grant. Now the prospect was more daunting. He went to see his old chief, James Spence, who said that he would support him and Alex set about a career in London. His first job was as locum casualty officer at the heavily bombed docks branch of the Queen Elizabeth Hospital for Children at Shadwell.

He made sufficient impression at this job to be appointed to the more permanent position of resident medical officer to the main hospital in the Hackney Road. This had now become part of the postgraduate Institute of Child Health of the University of London. It was a very popular teaching centre to which young aspiring doctors flocked from the Commonwealth and other countries, to further their education and thus aiming to pass postgraduate examinations.

Alex himself took and passed the diploma in child health in 1947 and one year later became a member of the College. The latter exam was a stiff hurdle for a budding paediatrician, because at that time the whole exam was in advanced adult medicine and the pass rate was rather low. The examination was in parts. He had moved back to Newcastle temporarily, was unemployed and during the exam was living in slightly deprived circumstances in lodgings at King's Cross.

It was at this time that he reported a new syndrome, from a study of a series of patients. This was the intra-uterine dwarf. These were infants who were of low birth weight but who were born at the correct dates or later. They were by no means premature, but had the proportions of the foetus in the womb. He was thus able to delineate a new disease and his description was validated by another paediatrician, Henry Silver in the United States. In the UK it came to known as the Russell-Silver syndrome, and in the USA the Silver-Russell syndrome.

He also described the 'Diencephalic syndrome'. These were children who were hyperactive, emaciated, had internal hydrocephalus with arrested growth and weight loss despite a voracious appetite. The cause was an undifferentiated glioma of the anterior hypothalamus. He followed these patients up and recorded that were the tumour to progress, the clinical situation changed and these young patients lost their appetite, became somnolent and obese. It was the subject of his MD thesis.

His originality and clinical abilities were by now becoming recognised locally and from being a lowly resident medical officer he was promoted to be the assistant to Alan Moncrieff [Munk's Roll, Vol.VI, p.343] at the Hospital for Sick Children Great Ormond Street. While he was there he made many friends among his colleagues. They recognised his skills and clinical abilities, and later referred their growth and endocrine problems to him.

Following this appointment he was given sessions at Harold Wood Hospital in Essex, and because he had made a profound impression at the Queen Elizabeth, was able there to open the first paediatric endocrine and growth clinic in the UK. This was for only two clinical sessions per week.

Alex was never very much interested in medical politics and would only attend medical committees were there to be an item on the agenda which was of immediate relevance to the future of the hospital or his clinic. He was not a laboratory man, but used the services extensively, encouraging the clinical biochemist Barnet Levin to undertake new and sometimes exotic investigations.

He was nevertheless a great stimulus to his juniors. He always listened attentively to their thoughts and ideas. There was a fallow period, but during the late 1960s a series of collaborative original papers reporting new chromosomal disorders, and metabolic diseases appeared in respectable journals such as The Lancet and Archives of Disease in Childhood appeared from the Queen Elizabeth Hospital.

Meanwhile he had moved his main NHS base from Essex to the Chelsea and Kensington Group of hospitals. One presumed at the time that he was able to concentrate his work more effectively, but he was now having regrets about not being able to pursue an academic career.

He had inherited some property and was running a company in Harley Street. Typically, his rents were low and more typically he did not send out bills to many of his private patients. When questioned about the apparent conflict of business and academe he smiled and said nothing.

All was revealed in 1966 when he accepted the chair of paediatrics and child care at the Hadassah Hebrew University of Jerusalem. His salary was small but now he could afford to take the position. He was returning to his roots: his mentor James Spence was a pioneer in community paediatrics and was concerned with the handicapped and deprived. Thus Alex bravely founded the Jerusalem Centre for Child and Family Developmental Rehabilitation. This was for both Arab and Israeli children. In 1970 he also opened the Children's Hospital in Ramallah on the West Bank.

Alex Russell was very much an individual. Possibly because of this honours came late. He was made a Fellow of the College in 1972. He was a co-founder and president of the International College of Paediatrics and Child Care.

He suffered coronary heart disease in his latter years and died in cardiac failure.

Leonard Sinclair

[Brit.med.J., 203.326,1149]

(Volume XI, page 491)

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