b.4 October 1909 d.10 April 2004
MB ChB Edin(1933) MRCP(1937) MD(1939) FRCP(1949)
Francis Dudley Hart’s life spanned the emergence of modern rheumatology as a separate specialty of medicine. He was born in a Glossop (Derbyshire) vicarage into an ecclesiastical family. Both his father and grandfather were Church of England clergymen. After education at the Grosvenor School, Nottingham, he entered a seminary, intending to follow in the family tradition. However, he found himself more attracted by the deductive reasoning of medicine, leading him to switch to the University of Edinburgh Medical School. He qualified in 1933.
The years before he qualified have since been called the 'dark ages of rheumatology’, when the treatment of rheumatism was the province of spa doctors and only a handful of different rheumatic diseases were separately identified. Today, rheumatology is one of the significant branches of hospital medicine and over 100 different rheumatic diseases are recognised, an enlightenment to which Hart made signal contributions.
His training appointments in Edinburgh, the Royal Northern Hospital in London and the Brompton Hospital, covered a wide field of medicine. He was appointed in 1939 as senior registrar to the newly reopened Westminster Hospital in London. Three months later, when war broke out, the authorities, anticipating the bombing of London, evacuated patients, students and staff to the sector hospitals. As a relatively junior physician, Hart was left with three surgeons to run the hospital as a casualty clearing station throughout the Blitz. Later, he served as a major in charge of a medical division of the Royal Army Medical Corps in Iraq, North Africa and Italy and was mentioned in despatches.
One of Hart's first scientific papers, published in 1939, had been on rheumatic fever in children, a condition that once affected 80,000 children and young adults in the UK, killing some and leaving others with permanent heart damage. In 1949 he was in New York, where Philip Hench described the dramatic anti-inflammatory effects of cortisone on rheumatoid arthritis. Back in London, he advised the Ministry of Health to await the results of a controlled trial before releasing cortisone for prescription by general practitioners, caution that paid off when the adverse effects of the drug became evident.
During his war service, working closely with the Millbank Military Hospital, Hart had become interested in ankylosing spondylitis, a form of spinal rheumatism known as 'poker back' disease and a not uncommon problem in young male recruits. Leaving the RAMC with the rank of lieutenant colonel in 1946, he was appointed to the staff of the Westminster Hospital as consultant physician in general medicine. There he established the first specialist rheumatology clinic in a London teaching hospital.
At that time American specialists taught that rheumatoid arthritis and ankylosing spondylitis were two aspects of the same disease, but Hart firmly differentiated them on clinical grounds. He was later proved right after the transplant scientist David James, together with his physician colleague Derrick Brewerton, investigated ankylosing spondylitis in patients in Hart’s rheumatism clinic. Tissue typing showed that the inherited type HLA B27 was present in over 90 per cent of ankylosing spondylitis sufferers and only rarely in rheumatoid arthritis.
In 1952, Hart, as chairman of the Royal College of Physicians committee on rheumatology, helped push through the recognition of rheumatology as a separate specialty of medicine. He pioneered the concept of an independent specialist research institute that could act as a resource centre in support of a national rheumatology research effort. The plan was backed by a gift of half a million pounds from Mrs Kennedy, née Mathilde Marks, and an heir to Sir Simon Marks of Marks and Spencers. The institute was declined as an onerous benefaction by most London teaching hospitals, but was eventually established as the Kennedy Institute of Rheumatology and affiliated to the Charing Cross Hospital.
Hart was for many years a member of the executive committee of the Arthritis and Research Council (later the Arthritis Research Campaign, ARC), where his role was to ensure a fair balance of funding between clinical and laboratory research. Through ARC's news sheet he explained to the lay readership the many different rheumatic conditions and their problems. He did an early survey of complementary medicine. Of 111 rheumatism patients, 80 per cent felt they had been helped by osteopathy or manipulation, 50 per cent by acupuncture and 40 per cent by faith healing.
Hart was a gifted teacher who taught 'over the bed', taking pains to include his patients with whom he shared great rapport. He examined for the London MB in medicine and applied pharmacology and was elected censor of the Royal College of Physicians. He contributed to French's Index of Differential Diagnosis and the British Pharmaceutical Codex. He advised the Ministry of Health on analgesic and anti-rheumatic drugs and was the author of, or contributor to, over 20 medical books and 200 scientific papers.
He loved the outdoors. Every summer he took his family on a pastoral holiday in a caravan near Mawnan Smith in Cornwall, where he enjoyed walking the Cornish footpaths and snorkelling in the sea. He was a capable musician and could play more than 15 instruments. He produced six long play records of his compositions, including his 'rheumatological song cycle', in which he put the story of modern rheumatology to music, building up his own accompaniment by successive synchronised tape recordings. He retired from the National Health Service in 1974, but continued in private practice until 1987.
In his long and active life he saw the virtual disappearance of rheumatic fever and tuberculous arthritis, the effective treatment of gout and polymyalgia rheumatica, the introduction of targeted anti-inflammatory drugs for rheumatoid arthritis and the contributions of surgical rheumatology and joint replacement that have radically changed the outlook for rheumatic disease sufferers.
He was predeceased by his wife Maureen and survived by his children Paul, Clare and Elizabeth, and by two grandchildren.
Allan St J Dixon
[Brit.med.J.,2004,328,1501; The Times 26 May 2004]
(Volume xi, page 249)
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