Lives of the fellows

Anthony Keith Thould

b.4 October 1930 d.11 July 2005
MB BS Lond(1954) MRCP(1958) MD(1960) FRCP(1974)

Tony Thould was a determined visionary who was to bring to the people of Cornwall much needed improvements in their medical care. He had good Cornish credentials when he was appointed as consultant physician to the Royal Cornwall Hospital in 1965. His mother was descended from the Tregions, well-to-do Cornish landowners and merchants and his family had always taken their summer holidays on a farm in the Camelford valley.

He had grown up during the Second World War in Southampton during the bombing. At the age of 13 he watched the assembly of the large and small craft in the final preparations for the D-day Normandy landings. But his father, a bank manager, thought that he was not paying enough attention to his studies and set him a challenge: "Either stop slacking and go to the local grammar school if you are lucky, or work hard and win a scholarship to a public school." Tony overdid it and won scholarships to three schools, choosing Stowe. He had planned a career in architecture, but at the last moment something told him to switch to medicine. He was accepted to St Bartholomew's Hospital Medical School in 1948. Six years later he graduated with a distinction in medicine.

The war was over but conscription for National Service had not yet been lifted. As a recently qualified doctor, Tony was called up for the Army, sent to Hong Kong and stationed at 33 General Field Hospital Kowloon from 1955 to 1957. There he was given considerable clinical responsibility and it was there that he met his future wife Bernine, always shortened to Bernie. She had come to Hong Kong from Australia on vacation and had stayed on to teach.

Back in London, he was appointed as a junior registrar in the medical department at St Bartholomew's and continued his postgraduate education under the head of the department, (later Sir) Eric Scowen. He recalled that Scowen devolved most of his teaching and clinical responsibilities to the senior registrars on his staff.

The membership of the College was a tough examination. Tony failed it at the first attempt, but realized that his weakness had not been in the theory of medicine but in the bedside clinical examination and diagnosis of patients. He spent the next six months concentrating on correcting this, tried again and passed. The MRCP was one of the two 'gateway' examinations for promotion to a consultant career. The other was the MD, London, taken by thesis. Scowen suggested that he take for the subject of his thesis 'The relationship between congenital deafness and simple goitre'. This entailed reading and categorizing 500 references in the literature and finding 20 examples of the syndrome in special schools for the deaf in England. The study concluded that children with mild features of the syndrome did not become deaf unless they lived in areas depleted in iodine. Thus it was common in mountainous areas such as the Andes, but rare in maritime countries.

In 1959, armed with both the MD and the MRCP, he moved to University College Hospital as registrar to Sir Max Rosenheim [Munk's Roll, Vol. VI, p.394], a two-year job. He had enormous admiration and respect for Sir Max as physician and teacher. During this time he worked on a research project for the Medical Research Council. This was a study of the health and medical problems of islanders temporarily moved to the UK because of the threat of a volcanic eruption on Tristan da Cunha. He joined the Royal Naval Volunteer Reserve and later served as squadron medical officer on a fisheries protection vessel on duty off Iceland.

After two years Scowen invited him to return to St Bartholomew's as senior registrar. He was at first reluctant to accept, but was advised to do so - senior registrar jobs were difficult to come by at that time. His relationship with Scowen was put to the test when the Medical Research Council invited him to join a six-week expedition to the Peruvian Andes to study mountain sickness, an opportunity of a lifetime. Scowen agreed to let him have leave of absence but two weeks later, when preparations were already in hand, rescinded the permission, a bitter blow. Tony was minded to resign but was advised by the professor of surgery to 'grin and bear' it. If he did resign he might never get a reference from the department that would be critical for his future chances of an appointment as a consultant.

The rules of a senior registrar job entailed spending the third year in an area of special medical interest. He asked to be attached to Wykeham Balme [Munk's Roll, Vol.VIII, p.16], who had trained in rheumatology and practised the specialty along with general medicine at St Bartholomew's and at the Whipps Cross Hospital. He enjoyed the experience and chose to stay with Wykeham Balme for the fourth and final year.

In 1965 Tony was appointed consultant physician in general medicine to the Royal Cornwall Hospital at Truro. His first impression was that some of the advances of modern medical care had passed the hospital by. The sheer scope of the job was immense, involving the full range of medical conditions without the support of specialist departments. The, then new, Treliske Hospital was being built without the provision for some of the necessary facilities. The deficiency was exposed when one patient had a heart attack during visiting hours and he had to apply cardiac massage and resuscitation with the patient on the floor in full view of the visitors. The only defibrillator in the hospital was rushed from one of the operating theatres but could not be used as it had the wrong plug. The patient was saved, but the episode could have been an appalling scandal. It helped persuade the chairman and members of the hospital management committee to give him the money to set up and equip a coronary unit and an intensive care unit. Later he added facilities for continuous ambulatory peritoneal dialysis to the ICU. At first his medical colleagues were unwilling to cede the beds necessary to support these units.

He pursued numerous commitments to local, regional and national committees: often using overnight sleeper trains to London and back so that he did not lose time from his clinical commitments. He was a member of the British Medical Journal's journal committee for 22 years under three successive editors. In 1974 he was elected FRCP.

All the while he retained his interest in rheumatology and, with no prospect of funds coming from the National Health Service to build an appropriate unit, he set up a public appeal that between 1976 and 1978 raised a million pounds to build the Duke of Cornwall rheumatology department at the Truro City Hospital. Subsequently the appeal raised a further million to build a second floor that would provide research and educational facilities. This enabled him to move across from general medicine to full-time rheumatology. By 1978 all 18 beds in the department were fully operational.

Cornwall at that time was an economically poor county. Many of its population were elderly or retired. The staff of the rheumatology department called themselves the 'Truro salvage squad', as long neglected rheumatism patients began to be referred there. He worked particularly hard at that time, publishing papers on rheumatological topics and lecturing at home and abroad. In 1983 he was awarded the Medicine Gilliland fellowship to study at Phoenix and Stanford universities. He needed to learn about the epidemiological methods used in the USA to keep track of patients with chronic diseases with a view to applying those methods to explore the extent, nature and severity of the burden of the rheumatic disease in Cornwall. He also served as editor of the Annals of Rheumatic Diseases.

In 1990, while holding his outpatient clinic, he suffered a mild stroke. He found himself unable to speak and with weakness on the right side of his body. Despite this he was able to drive home. Hypertension was diagnosed and he was advised to retire early. But he still had many things to do outside medicine. He travelled widely, was active in the Cornwall Heritage Trust, pursued domestic building projects, sailed his yacht, developed his garden and arboretum, excavated a lake, read and wrote books. In the millennium year a colon carcinoma was removed without recurrence. Not long after that myelomatosis struck him, requiring long-term chemotherapy. Despite these problems he continued with a busy programme of travelling, visiting friends and writing, including his 280-page autobiography.

Allan St John Dixon

(Volume XII, page web)

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