b.2 March 1918 d.10 February 2007
MRCS LRCP(1939) MB BS Lond(1940) MRCP(1941) MD(1944) FRCP(1959) Hon DSc Buckingham(1983)
John Paulley was a consultant physician in Ipswich and one of the founders of the independent University of Buckingham. The son of a doctor, John Paulley, and Elisabeth Wylmer née Green, he was educated at Epsom College and the Middlesex Hospital Medical School. His student career was distinguished, with prizes in clinical medicine, obstetrics and surgical pathology. Following pre-registration and casualty posts, he joined the Royal Air Force in 1940, serving in the UK and Middle East as a wing commander. He returned to the Middlesex Hospital after the war as a supernumerary registrar and was subsequently appointed first assistant to the professorial medical unit. However, frustrated by the inhibitions of an academic unit, he was appointed consultant physician to the Ipswich Hospital in the hope, more than amply fulfilled, that he could better practice high quality medicine in the environment of a district general hospital. His medical unit rapidly gained a national reputation.
An outstanding clinician, he was extraordinarily widely read, and a first class diagnostician. His astute clinical observations and investigations were soon demonstrated by early studies during wartime into the use of antimony products in the treatment of amoebic dysentery and the drinking habits of ‘burnt out’ pilots in the Middle East. Subsequently he was responsible for the recognition that giant cell arteritis and polymyalgia rheumatica were identical conditions and he identified an inflammatory process in coeliac disease and cardiac disease due to toxoplasmosis.
His studies in ulcerative colitis, first published in 1950, led to a special interest in inflammatory bowel disease and thereafter into psychosomatic relationships in the pathology of disease. These ideas were not confined to inflammatory bowel disease but expanded to include observations of potential contributory psychological factors in asthma, multiple sclerosis and rheumatoid arthritis. These promoted considerable resistance amongst numbers of more traditional physicians but at least in part are now widely accepted. They culminated in the outstanding textbook written together with a fellow general physician H E Pelser (Psychological managements for psychosomatic disorders, Berlin/New York, Springer-Verlag, c.1989). Those of us who worked with him as he explored patients’ attitudes and feelings, very often on his knees at their bedside (as a tall man it was the only way to get down to their level), could not fail to see the potential relationship between mind and body. Despite his special interests he was a true general physician and a fierce defender, not always popular in the College, of the importance of general medicine and would mount a stalwart defence against new administrative processes which he considered might threaten the quality of care delivery.
He was an excellent and devoted teacher and a great inspiration to those working with him, all of whom were encouraged to think ‘outside the box’. He developed postgraduate teaching in the hospital and was the first clinical tutor. He established a library of journals recognised during an inspection in 1982 as superior to many in teaching hospitals and ran a weekly journal club requiring team members to present original papers, excluding those in The Lancet or BMJ (all were expected to have read these) or controlled clinical trials (because these rarely contained anything of new scientific interest!). He was one of the first consultants to develop a multidisciplinary team approach, including his own physiotherapist, dietician and dedicated nursing team.
Perhaps as a consequence of his upbringing in the environment of his father’s single handed general practice, he was devoted to the support, development and training of general practitioners, as well as the importance of continuity of care. He regarded himself as always ‘on call’ for his inpatients, except during his yearly annual holidays. He immediately forged close working relationships with local practitioners, initially inviting them to join ward rounds, promoting seminars and then the establishment of the first vocational training scheme based on a district general hospital, which not only espoused all the principles of holistic care which he himself practised but also provided a curriculum based on weekly group tutorials, using what would now be called a problem-based self learning approach. He did however mount fierce opposition to the ever increasing sponsorship of teaching activities by the pharmacological industry, recognising their possible, perhaps inevitable, inappropriate impact on prescribing behaviour.
He was an inveterate writer, when provoked, of letters to The Times on an extensive range of subjects, including one suggesting the need for an independent university. This led to his involvement, together with a small group of famous academics, with the development of the University of Buckingham, from which he held an honorary fellowship and was vice-chairman of their planning committee.
His wife Deidre was also medically qualified and developed counselling skills to help those with psychological disturbances. John supported her development of the very successful Stockwell counselling centre in Colchester. They are survived by their four children – Sarah, Robert, Amanda and Julian. Their house was always most welcoming to visitors and the regular invitations to initially somewhat apprehensive new members of junior staff were always a delight. John enjoyed country pursuits but was most proud of his productive vegetable garden. Despite failing sight he remained intellectually active and to the last was capable of challenging his own doctors’ pharmacological advice.
In conclusion, he was one of the great general physicians of his generation. A big and somewhat superficially daunting man, he could be somewhat didactic and a powerful defender of his own views, but he listened to others. He was entirely honest, kind and in many ways a gentle man. He not only made a major contribution to a wide range of aspects of clinical medicine and psychosomatic medicine in particular, but equally and perhaps more importantly was responsible for the development of attitudes and skills in all those who had the privilege of working with or taught by him.
John L Day
[The Times 14 April 2007]
(Volume XII, page web)
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