Lives of the fellows

Hugh Alexander Fleming

b.22 October 1923 d.5 August 2006
MB ChB NZ(1947) MD(1952) MRCP(1955) FRCP(1967) MA Cantab(1970)

Hugh Fleming was the founder of the East Anglian regional cardiac unit at Papworth Hospital and a world authority on sarcoid heart disease. He was born in Glasgow, but at the age of one his parents migrated to New Zealand, where his father eventually established a small importing business. The family settled in New Plymouth, where he was brought up in strict Scottish Presbyterian tradition. He was educated at state schools and the New Plymouth Boys High School, where he won a New Zealand University national scholarship that enabled him to go to medical school in Dunedin. For five years he lived in Knox College, being in his final year president of the Students Association. This experience of community life was the happiest of times. He took up cross-country running with fair success and represented the university. Later in life he resumed running for relaxation after work and he continued to run for exercise and for pleasure well into his sixties.

His time at university was during the Second World War and all vacations were spent working in essential industries or in the Army. Such work was also necessary to supplement his scholarship. He chose jobs for interest and variety, and they ranged widely from dairy farming to scheelite mining. The latter was in a remote area beyond Glenorchy on the South Island and the love of those mountains remained with him all his life. His first hand knowledge of various occupations gave him insight into the employment problems of his patients.

He graduated in 1947 with a distinction in pharmacology and therapeutics and was awarded the New Zealand medical travelling scholarship. However, a routine chest X-ray revealed a tuberculosis lesion that, although small, dominated his life for many years to come, as it would not resolve in spite of repeated periods of sanatorium rest, phrenic crushes and pneumoperitoneum. This was, of course, before the era of antibiotics. He eventually persuaded a young surgeon to carry out a resection of the still cavitated lesion in 1952. The surgery was successful.

In between hospital stays, he had completed house jobs in Dunedin Public Hospital, worked on the medical professorial unit as a registrar, spent time in pathology, and studied as a MRC research fellow, mainly in the basement of the department of medicine under Sir Horace Smirk [Munk’s Roll, Vol.IX, p.482]. His work there was greatly supported by his future wife, Elisabeth, and not greatly assisted by Smirk, who was much involved in the writing of his book on high blood pressure and sequestrated much of the hypertensive literature from the library into his home where it was inaccessible. Hugh’s work involved creating hypertensive rats and rabbits and estimating renal function. This was still being referred to by Sir John McMichael [Munk’s Roll, Vol.IX, p.341] several decades later.

In 1950 he had married Margaret Elisabeth Galway after a long engagement imposed by the tubercle bacillus. Elisabeth’s father, Victor Edward Galway, was a professor of music, cathedral organist and acting vice chancellor. The medical dean, Sir Charles Hercus [Munk’s Roll, Vol.VI, p.236] strongly advised Hugh that a clinical career was out of the question with his medical history, but bedside medicine was what he wanted and he and his wife decided that they would risk it. With the help of his travelling fellowship, he and Elisabeth decided to travel to England for postgraduate study. This was initially planned to be for one year.

In London his intention was to study chest medicine and, in particular, pulmonary physiology. The first year at the Royal Postgraduate Medical School at the Hammersmith Hospital was not very profitable from a research point of view. Hugh decided that he needed more ‘hands on’ clinical experience in a good hospital. He therefore applied for a junior house physician job with Guy Scadding [Munk’s Roll, Vol.XI, p.501] at the Brompton Hospital. He has described the circumstances of his appointment in his memoir Papworth cardiac unit: the story of the early days of the cardiac unit at Papworth, a personal account 1957-1967 (Papworth, Papworth Hospital, 1996).

He then became acting senior registrar to Paul Wood [Munk’s Roll, Vol.V, p.456], owing to the cardiac senior registrar developing tuberculosis. He quickly became fascinated with cardiology and thereafter this was the direction of his work. He subsequently worked at Sully Hospital, Glamorgan, where he helped to establish cardiology and cardiac surgery, and after three years there, returned to the Brompton as senior registrar in cardiology.

Consultant posts were scarce and London was full of well-trained senior registrars looking for jobs, so in 1958 he was persuaded by Paul Wood to accept the post of director of the Hallstrom Institute of Cardiology at the Prince Alfred Hospital in Sydney. Owing to the outdated honorary system this turned out to be a most unhappy time. One day, however, the telephone rang: “Would he be interested in a job in Cambridge?” He borrowed the airfare and, in 1959, became the first consultant cardiologist at Papworth Hospital and in East Anglia.

He was the first non-Cambridge graduate to be appointed to the Addenbrooke’s Hospital staff, where he was greeted with: “I understand that we have no need of a cardiologist, but I suppose that you will find something to do.” For eight years he was the only cardiologist in East Anglia and, during that time, he made cardiology the respected specialty that it remains to this day, with 41 specialists in the region.

He examined in medicine and pharmacology for Cambridge University and in 1969 was elected a fellow of Darwin College. He greatly enjoyed this and, over the years, served on a number of college committees; he continued to be active in college affairs for many years into his retirement. The bridge across the millstream that he endowed is now officially ‘Fleming’s Bridge. He served on the council of the British Cardiac Society and the British Thoracic Society and founded ‘Hugh’s Club’ – an association of cardiologists who for many years met to discuss current problems. He was much involved in the planning of the Cambridge clinical school and, after its foundation, in the teaching of clinical students. He particularly enjoyed bedside teaching and its lessons; for example, he was moved when a rather tough houseman told him that he would always remember that he had taught him that patients were people.

He worked long hours as a busy clinician and his research emerged from this – very much in the Paul Wood tradition. He published widely and of particular interest were pulmonary hypertension, pulmonary embolism and mitral valve disease. He made a detailed study of the prophylaxis against infective endocarditis and almost succeeded in establishing a trans-Atlantic agreement on policy. He became very interested in sarcoidosis of the heart and was responsible for showing that this was not the rarity that it had previously been described, but an important and much overlooked problem. His advice on problems of sarcoid heart disease was sought from all over the world and he lectured widely on this subject, as well as publishing numerous papers. Throughout, he took a detailed interest in the pathology and he leaves a large collection of pathological material and photomicrographs that he took on a research microscope housed in a spare bedroom at home. This microscope and the material now remain at Papworth Hospital.

With the advent of cardiac transplantation in 1979 Papworth went through a tumultuous period. The disturbance was such that he feared for the survival of the unit. He quietly continued to devote himself to the care of the population of East Anglia with heart disease. This he achieved both in Cambridge and in the clinics that he had set up around the region – a hub and spoke model that remains one of Papworth’s strengths. The cardiac service at Papworth was never compromised by transplant activity.

A few years later another dark cloud overshadowed his life. Elisabeth developed cancer. She died in 1983. Hugh was bereft until he realised that his former secretary, Julia Cusden, was the soul mate that he needed for the rest of his life. After an old-fashioned courtship they married and enjoyed remarkable happiness. He had two daughters from his first marriage: Jan and Jennie.

Boastfulness was not part of his nature, but he did say that he had been privileged to advise eight Nobel laureates. He put his NHS practice first and regarded private practice as a ‘safety valve’, for when the NHS could not cope – a healthy attitude that was also reflected in the parking arrangements for his rooms at his home – a bicycle rack. He was an ideal senior colleague, available to give advice and help, but content to let the next generation take control.

He was fortunate in having a succession of first class junior staff. Many attained professorial or other senior posts all over the world. He kept in contact with them and was a welcome visitor to their homes for years afterwards, especially following his retirement in 1988. This phase of his career allowed him time to undertake medico-legal work, and sit on medical appeals tribunals until he could no longer bear the hopeless inefficiency with which they were conducted. His photography was digitised and blossomed with a particular focus on misericords. His garden was the envy of Barrow Road. His tennis became more skilled, despite his hip replacement and cataract surgery. His caravanning took him to the west coast of Scotland and all over Europe, including a six-week trip to Padua and back to give a lecture. But New Zealand drew him back time and time again to revisit much-loved wild places and to keep in touch with old friends. He had all the qualities of a native of those Islands – warm, resolute, independent, socially aware, and a great lover of nature and sport.

Throughout his life he held a simple Christian belief and for many years he actively supported Great St Mary’s in Cambridge. He would have been amazed that the church was packed to the galleries for the service of thanksgiving for his life.

Michael Petch

[Brit.med.J.,2006,333,1223; The Independent 13 September 2006]

(Volume XII, page web)

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