Lives of the fellows

Thomas Ernest Oppé

b.7 February 1925 d.25 June 2007
CBE(1984) MB BS Lond(1947) MRCP(1948) DCH(1950) FRCP(1966)

Tom Oppé was a pioneer in the development of health services for children and, in particular, in the nutrition of babies. He was educated at University College School, where he studied no science, preferring classics. At the age of 15 he went into a bank, but after six months decided that the world of money was not for him. In 1942 he began his pre-clinical studies at Guy’s, then evacuated to Tunbridge Wells. There was little formal teaching and in 1947 he emerged with an honours MB and distinction in medicine, a scepticism for the value of formal lectures, a dislike for things surgical and a determination to become a paediatrician.

The seed for this was sown through a chance meeting on a railway station with one of the consultant paediatricians at Guy’s, Richard Ellis [Munk’s Roll, Vol.VI, p.164], who recognised Oppé’s Guy’s tie and stopped to speak with him. The conversation made a deep impression on Tom Oppé and may equally have impressed Richard Ellis who, a year or two later, whilst Oppé was still a medical student, asked him to do a paediatric house physician locum whilst the house physician was off sick. This experience left him in no doubt that he wanted to become a paediatrician.

His National Service was spent in the Navy as a surgeon lieutenant, mostly on board the aircraft carrier HMS Implacable. He recalled that this provided him with plenty of time for bridge, to look after the bar with a vast wine cellar, and to study the effects of an enclosed environment on medical illness.

Two strands of experience were to have a bearing on the course that his career was to take. The first was as research assistant to Cross in the department of physiology at St Mary’s, Paddington, which marked the beginnings of studies on the respiratory problems of the newborn infant; some years later this was to be followed by a period at the Boston Lying-In Hospital under the eye of Clem Smith, where more involvement with neonatal respiratory problems, although on this occasion in an obstetric environment, provided insight into the benefits of perinatal collaboration.

The second strand followed a period of nine months enforced leave from his house job at Great Ormond Street as he was admitted to Guy’s, and subsequently a sanatorium, with tuberculosis. As a form of recuperation he was taken back at Guy’s on a project to discover whether there was a psychiatric component to pink disease. From the psychiatric histories that he was taking, he acquired a first hand appreciation of the psychodynamic interactions between children and their parents. Behavioural studies on early mother-infant interactions, as well as studies on the effects of deprivation on child health and development, became subjects of his interest. His appreciation of the psychological components of family stress and parenting failure were later applied through the now customary multi-disciplinary approach to child abuse, as well as in the support of families with children with chronic neurologic disease and in the management of so-called psychosomatic disorders. Later in his career, many students and postgraduates benefited from experiencing Tom Oppé’s support for the doctor-led St Mary’s-based home care team, one of the first of its kind in the country; this had amongst its objectives the improving of a family’s own ability to cope with chronic disorders and so reduce the need for hospitalisation of children, a major initiative in child care provision. Specialist care was provided in the child’s home. Oppé also helped establish a community clinic, the Dorothy Gardner Centre, which not only had a nursery but also facilities for teaching and research. This involvement with care in the community was the forerunner of community paediatrics.

His first consultant post was as a consultant paediatrician in Bristol, where he came under the influence of Beryl Corner [Munk’s Roll, Vol.XII, web] – a pioneer in the care of the newborn, who once famously admitted a precious newborn gorilla from the Bristol Zoo to the hospital’s baby unit. Oppé always kept a picture of Corner in his office. In 1960 he moved to St Mary’s Hospital in London, where he became professor and later dean of the medical faculty of London University. He was a founder member of the Neonatal Society.

Tom Oppé’s other major impact was in the sphere of infant nutrition. In the first half of the twentieth century, the vast majority of babies were breast fed. Those that could not receive nourishment in this way were given a minimally modified form of cow’s milk with a reduced protein load. After the Second World War this all changed and the majority of babies were being bottle fed, with weaning on to solids at younger and younger ages. Not only were there increasing numbers of young children being diagnosed with coeliac disease, but many babies were being admitted to hospital with convulsions due to low plasma calcium levels. Oppé did pioneering work to help understand what the nutritional needs of infants and children were and chaired the Department of Health and Social Security working party which produced a series of reports including, in 1974, Present-day practice in infant feeding (London, HMSO). This working party recommended that breast feeding was the preferred method of feeding, even in a socially developed country, and that baby milk should contain less protein, sodium, calcium and other minerals than the infant formulae did at that time. They also recommended that the preferred time for weaning on to solid foods should be four to six months. These points, although hardly contentious nowadays, caused quite a stir when they appeared. Substantial changes to the manufactured formulae eventually ensued and the incidence of breast feeding increased substantially. Oppé, with his consummate skills in encouraging discussion and forging a consensus along with the application of his scientific background, played a major role in this very important turning point in the welfare of children.

He was an excellent administrator and was secretary of the British Paediatric Association for six years. He became a senior-vice president of the College and established a separate examination for those wishing to enter paediatrics. He was a member of the Committee on Safety of Medicines and was one of the key members of the influential Court Committee which produced a blueprint for the provision of paediatric services, Fit for the future (London, HMSO, 1976), which was accepted by government and implemented almost in full over the next 25 years.

As a discerning clinician, he was particularly interested in recognisable patterns of abnormalities in children and worked extensively on Williams syndrome, being a founder member and first president of the Society for the Study of Behavioural Phenotypes. He was involved with many national bodies, including the National Association for the Welfare of Children in Hospital (now Action for Sick Children) and the NSPCC, where he had a profound influence on increasing the awareness and recognition of child abuse. He also made a significant contribution to the work of the Spastics Society (now Scope), by serving on the medical advisory committee for 14 years. He served on the editorial boards of several journals, including the Journal of Medical Ethics. In 1984 he was awarded the CBE for services to paediatrics.

Tom Oppé met his wife, Margaret née Butcher, a nurse at Guy’s, when he was a student. They had three sons and a daughter, and later fostered an 11 year old girl who became a member of the family. He was immensely proud of his children and grandchildren, and the family spent many happy holidays in their cottage at Caherdaniel in Ireland. A veteran pipe smoker, Tom delighted in devising fiendish intellectual games with which to engage friends and family at household parties over the New Year. The most hospitable of hosts, he and Margaret had an extensive network of friends who, mostly readily, participated in these activities to Tom’s delight.

Rodney Rivers

[The Independent 24 September 2007;The Times 17 August 2007]

(Volume XII, page web)

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