Lives of the fellows

Wallace Fox

b.7 November 1920 d.22 January 2010
CMG MB BS Lond(1943) MRCS LRCP(1943) MRCP(1950) MD(1951) FRCP(1962) MFCM(1972) FFCM(1976)

Wallace Fox was director of the Medical Research Council (MRC) Tuberculosis and Chest Diseases Unit. A man noted for his outstanding breadth of vision, his work helped to change tuberculosis (TB) from being an untreatable disease to one that can effectively be alleviated in both rich and poor countries, potentially saving millions of lives worldwide.

Born in Bristol, he was the son of Samuel, a fashion designer, and his wife Esther née Stonehill, whose father, Mark, was a linseed oil manufacturer. Educated at Cotham Grammar School in Bristol, he studied medicine at London University and Guy’s Hospital. Qualifying in 1943, he caught TB himself and was confined to bed rest at the Bristol Royal Infirmary for two years, an experience which stimulated his interest in the disease which, some said, bordered on the obsessional. After house jobs at Preston Hall Sanatorium at Aylesford in Kent (from 1946 to 1950), then back at Guy’s for a year, he became assistant chest physician at the Hammersmith Hospital in 1951. The following year he joined the staff of the MRC Tuberculosis Research Unit, led by Philip D’Arcy Hart [Munk's Roll, Vol.XII, web].

At the time when he joined the unit, half of those who contracted TB died from it. New anti-bacterial drugs were being introduced to combat the disease, but the method of control preferred by the World Health Organization (WHO) was the BCG (Bacillus Calmette-Guerin) vaccination. He began a career long collaboration with Denny Mitchison. Fox pre-empted the WHO’s later change of policy by deciding to concentrate on treatment and he organised a national survey of drug resistance, producing a combination drug regime streptomycin with isoniazid or para-aminosalicylic (PAS) acid which became standard therapy for the next 15 years in western Europe. However the PAS was too expensive for poor countries and he developed a cheaper alternative – thiacetazone.

In 1956 he was seconded to the WHO as senior medical officer and director of research of the Tuberculosis Chemotherapy Centre in Madras (now Chennai), India. The he ran a study comparing the results of drug treatment given in a sanatorium setting and those when the medication was taken at home. It was found that there was no difference in the outcome – a very welcome result for poor nations in particular as the costs of hospitalisation were prohibitive for them. As Mitchison commented ‘It was one of the most cost-effective pieces of research ever – it was probably responsible for closing down sanatoria worldwide’. The problem remained that treatment needed to be taken for at least 12 months if it was to be effective and not recur; the solution to this, he felt, was to supervise the therapy.

On his return to London in 1961, he began to research shortening the necessary treatment period. Four years later he was appointed director of the TB Unit and initiated various trials in Africa, Hong Kong, Singapore, Prague and Algeria. New drugs were even tested on the nomadic Bedouin tribes of the Sahara. It transpired that a six month course of two drugs rifampicin and isoniazid plus pyrazimanide for the first two months was the most effective and it is now recommended worldwide by the WHO. The unit closed with his retirement in 1986.

During his time at the unit, he also made important contributions to the treatment of spinal and pericardial TB and worked with Margaret Turner Warwick at the Royal Brompton on asthma and lung cancer. He played a leading role at the WHO and received many national and international honours and awards including being appointed CMG. He published many scientific papers on TB and respiratory disorders generally.

A man of great learning, his interests included, art, classical music, literature, history, geology, and palaeontology. He also loved to travel.

In 1956, in India, he married Gaye Judith née Akker, whose father Tod was a company director. When he died from the Alzheimer’s disease that had clouded his final years, he was survived by Gaye, a talented artist and their three sons, Adam, Jason and Daniel.

RCP editor

[The Guardian - accessed 27 April 2015; The Telegraph - accessed 27 April 2015; Lancet - accessed 18 May 2015]

(Volume XII, page web)

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