b.16 August 1917 d.19 June 2010
BM BCh Oxon(1941) MRCP(1949) FRCP(1964)
Adolf Marcus Joekes, known to all his professional colleagues and friends as ‘Jo’, was a pioneering figure in UK nephrology. He was part of the team that performed the first haemodialysis for acute renal failure in the UK, and also undertook the first renal biopsies.
He was born in Aerdenhout, Netherlands, but went to Britain as a child when his father, Theodore Joekes, a pathologist, took a position with the Medical Research Council in Hampstead after the First World War. His mother, Marianne née de Graaff, was also a doctor. After qualifying in medicine at Oxford University and St Bartholomew’s Hospital, London, in 1941, Joekes became an MRC fellow in neurology, and first worked for the Royal Navy on an effective treatment for seasickness. He then worked for the Royal Air Force and was among the first to isolate adrenal cortical hormone from human urine, this being investigated because of a prevalent theory that eating large amounts of adrenal gland reduced flying fatigue.
His interest in kidney disease was stimulated by the case of a young man he cared for who had been crushed in the Blitz. Despite recovering from otherwise rather minor injuries, the patient died anuric two weeks later. Joekes knew of Eric Bywaters’ [Munk’s Roll, Vol.XI, p.86] work on crush syndrome, and he was able to read in Dutch Willem J Kolff’s original thesis on his work with the artificial kidney, De kunstmatige nier (Kampen, J H Kok, 1946). In 1946, Joekes was able to work with Bywaters at the Royal Postgraduate Medical School, Hammersmith Hospital, bringing with him a Kolff artificial kidney, the first to be used outside the Netherlands. The first patients with acute renal failure were successfully dialysed by Bywaters, Joekes and their colleagues between 1946 and 1947. It was not an easy time. There were many problems with the equipment, and he described how he would set up the machine during the day, then stay up dialysing a patient all night, before going to bed, only to be woken when the patient got worse. But, despite some documented successes, there was remarkably little enthusiasm for dialysis treatment for acute renal failure since the conservative approach to management, using draconian dietary and fluid restriction, held sway in the same department of medicine.
Joekes was a true nephrology polymath, a man of formidable intelligence whose interests spanned almost all aspects of the emerging specialty of nephrology. In 1954, he was the first in the UK to perform renal biopsies, having recently moved to St Mary’s Hospital, Paddington. Here he also began a formidable partnership with a young lecturer in pathology, Robert Heptinstall, later to become one of the giants of renal pathology. They published a series of seminal papers on clinicopathological correlations in glomerular disease. Heptinstall himself ascribes his long term interest in renal pathology to this satisfying collaboration, giving credit to Joekes’ ‘wonderful imaginative mind’.
Joekes was one of the Renal Association’s invited founder members in 1950 and was the secretary from 1956 to 1961. In 1956, the Renal Association received a letter from Jean Hamburger [Munk’s Roll, Vol.IX, p.221] on behalf of the Société de Pathologie Rénale proposing an international meeting on the kidney in Évian in 1959. Eventually held in Évian and Geneva in 1960, this was the meeting at which the International Society of Nephrology (ISN) was born. Joekes played a key role as secretary of the organising committee for the meeting. He was perhaps the obvious person to lead for the Renal Association as he was its secretary at the time; but probably more importantly he was multilingual and could cope when Hamburger, who was to become the first ISN president, preferred business to be conducted in French. Joekes is recorded as thinking that the first draft of the meeting’s scientific programme was ‘high on spa water and low on the science of renal disease’ (the Evian water company was a major sponsor of the meeting).
In 1959, Joekes moved to St Peter’s, St Paul’s and St Phillip’s hospitals (colloquially known as the ‘Saintly Ps’) and the Institute of Urology, where he continued his clinical work on acute renal failure and nephrotic syndrome. At the Renal Association he presented papers on the role of tubular proteinuria, albumin synthesis in nephrotic syndrome, focal glomerulonephritis, acute renal failure during open heart surgery and renal oxalate handling in primary hyperoxaluria and chronic renal failure.
He was an early advocate of the use of nuclear medicine for kidney disease and also worked as a civilian adviser to the RAF medical centre at Halton near Aylesbury, which provided renal failure care for the armed forces, as well as the civilian hospitals of southern England. Willem Kolff, who was now in America, sent him an improved dialysis machine for Halton, so he got RAF technicians to make copies of it, and as a result was able to start one of the country’s first three dialysis units in June 1957.
In the mid 1960s, he formed a deep friendship with Lord Antrim, and together they founded the St Peter’s Trust that would further research work in both urology and nephrology, and act as a means of improving communication between these two fields. The trust, which continues, raised the money to create the first chair in nephrology in the UK, established at University College London in 1991.
He married Anne Rosemary née Muirhead in 1945. They had two sons and two daughters. Joekes retired in 1982 and lived with his family near Bath.
G H Neild
[Renal Association obituary – www.renal.org/aboutus/pastmembers/10-06-24/Dr_Mark_%E2%80%98Jo%E2%80%99_Joekes_1914-2010-2352053858.aspx – accessed 3 June 2011]
(Volume XII, page web)
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