Lives of the fellows

Ronald Temple Duncan Emond

b.7 March 1922 d.26 February 2011
MB ChB St And(1945) DTM&H(1949) MRCP(1956) FRCP(1972)

Ronald Emond was a consultant in infectious diseases at the Royal Free Hospital, London. He was born in Oban in the west of Scotland, the son of George Duncan Emond, a solicitor, and Jean Temple Emond née Marshall. Ronald spent his early childhood around the shore, seas and boats. For the rest of his life he enjoyed sailing, and loved the waters and landscapes of the Western Isles.

Following his father’s career, the family moved first to Glasgow and later to Barnhill, an area of Broughty Ferry, in the suburbs of Dundee. Ronald became a scholar at the highly regarded Morgan Academy. However, his final school examinations were delayed for a year following a back injury which confined him to bed rest. During this period, he developed a lifelong habit of reading and a keen interest in practical projects involving gadgetry and handiwork.

Finally completing his school examinations, he entered medical school at the University of St Andrews, where his studies were soon overtaken by the Second World War. His ward experience included work in Dundee Royal Infirmary, but also in the military wards which were quickly set up in the Tayside area (even the Gleneagles Hotel became a military hospital).

Following his graduation in 1945, Ronald joined the Royal Air Force Medical Service and, with many others, went to the Far East, where the later wartime struggles were taking place. He arrived in Burma via Cairo and India, then travelled northwards from Rangoon and finally reached a small military hospital in the hills. When a new nurse arrived to support the ward contingent, he immediately enlisted her to play tennis. Thus his friendship began with Nesta Mott, who would be his lifelong companion.

During his time in the Far East, Ronald saw many infectious and tropical diseases. He saw the devastating effects of smallpox and learned how cases could be safely managed. When he returned to the United Kingdom in 1948, he decided to follow his interest in infectious diseases. He continued his early career in Tooting, where, in 1954, the Grove Fever and Fountain hospitals were destined to become part of St George’s Hospital, and completed his specialty training at the South Middlesex Hospital.

In 1951, he and Nesta were married and, soon afterwards, Ronald was appointed physician superintendent at Coppetts Wood Hospital, a fever hospital, with its own district public health laboratory in Muswell Hill, north London. Here he found the traditional isolation hospital with wards (pavilions) dedicated to the cohort management of different infections. Not only the sole physician in attendance, the physician superintendent was also responsible for management, hiring and firing, staff and patient safety, and ensuring that staff received their wages. This included the maintenance staff, gardeners who took care of the hospital market garden and orchard, and the keepers of hens and pigs. He recounted his first human resources decision, which was to dispense with the services of the none-too-fragrant pig-man.

Despite the optimistic view of the early 1950s that infections would be conquered by vaccination and the use of antibiotics, Ronald was a key figure, working with Lawrence Garrod [Munk’s Roll, Vol.VII, p.203] and other London microbiologists of the day, in documenting the spread of the first pandemic of antibiotic-resistance Staphylococcus aureus. He wrote a long series of clinical and epidemiological papers, together with observations on the speciality and on training in infectious diseases, and continued to publish into the 1980s.

In 1954, Coppetts Wood Hospital had 144 beds with a relatively low level of occupancy. By 1955, the hospital was threatened with closure, but was reprieved, with a plan of future modernisation. One by one, wards were updated. Two were converted to single occupancy cubicles and, by 1963, they had been taken over by the transfer of the Lawn Road Fever Hospital services to Coppetts Wood. The other ward was a general medical ward for the Archway group of hospitals. The infectious diseases consultant, A Melvin Ramsey, with the trainee doctors of the Royal Free, joined the staff contingent. In 1968, Coppetts Wood Hospital became part of the Royal Free Hospital group. Ronald became a consultant to the Royal Free Hospital and a teacher to the medical school, and participated actively in the Royal Free’s hospital management system.

In the 1960s, the World Health Organization commenced plans to achieve the global eradication of smallpox. Ronald again travelled eastwards and spent time in India, seeing hundreds of cases, to become a highly experienced Ministry of Health smallpox consultant. This experience was extensively called upon in 1973, when a case occurred in a large London teaching hospital. Ronald and a local Medical Officer of Health worked tirelessly to care for the patients and control the resulting outbreak but, sadly, could not prevent the deaths of two case-contacts. Before seeing the suspected cases, Ronald self-administered a booster vaccination. Ever professional, he wore his oldest business suit to attend the cases, together with wellington boots, which he decontaminated by washing with disinfectant and then placing them upside down to dry, on posts in his garden.

Following this outbreak and the impending eradication of smallpox, an overarching national epidemiology service was developed – the Communicable Disease Surveillance Centre (CDSC), part of the then Public Health Laboratory Service. Ronald and the CDSC director, Spence Galbraith [Munk’s Roll, Vol. XII, web] worked closely together and set up the first infectious diseases and epidemiology cross-training system in the UK.

Lassa fever was described in the late 1960s in West Africa and caused deaths in healthcare workers, both locally and in laboratory workers in the USA. Marburg virus, imported with infected laboratory primates from Africa, had caused a large outbreak in Germany and Yugoslavia in the late 1950s. Following these events and the 1970s smallpox cases in London, the Health and Safety Executive and Department of Health set up the Advisory Committee on Dangerous Pathogens, of which Ronald became a key expert member. The old, single-use smallpox hospitals were closed, and Coppetts Wood became a resource in case of the suspicion of a smallpox case. In 1974, working with Philip C Trexler from the Royal Veterinary College, Ronald developed and tested the flexible film patient isolator for the isolation of patients with haemorrhagic fevers. In the 1970s and 1980s, Lassa fever cases and an Ebola case were managed safely in the unit. The Coppetts Wood High Security Infectious Diseases Unit became widely known. Although the isolator was sometimes criticised, it provided an element of safety at a time of uncertainty about the likely spread of dangerous imported infections, and provided a focus of expertise in facilities and patient management. The isolator is still one component of a national resource for expertise in dangerous infections, now based at the Royal Free Hospital in Hampstead, and highly respected across the UK and Europe.

For his work in managing and developing systems for containing hazardous infections, Ronald was awarded the Tulloch memorial prize and medal. He was very proud of this, which represented both his Scottish roots and the famous microbiologist, William John Tulloch, who was appointed the first professor of bacteriology in 1921 at Dundee, Ronald’s alma mater. Equally valued was his renewed contact with friends and fellows from Dundee and St Andrew’s, which they continued as long as their health allowed.

Ronald expected 100 per cent effort and a high quality, evidence-based approach to all aspects of medical care and safety. He did not tolerate slapdash thought or action, and he hated unreliability and unpunctuality. But, he was not above a little intellectual quizzing and teasing, a joke, dressing up and sharing festive occasions – always visiting the hospital on Christmas morning. He provided tennis and croquet equipment to enhance the recreational facilities, and competed hard when they were used. He and his wife were generous in inviting colleagues to share events and entertainments in his beautiful garden in Totteridge.

Ronald took an active interest in the personal training needs and well-being of junior doctors and nurses. He lectured and taught, campaigned for high-quality training and accreditation, and authored or co-authored four textbooks, including two colour atlases richly illustrated with excellent clinical photographs which he took over many years (A colour atlas of infectious diseases London, Wolfe, 1974, Diagnostic picture tests in infectious diseases London, Wolfe Medical, 1987).

While examining in London for the diploma in tropical medicine and hygiene, he suffered a transient stroke, and was swiftly referred to a neurological unit by his fellow examiners. He afterwards remarked on how fortunate he was that his symptoms did not occur later, on the underground journey back home. Following this, he retired in 1986 to pursue many major interests – the expanding family, his garden, sailing, photography and gadgets. He was a keen photographer and had an enormous clinical and family archive, which he maintained throughout his life. His garage had no space for the car, but was dedicated to his office, archive and computer system, including the latest broadband services. This gave him pleasure as he became less mobile in his later years, until a major acute illness overtook him in late 2010.

After a brief return home, he died in the Royal Free Hospital, just a few months before the death of his wife Nesta. He was survived by his four children, three of whom are doctors and one an architect and designer.

Barbara Bannister

(Volume XII, page web)

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