b.6 April 1928 d.14 March 2011
BSc Lond(1948) MB BS(1951) MRCS LRCP(1951) MRCP(1956) MD(1961) FRCP(1972)
Harry Hall was a consultant physician at the Royal Devon and Exeter Hospital. He was an outstanding clinician, noted for his diagnostic skill and his readiness to develop new services for patients. Diagnosis, for much of the 20th century, depended on clinical acumen, something Harry had in good measure but which he continually sought to refine. You might be having a quiet lunch when he would erupt on the scene to talk about his latest twist in applying mathematical methods, really needing to know now how exactly you made a diagnosis.
He was born in Kingston upon Thames, Surrey, the son of Edward Hall, a civil servant, and Emily Hall née Littler. He attended Tiffin School and entered University College London in 1945, obtaining an intercalated BSc in physiology in 1948 before graduating in 1951 with a distinction in medicine, having been awarded the UCL Andrewe’s scholarship, the physiology prize and scholarship, the Erichsen prize and the Magrath prize in surgery. He gained his membership of the RCP in 1956.
After initial house appointments at University College Hospital, he enlisted in the RAF on a short service commission, first at Cranwell then, with the rank of squadron leader, at the Institute of Pathology and Tropical Medicine.
On leaving the RAF, he took registrar posts at Fulham, University College and Whittington hospitals. He then became a senior medical registrar at the Royal Devon and Exeter Hospital in 1959, rotating to Bristol Royal Infirmary in 1962. From there he took up an Eli Lilly travelling fellowship to the graduate school of the University of Pennsylvania, USA.
He was appointed as a consultant physician to the Royal Devon and Exeter Hospital in 1963. His ability to see a problem and solve it resulted in him setting up a renal service which was in the vanguard of chronic renal dialysis. Undeterred by considerable regional and national opposition, he developed this service, initially with little funding or staffing, until it became a model for similar services in district general hospitals and attracted others to join him.
At the same time as developing the renal service, he continued with two other important specialties, namely rheumatology and diabetic care. He had seen the introduction of corticosteroids for rheumatoid arthritis and later became an enthusiastic proponent of disease-modifying drugs. He had also been trained in the care of diabetes, so he provided long-term care for many diabetic patients well before more specific services were established for them.
He went on to improve local gastroenterology services by introducing routine and emergency fibreoptic gastroscopy. And, at a time when there was widespread scepticism about fibrinolytic therapy for myocardial infarction, he was an active proponent – and was delighted when he was shown to be right.
Harry was the person you went to if you were stuck with a diagnosis or if you needed care for yourself or your family. His bed-side manner, though, was not always a smooth one. A consultant with an obscure disease recounts how Harry said: ‘I don’t know what’s wrong with you, but you’re not going to die from it’. This was one of the rare occasions when the diagnosis eluded him, but the prognosis was entirely accurate. Patients enjoyed, and often commented on, his frank and truthful, but always caring and compassionate, manner. Their welfare he placed above all else; it was a foolish medical manager whose actions impeded optimum clinical care.
Though he rightly challenged some of the directions postgraduate and continuing medical education took, it would be incorrect to say he was opposed to academic medicine. When medical audit came in he spoke and wrote about what he saw as an unnecessary interference with clinical practice. In his own case, every week he reviewed all the letters sent out by his staff, vigorously discussed difficult cases, identified and rectified any mistakes. For him audit was not a new idea but an intrinsic, well-established, part of clinical practice which he and others had been doing for decades.
He could also turn his formidable intellect to other problems. Again, some have doubted his interest in committees, forgetting that he chaired the central manpower committee. This was a time when there were so-called ‘time-expired senior registrars’ due to the lack of permanent posts for those who had been trained. He made a telling comment that the manpower committee’s job was to ‘turn a pyramid into a cube’. More importantly, he made the compassionate comment: ‘Time is not the only thing that expires for senior registrars – hope does so as well’. He was disappointed when his manpower proposals were opposed on seemingly irrational grounds, but pleased some years later for another Exeter-based doctor to build on his work.
In his private practice he became chief medical officer for the Medical Sickness Society, where he robustly challenged received wisdom about permanent health insurance by using private investigators and video recording to show how a few people cheated by falsely claiming they were badly disabled when they were leading an active life.
He continued publishing papers on topical subjects into his 80th year. The diversity of his publications, starting with the earliest one, a literary criticism of the Thomas Mann novel Doctor Faustus, progressing through his MD research on finger clubbing, via Bayes’ theorem on probability, then on to a final commentary about identifying sick children, attests to the fecundity of his mind. It was a brave, and often sorrowful, opponent who argued with Harry on a subject they erroneously thought he would know little about. Literature, music, philosophy, statistical theory and contemporary science were all topics where he could hold his own with experts.
His family was important to him. He was devoted to and took great pride in the achievements of his two daughters and four grandchildren; he and his wife Christine Mary née Tyler celebrated their diamond wedding. Throughout his life Harry was physically active, enjoying diving, sailing, windsurfing, mountain biking, skiing and walking daily with his beloved dogs. He kept these activities going into his eighties, though not without the occasional tumble. His physicality was his undoing, as he sustained multiple injuries by falling from a ladder, injuries from which he did not recover.
Harry’s life is a prime example of how successfully the interface between specialism and generalism can work to mutual benefit. He was just as happy in the wide expanses of general (internal) medicine as working in detailed areas of chosen specialties. Everyone benefited from his approach – most notably patients – and that’s what Harry would have seen as his great achievement.
[Brit.med.J., 2011 343 5632]
(Volume XII, page web)
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