Lives of the fellows

Hugh Edward de Wardener

b.8 October 1915 d.29 September 2013
CBE(1982) MBE(1946) MRCS LRCP(1939) MB BS Lond(1939) MRCP(1946) MD(1949) FRCP(1958)

Hugh de Wardener was the first professor of medicine at Charing Cross Hospital Medical School, based at Fulham Hospital, a pioneer of dialysis treatment and the first doctor in the United Kingdom to perform renal biopsies.

Hugh was born in Paris to American parents. His father, Edouard de Wardener, the son of an Austrian soldier who had travelled to America to fight in the Civil War, and his mother, Becky (née Pearce), a doctor’s daughter from Albuquerque, New Mexico, who was in Paris for singing lessons, had met and married in Paris in 1914. His parents’ marriage did not last long and he was brought up by his mother and a nanny from Alsace. The three of them wandered around Europe, never staying anywhere very long. He went to school in many places including Lausanne, Rome and Florence until, at the age of eight, his mother took him to Albuquerque, to spend a year with her parents, where he learnt English. He returned to France by himself (in the care of the purser), to be sent to a Spartan school in the Pyrenees, where he learned to swim very fast to avoid being set upon by the bigger boys in the pool. Soon afterwards he was sent, with a strong French accent, to a prep school in Sussex and then, aged 13, to Malvern College in Worcestershire.

At birth his father had registered him as Edouard Hermes Hippolyte. This was swiftly and officially amended, on his birth certificate, to Edouard at his mother’s instruction. At school in England he became a fan of the Bulldog Drummond books and decided that he too would be called Hugh; it was as Hugh Edward that he was naturalised British in 1938; because of his hair he was often known as ‘Ginger’. His mother had persuaded Bloomingdales, the New York store, that they needed an office in Paris with her to run it, so Hugh’s home was once again in Paris and, though at school in England, his holidays were spent in Paris and in the Mediterranean; he was on Majorca when the Spanish Civil War broke out and was amongst those rescued by the HMS Repulse. His mother married again, to an American opera singer, the resident bass at the Opéra Comique; his uncle Rudolph de Wardener, a banker also resident in Paris, was married to an American/Yugoslav actress who had become the directrice of the Paris fashion house Mainbocher. Even by the time he qualified as a doctor he was not very ‘English’.

Although he wanted to do medicine, the cost of the lengthy training dictated that he study something else and he chose engineering; however, realising later that maths was intuitive and that he lacked that intuition, he discussed it again with his mother, and she found the money for him to switch to medicine. He studied at St Thomas’s Hospital Medical School and, once qualified in June 1939, he took the first job he could find, in Scunthorpe, where, within a week, he found himself as the only physician. He was married the day before the Second World War was declared, joined the RAMC as soon as he could and was in uniform before the end of the year. He was on the last ship to arrive in Singapore before it fell to the Japanese in February 1942 and spent the next three and a half years as a prisoner of war (POW).

He spent a year in Changi before being amongst the first to be sent north, to Siam, to the Burma-Siam Railway, which the Japanese were building using POWs as the labour force. He said, in later life, that there was never a time when he didn’t want to do research, though he didn’t really mind what the research was, and while in Changi he had his first opportunity to demonstrate his ability to collect and use clinical information to advance medical knowledge and treatment. His study of Wernicke’s encephalopathy, particularly amongst patients with dysentery, and their treatment with vitamin B1 proved that the Wernicke’s was due to vitamin B1 deficiency and was not associated with alcoholism. This work was written up as a paper published in the Lancet in 1947 (‘Cerebral beriberi [Wernicke’s encephalopathy]: review of 52 cases in a Singapore prisoner-of-war hospital’ Lancet 1947 Jan 4;1[6436]:11-17). Later he found himself managing an epidemic of cholera amongst POWs working on the railway in one of the camps in the jungle. This experience too he wrote up as a paper which was also published in the Lancet (‘Cholera epidemic among prisoners-of-war in Siam’ Lancet. 1946 May 4;1[6401]:637-40). His notes containing the data for these two papers had been sealed in a biscuit tin, soldered shut, wrapped in oilskins and buried in a grave in Chungkai cemetery; to have been found with them would have meant certain death. They were retrieved after the liberation. Not written up as a medical work, but described in a book written by a fellow prisoner (John Coast Railroad of death, etc [The personal narrative of a subaltern taken prisoner at the fall of Singapore] London, Commodore Press, 1946), Hugh hit on the idea of inoculating prisoners suffering from diphtheria using serum obtained from prisoners who had had, and recovered from, that disease. This treatment produced some good results in an otherwise often fatal condition. Overall there is no doubt that his work in captivity saved many lives as well as, later, adding to medical understanding of the various infections and malnutrition that he encountered. He was awarded a military MBE in 1946. Towards the end of the war, after the railway had been completed, the POWs had some leisure and several amateur dramatics groups started up; de Wardener took part, first acting, then directing and he enjoyed it so much that he seriously considered a career on the stage, until he realised that he had no private income to fall back on.

He considered himself to have been lucky all his life. He was lucky to have been large as a child (5ft 10 inches at the age of 13) and so was never bullied; he was lucky that the war held off just long enough for him to have qualified; he was lucky to know someone who helped him, a newly qualified doctor, to join the RAMC at a time when they were recruiting GPs; the only time he was shot at in the war he was driving a truckload of mattresses which stopped the bullets; he jumped into a slit trench seconds before a shell exploded where he had been standing. He considered that he had been lucky to have been a POW and a doctor. ‘We were able to do our job and we didn’t have to do any of the horrible work, the hard labour.’ ‘Not only had I been able to do my job, I had had wonderful experiences seeing things I could write up which were a great help in point of view of a career. I was lucky to have been somewhere when these experiences were taking place. When I came back my name was made, I was given a job at Thomas’ without any trouble.’

He was demobilised in 1945 and became a house physician and then registrar at St Thomas’ Hospital. His academic career started in 1950, when he was appointed to St Thomas’s Hospital Medical School, first as a senior lecturer and then as a reader. In 1960 he was appointed as professor of medicine at Charing Cross Medical School.

The basis for his long and glittering career in nephrology was his knowledge and understanding of renal physiology. Much of his teaching of undergraduates focused on this. He told students that if they grasped how the kidneys work normally they would better understand renal pathology. His great interest in, and understanding of, renal physiology was recognised when, in 1956, he was elected to the Physiological Society.

Much of his early research and many publications whilst at St Thomas’, related to the renal circulation under various conditions and to the mechanism of urinary concentration. At Charing Cross his interests in normal kidney function continued. Soon after his appointment he set about establishing a range of normal values for a variety of renal tests. Some of his students from that time remember participating in such studies and can attest to the nauseating effects of oral ammonium chloride used in urine acidification studies!

At Charing Cross his pursuit of a ‘third factor’ affecting sodium transport in the kidney – the natriuretic hormone – occupied much of his laboratory time and paper writing. But many other research projects were undertaken by other doctors and scientists on the team with his close involvement and supervision. Each ‘sub-team’ attended a weekly ‘metabolic meeting’ and reported progress with ‘the prof’ in the chair, taking a keen and active interest. Indeed it was the multiplicity of his research and clinical interests that made him an outstanding figure in nephrology on a world-wide basis. These interests included urinary tract infection (Fulham had a Medical Research Council renal infection laboratory), calcium, magnesium, aluminium and vitamin D metabolism, metabolic – especially renal – bone disease and many aspects of renal failure, haemodialysis and renal transplantation. Incredibly he produced papers for publication in every year from 1949 to 1997, in spite of a cardiac arrest at the age of 75 caused by a clot dislodged during an angiogram of his coronary arteries.

He was the instigator and deeply involved, from its earliest stages, in the development of a computer programme to collect, store and display physical, biochemical and haematological data pertaining to dialysis and transplant patients. This project came to fruition and was used nationally on a wide scale. On a lighter note, Hugh always enjoyed involvement in clinical topics that were published under rather catchy titles such as ‘stock-car kidney’, ‘tetracycline poisoning’, ‘diuretic-induced oedema’, ‘the shrinking man syndrome’. He was equally concerned for the welfare of patients and their ability to lead as normal lives as possible to which end, in 1971, he set up the Holiday Dialysis Trust, purchasing St Anne’s Convent, Emsworth, which continues to provide self-catering holiday accommodation with nurse-led haemodialysis for patients and their families.

After his ‘retirement’ – a term he hated and which was singularly inappropriate to him – in 1981, he remained heavily involved in research, still focusing significantly on sodium transport mechanisms. Subsequently he worked on links between this and essential hypertension. He co-authored over 50 papers on this subject until 2012, when he was 96.

Nothing demonstrates more clearly his wide knowledge of kidney function and diseases than the five editions of his book The kidney; an outline of normal and abnormal structure and function (London, J & A Churchill, 1958). He was the sole author of all five editions. The clear and easily read text reflected his high standards when it came to the written word. In all his publications he sought for plain English – and no doubt plain French in some cases! To sit with him while he revised the grammar and prose of a paper to be submitted for publication was a lesson in both English and medicine. Once, when vetting the first draft of a junior’s MD thesis, he commented that he could not understand a particular, half-page, paragraph; he asked the author to explain it. After some thought the author described what he was trying to say using three brief sentences; de Wardener responded ‘Then why didn’t you bloody well write that?’, and blue-pencilled the half page!

Although he had decided against a career in the theatre, he much enjoyed the theatrical aspects of addressing an audience and giving lectures. The standards he set himself as a speaker were as high as for his written work; he dreaded being thought either boring or unintelligible. When invited to deliver a paper at a conference in Italy he decided neither to take the easy option of speaking in English nor to risk mangling the Italian language himself but to employ a young Italian actor. The paper was first translated into Italian and then back translated to check the accuracy. He taught the actor how to deliver the paper and recorded the result. He mimed to the recording until two minutes before the end when he returned to sit down among the audience and allowed the recording to finish without him. He said that there were many grateful Italians.

Hugh de Wardener’s contributions to renal medicine were recognised in different ways and in many countries. He was president of the International Society of Nephrology (from 1969 to 1972) and of the Renal Association (from 1973 to 1976). He was a member of the Medical Research Society, the British Hypertension Society and the International Society of Hypertension. He was elected to l’Académie Nationale de Médecine, Paris, the Czechoslovak Medical Society, l’Académie Royale de Médecine de Belgique and the Association of Physicians of Great Britain and Ireland. His awards, among others, included the Homer Smith award from the American Physiological Society and the Hamburger award from the International Society of Nephrology. He was made a CBE in 1982. The new renal unit at Hammersmith Hospital was named in his honour and it was fitting that he should have died there, just one week short of his 98th birthday. The awards and accolades are all a matter of public record, but far more difficult to convey is the effect of his presence on patients and his readiness to listen; his ability to reassure and to inspire confidence was innate and lifelong. In Railroad of death, the author, a newly-arrived patient in the diphtheria ward wrote ‘His soft level voice sounded as sympathetic as it did efficient and after half a minute I felt as if a great pressure had been lifted off my chest.’ The patient lying next to him confided later ‘there’s no need to worry any longer, Ginger’s got it properly under control’.

Hugh was an accomplished athlete. Perhaps helped by his early experiences in the swimming pool in the Pyrenees, he became captain of swimming at Malvern and held the public schools freestyle record for many years, he was a powerful swimmer all his life. He played ice hockey for St Thomas’ while a student (Richard Doll [Munk’s Roll, Vol.XII, web] was also in the team) and the week after his finals in June 1939 he bicycled from London to Marseilles in exactly 10 days. He bought a Hobie cat and took up sailing on his first retirement. He loved dogs and he loved music, particularly Mozart. His stepfather had introduced him to opera and he was a member of Glyndebourne for nearly 50 years. A man of great charm, he was married four times and had four children (Simon, Gabrielle, Max and Rudy); the oldest was born in 1942 and the youngest 30 years later. His long and happy fourth marriage was with Josephine Storey, the nurse with whom he had first set up the renal unit in Charing Cross Hospital in 1969.

He said that ‘as a doctor you can’t often say that you really save a life, you are about when they recover or you are using well known techniques for getting them better, you do the right thing and it is an accumulation of previous peoples’ work that you are passing on but just occasionally, perhaps two or three times in your life, you actually make a difference’. The case he would quote was of a young POW with diphtheria, which had led to paralysis, including of the diaphragm and pharynx, so that he couldn’t swallow; the patient also had dysentery. They made a mixture of date sugar, egg, salt and water and delivered it by catheter, but they only had a bladder catheter which, not being long enough to reach to his stomach, ended half way down his oesophagus. He posted an orderly at the patient’s head 24 hours a day with a 2cc syringe (the only one they had). The orderly would drop 2cc into the catheter and then listen until he could hear the liquid glug down in to the patient’s stomach and then repeat the process. By doing this 24 hours per day, they were able to get two or three litres a day into the patient and he survived. In that case de Wardener felt that he had made a difference.

Few professors of medicine can have matched Hugh de Wardener’s diversity of clinical and research activity, which he sustained for more than half a century. Along with his academic prowess he was, of course, always a physician dealing throughout his professorial career with not only renal but also general, acute medicine. Ward rounds, clinics and patients were never pushed aside by his research and academic commitments. He always strove to use patient-derived information to further clinical knowledge. He believed and taught that ‘every patient can teach you something’. He was truly a doctor who practised and succeeded in combining ‘the science and art of medicine’.

Malcolm Phillips
Simon de Wardener

[The Telegraph 7 October 2013 – accessed 26 March 2015; The Guardian 29 October 2013 – accessed 26 March 2015; The Renal Association Professor Hugh de Wardener (1915-2013) – accessed 26 March 2015; BMJ 2013 347 6561 – accessed 26 March 2015; BBC Radio 4 Last word 8 December 2013 – accessed 26 March 2015; Who’s who London, A&C Black, 2013]

(Volume XII, page web)

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