Lives of the fellows

John Lister

b.8 August 1920 d.11 November 2013
BA Cantab(1941) MB BChir(1943) MRCS LRCP(1943) MRCP(1947) MD(1952) FRCP(1961) Hon FACP

An erudite observer of clinical practice and an assiduous collector of patient data, John Lister made a mark in two related areas of medicine. As a columnist for The New England Journal of Medicine for nearly 30 years, he explained, explored and interrogated NHS reform for the US medical establishment, doing much to advance professional relations between the two countries. And as a diabetes specialist, he helped establish the pioneering Bart’s-Windsor study, following on from his ‘orphan observation’ of insulin sensitivity in patients some two decades earlier, when he coined the classification type I and type II.

John Lister was born in Cambus, Clackmannanshire, in Scotland, the older son of Thomas Lister, a chartered accountant, and Anna Rebecca Black. He was educated at St Paul’s and St John’s College, Cambridge, where he studied natural sciences. Lister completed his medical studies at St Bartholomew’s Hospital in 1943, before serving in the Royal Army Medical Corps in France and Germany during the Second World War.

When still in his twenties, and after failing to secure a position at Bart’s, he tried his hand at medical journalism and became editor of the Clinical Journal. In 1948 he joined Una Ledingham as a senior registrar at the Royal Free Hospital in London, where they explored the now obsolete discipline of ‘constitutional medicine’ – based on the premise that disease susceptibility and other traits could be deduced from analysis of the phenotype.

Lister and Ledingham studied patients attending the diabetes clinic by combining the insulin sensitivity test of Harold Himsworth [Munk’s Roll, Vol.IX, p.238] with W H Sheldon’s somatotyping technique, which involved taking serial photographs from which various body proportions could be measured. The study was completed and published in the British Medical Journal in 1951 (‘Constitution and insulin sensitivity in diabetes mellitus’. Br Med J. 1951 Feb 24;1[4703]:376-9).

There are ‘two broad groups of diabetics – the young, thin, non-arteriosclerotic group with normal blood pressure and usually an acute onset to the disease, and the older, obese, arteriosclerotic group with hypertension and usually an insidious onset,’ they wrote. ‘These types we have provisionally designated type I and type II, respectively.’

As the physician Edwin Gale would later write, this observation was made ‘twenty-five years before the world was ready to recognise it’. The terminology did not catch on – Lister did not even mention it himself in his 1959 textbook, The clinical syndrome of diabetes mellitus (London, H K Lewis & Co).

It was only reintroduced in the mid-1970s after he invited Andrew Cudworth [Munk’s Roll, Vol.VII, p.129], a newly appointed senior lecturer at Bart’s, to Windsor. Cudworth noticed a tray of filing cards on Lister’s desk, which Lister explained were white and blue, with the blue cards marking type I diabetes. Cudworth used the data collected in Lister’s card tray as the basis of the pioneering Bart’s-Windsor – subsequently Bart’s-Oxford – family study (which continues to this day) and resulted in the seminal observation that type I diabetes can be predicted in non-diabetic family members by measurement of islet autoantibodies. This observation paved the way for trials of immune intervention designed to delay its onset. Credit for the terminology went unattributed for longer still – it was only with the publication in 2001 of a paper by Gale that Lister’s contribution was finally acknowledged (‘The discovery of type 1 diabetes.’ Diabetes. 2001 Feb;50[2]:217-26).

After a brief spell in the US, Lister took up a consultant post in Windsor, where he worked for more than 30 years at the King Edward VII Hospital, and at his private practice which attracted royalty and film stars from the nearby Pinewood and Bray studios.

His commitment to medical education led to the creation in Windsor of the UK’s first purpose-built centre for postgraduate medical education. In 1972 he became postgraduate dean of the University of London for the northwest Thames region, supporting the national training and professional development of doctors across all specialties.

Though Lister was unassuming about his contributions to medicine, he had built an international profile as a commentator on clinical practice. In 1952, with the NHS entering its fourth year and fascination with our national experiment in healthcare growing in the US, he was asked by The New England Journal of Medicine to write a monthly column on medical affairs in Britain.

’By the London Post’ would become a must-read commentary on both sides of the Atlantic, tracking advances in clinical care and the successes and struggles of the NHS. It was informed by Lister’s keen socio-political eye, obsessive note-taking and collecting of newspaper clippings and interests in the wide historical sweep of medical practice. Paracelsus, Rahere and Linacre would sit alongside commentary on contemporary events such as the Coronation, Beatlemania (prompting a wry editorial response: ‘What is a Beatle?’) and three decades of NHS reforms.

Lister’s observations on the NHS were astute. On its 10th anniversary he noted its enormous benefits, but observed the anxieties of escalating costs, particularly on new drugs and doctors’ pay, and the lack of integration. He returned to the latter subject in 1974, criticising a ‘controversial reorganisation of the NHS’ that could be justified only if it solved this problem.

In 1980, after 339 consecutive columns, and after agreeing twice to postpone his retirement, he wrote his final dispatch. On awarding him an honorary fellowship, the American College of Physicians credited Lister with a ‘major impact on world medicine…fostering Anglo-American medical friendship more effectively than any physician of his time.’ Lister said merely, ‘I just keep my eyes and ears open.’

Lister willingly acknowledged that the bedrock of his professional success lay in his long and happy marriage to Eileen, who, a doctor herself, had given up her career to support him and their three sons, Andrew (who would become professor of medical oncology at Bart’s), Ian and Robert.

After the death of his wife in 1996, and showing his characteristic zest for life, Lister remarried at the age of 80. He died aged 93. His wife, Moyra, and two sons from his first marriage survived him.

Sam Lister

[The Times 19 November 2013 – accessed 6 December 2015; Ascot, Windsor & Eton Express 21 November 2013 – accessed 6 December 2015; The Herald Scotland 22 November 2013 – accessed 6 December 2015; The Telegraph 4 December 2013 – accessed 6 December 2015; BMJ 2014 348 1204 – accessed 6 December 2015]

(Volume XII, page web)

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