Lives of the fellows

John Everard Cotes

b.24 February 1924 d.15 April 2018
BA Oxon(1945) BM BCh(1948) MRCP(1949) DM(1966) FRCP(1969) Hon FFOM(1981)

John Cotes was a respiratory physiologist who played a key role in the conquest of Everest in 1953. He also played prominent roles in the European Respiratory Society, the Thoracic Society and the Association of Respiratory Technicians and Physiologists, and was an honorary fellow of the Faculty of Occupational Medicine.

Cotes was a quintessentially English figure, known for his old-fashioned courtesy and rarely seen without a tie. As a student, he was a scout leader who believed in self-sufficiency and being prepared. He was always very thin and at that time was reputed to live on charcoal biscuits.

He was the son of Everard Charles Cotes – a Reuters journalist and entomologist. His mother, Phoebe Violet Cotes née Delaforce, was from the well-known Portuguese port wine company of that name. He attended Leighton Park School and then New College, Oxford and St Bartholomew’s Hospital to study medicine. At school he was a keen runner, breaking records for sprinting. This success stimulated an interest in the relationship between shortness of breath and exercise.

After junior posts at St Bartholomew’s and Great Ormond Street hospitals, Cotes did his National Service at the RAF Institute of Aviation Medicine at Farnborough. At the time the performance of pilots at high altitude was critical and he established a reputation there for his work on breathing apparatus. After moving to the Medical Research Council (MRC) in South Wales, his director was informed in October 1952 that another attempt on Everest was planned. ‘Frantic endeavours’ were being made to get an ‘apparatus devised’ and a ‘regimen worked out’ to enable the climbers to adapt to high altitude. An urgent request was made for Cotes to be seconded back to Farnborough.

Cotes, at 27, had been offered an opportunity to work on the most high profile project in his field. He refused, believing the expedition would fail. The high altitude committee of the MRC was fixated upon improving pre-war oxygen apparatus (devised for pilots) used in previous failed attempts. Cotes was convinced that this was inappropriate for climbers taking strenuous exercise as climbers breathed more rapidly and deeply than air crew who were sedentary. The failure of the previous expeditions had also been partly due to the lack of interest taken in the equipment by the climbers, leading to elementary mistakes. Cotes’ director at the MRC said that he was ‘inclined to think there is a lot in what Cotes says’. His conclusion was cutting, noting that ‘Drägers of Lübeck are making new equipment for the Swiss, but no doubt this equipment has been discussed by the High Altitude Committee….’

Cotes ultimately agreed to help, but it remained a battle to get his view accepted. George Finch, a veteran of the 1920s and 30s expeditions, declared to the Royal Society that climbers were ‘particularly prone to claustrophobia’ and would ‘simply not be able to tolerate a close fitting mask’. Cotes ignored him and developed a radically new apparatus. This reduced the resistance to air flow, was tolerant of high winds and enabled heat to be retained to prevent freezing. He organised a demonstration of the mask, putting expedition members through a decompression chamber. This simulated climbing conditions, reducing air pressure to that at 29,000 feet and the temperature to -20 °C in a 30 mph wind. Members of the expedition removed their masks during the experiment. John Hunt describes this as a ‘horrifying sight’ as they rapidly became disorientated with tongues ‘hanging out’.

After gaining acceptance of the new apparatus, Cotes emphasised the importance of familiarity with using the equipment, including when sleeping. Trials demonstrated the oxygen masks substantially improved climbing performance. Edmund Hillary and Tenzing Norgay climbed directly to camp four in five hours – ‘a truly remarkable achievement’. Throughout the climb the equipment performed faultlessly.

During the 1950s Cotes spent time advising the chemical weapons research programme at Porton Down, then researching Second World German nerve agents. During this period he was deliberately exposed to mustard gas on both forearms and bore scars for the rest of his life. Cotes never discussed this, but a colleague said that they exposed 10 subjects to a poison, decontaminated nine of them and left the tenth to reveal what happened if they were not decontaminated. He was an adviser on respiratory problems to the Ministry of Defence until 1989.

For 25 years he was part of a team at the MRC pneumoconiosis research unit (PRU) in South Wales. Large numbers of people were at that time occupationally exposed to coal dust and other inhalants. Pneumoconiosis and welder’s lung (not then regarded as a problem) caused lifelong respiratory problems. Cotes wrote important papers which established the impact of these occupations on lung performance. His book Lung function: assessment and application in medicine (Oxford, Blackwell), published in 1965, became the Bible in its field (though with self-deprecatory humour he called it the ‘Mrs Beeton’) and ran to six editions with a seventh, this time a multi-author text, close to publication at the time of his death. This work underpinned major improvements in standards of occupational hygiene.

His wife, Patricia (née Beckingham), died in 1975. He went on to marry a fellow respiratory physician, Sarah Pearce, who had just been appointed to a consultant post in Durham. No-one thought he would move from his prestigious position in the PRU, but with characteristic determination and optimism he had courted Sarah from a distance of 300 miles and persuaded the MRC to move him to the North East. He set up a new unit, the respiration and exercise laboratory, at Newcastle University and built up a research team. He supervised PhD students and staff from Europe and beyond who wanted to work with him and carried out work on the respiratory problems of shipyard welders using a mobile laboratory on a trailer. ‘Welders’ lung’ was not then accepted as a respiratory disease and a protracted legal battle was being fought. Cotes was called upon by both sides for informal advice, but declined (lucrative) involvement himself, believing this would undermine the trust of employers or welders if he was seen to be supporting either side.

From 1970 to 1971 Cotes led a research programme in Papua New Guinea, based in villages that had little contact with the outside world, investigating the effect of environment and ethnicity on lung function. He developed many international links and published 350 papers and other communications. He welcomed international colleagues to the PRU and subsequently to his research unit in Newcastle. Junior researchers were impressed by the time and trouble he took to help them. He furthered the careers of several Polish academic physicians and in recognition of this was awarded an honorary doctorate by the University of Warsaw. At international conferences there were always people from developing countries who wanted his autograph or to be photographed with him.

After his official retirement he continued writing papers and working on his book, Lung function, its sixth edition produced when he was 82. He revived an old interest in croquet and was very proud of the flourishing club he founded and, with huge commitment, built up in Durham.

He suffered a life-threatening cerebral haemorrhage in 2013 while working on the seventh edition of his book. Through determination he made a remarkable recovery, but in 2016 blindness led to his terminal decline.

John Cotes was a family man who valued children above all and was survived by four (Peter, Lucy, Simon and Roger), nine grandchildren and four great grandchildren.

Sarah Pearce

[The Times 20 April 2018 www.thetimes.co.uk/article/john-cotes-obituary-3npxq0mqj – accessed 25 June 2018; The Physiological Society Obituary Notices www.physoc.org/joint-meeting-of-feps-the-hungarian-physiological-society/obituary-notices – accessed 25 June 2018]

(Volume XII, page web)

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