Monday, 1 April 2019

Britain is a country which still needs to say "Farewell and Thank You" to its brilliant old, medical pioneer and compassionate clinician, Sir Stanley Peart

If you have either had a kidney transplant or know someone who has had one or have been diagnosed with high blood pressure, you may well have reason to thank Sir Stanley Peart for the work he carried out in his career as a medical pioneer in the last century at St Mary's Hospital in Paddington, in the City of Westminster, London. Having said that, apart from an obituary in the regional newspaper, 'Ham&High' and a couple of tweets, his passing, at the age of 96, has gone unnoticed..

Stanley was born, William Stanley Peart in the Spring of 1922 in South Shields, County Durham, the son mother, Margaret, with Scots 'Fraser' ancestry and a father, Jack, who was a professional football player, a centre forward known as "the nightmare of goalkeepers", who had played with nine league clubs, including Newcastle United, Derby County and Sheffield United before Stanley was born.

Who could have predicted that 34 years later he would become Professor of Medicine at St Mary's Hospital in London after a formidable track record of work as both a clinician and medical researcher with Fleming at St Mary's, followed by Edinburgh, the RAF and Mill Hill. He continued, as far as he could to maintain his two roles with his new research on tumours on the adrenal gland while still finding listening "to somebody's problem, trying to dissect it out, just as satisfying to me as any research programme." 

By the age of three he was living in Rochdale, Lancashire where his father was player-manager with the football club and his earliest memory was when he was three years old watching, from the window, the mill girls going to work with clogs on their feet at five o'clock in the morning. Five years later he was in Bradford, West Yorkshire where his father was manager of Second Division Bradford City and when he was 10, he passed the entry scholarship to Bradford Grammar School for Boys. In 1935, at the age of 13, his education was disrupted when he had to move to London when his father became manager of Fulham Football Club, tempted South with £600 a year and the same bonuses as the players.

His new school, Kings College School, a boys public school in Wimbledon, was not a happy experience because with his Yorkshire accent he stood out like a sore thumb and recalled a "terrible French master" who "asked me, in French, some questions and I sort of answered it with a sort of Yorkshire accent, quite wrong and all the pupils there laughed and that was devastating for me. I felt so awful." He dropped the accent and life became easier.

Of all his teachers later recognised the "tremendous influence" of his biology master who was "the zoology man" and in 1939, at the age of 17, the year that Britain entered the Second World War, Stanley applied for a place to read medicine at University and given his clear and exceptional promise "was offered a place, but not an exhibition or scholarship to Oxford University." However, unable to afford the undergraduate fees, he couldn't accept the offer and later reflected : "So Oxford marred my life, actually, in a way." 

Instead, Stanley secured a 'rugby scholarship' to study medicine at St Mary's Hospital at Paddington in London. He recalled being interviewed by Sir Charles Wilson, who became Lord Moran, Winston Churchill's physician during the War, who said : "Well you play rugby. How fast do you run the hundred yards ?" To which Stanley thought : "I roughly knew how fast, so I thought, well, if I take point two of a second off, it will look good. So I said 10.2, which was somewhat faster that I could run. But I sort of brazened it out a bit." It worked and he was offered a place.

Within his studies he was drawn towards anatomy and recalled : I just liked it. It has, obviously, some sort of aesthetic quality, even when about those shrivelled frames. There's a certain beauty in seeing that when you look where a nerve goes and how it gets to its destination and to display it nicely gave me a lot of pleasure."
In pursuance of his studies he bought a brain from his local curator with the £5 given to him by his mother, which he stored in the garden shed and "was trying to see the various tracts in the brain and the various structures" which he found  "absolutely fascinating."

With the Second World War around him, Stanley wanted to join the RAF but as part of a 'reserved occupation' he had been excused the call up for service in the armed forces and had to continue with his medical education where the clinical course, at the age of 19, gave him "the revelation and opened my eyes to all the diversities of human nature. All the ways in which people reacted to circumstance. All the things they told you about their life. I learned an enormous amount from that. It sort of matured you in a very quick way." It was around this time that he met Peggy, who was to be his future wife and was a charge nurse at St Mary's.

When he was now taught by George Pickering he gave up all thoughts of a career in surgery. It was now "medicine and the questions behind what we were looking at were all important." In that first meeting George ; "brought an amputated leg which had arteriovenous anastomoses within it, leading to overgrowth of the limb and subsequently to amputation to try and correct the high cardiac output and failure which it caused. He had injected the arteries with a barium paste and wanted someone to try and find the connections by simple dissection. As I liked dissection, I volunteered, and though I was unable to show any major connections, which were presumably at arteriolar-venular level, it was to mark the beginning of a very long apprenticeship."

Having qualified in 1945, at the age of 23, Stanley finished his residency and became a 'peniciiln registrar' at St Mary's with the job of looking after everything 'clinical' which came into the wards which were in the the care of the old giant of immunology, Almroth Wright and creator of the world's first antibiotic substance 'benzylpenicillin', Alexander Fleming. These were the pioneering days of antibiotics and it was very painful when administered to patients as Stanley himself testified : "People used to be screaming with the pain of it, I could understand because I had a boil on my neck and Fleming injected this stuff into the base of that on my neck. I nearly collapsed actually."

He considered himself lucky because his job as registrar brought him into "close contact with Fleming and all the people around Almoth Wright". Working in Fleming’s penicillin ward he saw the groundbreaking drug was used to treat many soldiers and war veterans. Fleming taught him some bacteriology and "how to draw pipettes, how to do bacterial counts, how to draw blood". 

He witnessed the miracle effect of penicillin because puerperal sepsis was very common at St Mary's because the high rate of dirty, back street abortions taking place in its vicinity. He saw some women with "colossal infection", who were cured. "It was absolutely miraculous to somebody who was used to seeing people die of pneumonia previously. It was a complete revolution." He remembered Fleming as "a quiet, small man, sitting, looking down the microscope, with a cigarette drooped from one corner of his mouth. He used to love coloured bacteria and used to draw pictures with them on agar so that he'd just grow them up solid, so he'd have a union jack."

In 1946 he left St Mary's on a £300 p.a. Medical Research Council scholarship to work at Edinburgh University on his investigation of 'sympathins', those substances secreted by sympathetic nerve endings which act as a chemical mediator. He displayed the confidence and determination of youth : "I was fascinated. What I wanted to do from an early time, was to make my own little mark. I wanted desperately to do something which was unique and really made an advance, That was my ambition."

He now came under the influence of the brilliant Marthe Vogt, who was about to reveal the earliest evidence for the role of acetylcholine as a neurotransmitter and under her direction switched his attention to the liver, worked on laboratory rats, rabbits and cats and "switched to splenic sympathin and lo and behold as soon as I started to do this I started to get results. They started to flow." The result was his groundbreaking paper 'The Nature of Slenic Sympathins.', published in 1949.

Having gained his Membership of the Royal Colleges of Physicians, in 1947 and still only 25 years old he left Edinburgh and joined the RAF Medical Service based at the RAF hospital at Ely in Cambidgeshire In addition to the clinical cases he dealt with among RAF personnel he also gave his opinion on civilian cases from the area. It was emblematic of his immense capacity to want to do good that he was "running a sort of private hospital service for the inhabitants from around Ely and the villages beyond."

After two years he left Ely having gained the position of Clinician and Lecturer back at St Mary's with his research focus centred on the kidneys and the enzyme, renin, secreted by and stored by them, which promoted the production of the protein angiotensin. His focus was to test the proposition that it 'was likely that renin would be an enzym working on a substrate in the plasma to produce a peptide.'

His pursuit of renin in large enough quantity took him the Northumbria with George Pickering where rabbits were hunted and sent to the London market. Thus they obtained 2000 kidneys which they duly cut an dried in alcohol then ground into a powder and he got what he called "my crude preparation which I used for my preparation of angiotensin."

It was now at the suggestion of George Pickering, now Professor of Medicine that he left St Mary's to join the Department of Physical Chemistry at the National Institute of Medical Research at Mill Hill on the outskirts of North London, to continue his work on the purification of angiotensin. He did this before, what would be, his final move back to St Mary's in 1954 where he returned to his old position as Senior Lecturer in the Medical Unit, before he was placed in charge of the Unit when he replaced George as Professor of Medicine two years later, a position he held for 31 years until his retirement in 1987

He focused the Medical Unit's research on the substances released by tumours working with phaeochromocytomas, rare cancers which start in the inner section of the adrenal gland and force it to make an excess of the hormones adrenaline and noradrenaline and consequently create sweating, headaches and high blood pressure. In fact, it was the Unit's work into blood pressure became the main focus of its research under his direction.
The kidneys were another focus, as he recalled when interviewed in 1993 : "There I was, being confronted by patients with renal failure, for who I could do very little except dialyse them." As a result he became the driving force behind kidney transplants in the early 1960’s, attempted after the introduction of the immunosupressive drug, azathioprine and a dedicated transplant ward was opened in 1966 with 6 single rooms for barrier nursing as well as a small operating theatre and an out patient clinic.

An analysis of 65 of the cases of him and his team was published in the Lancet in 1969. The transplant unit had access to “brain dead” young adults with head injuries at the neuro-surgical unit of the Atkinson Morley Hospital, Wimbledon and both organs were transplanted into two patients within a short time of the donor’s death.

Stanley received the acclaim of his peers when he was elected as a Fellow of the Royal Society at the age of 47 in 1969. He was Chair of the Medical Research Society for more than a decade from the mid 1960s and later served for five years as a member of the Medical Research Council, during which he was involved in the decision to create a MRC unit in Reproductive Biology in Edinburgh. He received his knighthood at the age of 63 in 1985 and was he awarded the 'Buchanan Medal' of the Royal Society in 2000 'for his contribution to the foundations of understanding of the renin angiotensin system in particular through his seminal work on the isolation and determination of the structure of angiotensin, purification of renin, and subsequent studies on the control of renin release'.

In 2000, when Professor Jane Anderson, now the Chair of the National Aids Trust was asked : "Who were your most influential teachers ?" She replied : "Two amazing men. Professor Stanley Peart, who was an inspirational clinician and Dr Hillas Smith whose clinical approach to infectious disease led to my current field."

Stanley's daughter, Celia, has said : “People will remember my Dad for his kindness. He had this amazing combination of being a clinical detective but also an incredibly compassionate man. He was absolutely loved by his patients and was able to combine being an academic, researcher and clinician. No one could do that anymore.” 

and

“He always wanted to know how things worked in all sorts of fields. He’d come over and ask the grandkids : "Why do pigeons bob their heads?" He always asked questions to make them think.”

Stanley was interviewed about his life in medicine by Max Blythe and Dr Brigitte Askonas on five occasions when he was 71 in 1993 : Part 1Part 1 (2)Part 2Part 3Part 4Part 5

P.S.
Stanley's obituary was published in 'The Times' on April 10th. 

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