Michael Boulton Jones joined the Renal Unit of Hammersmith Hospital in early 1972 as senior registrar, and left to become consultant in Glasgow (see his commentary on Glasgow) in mid 1975, when he was succeeded by Andy Rees. “It was a fantastically interesting place to work but it was also very odd.”
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Keith Peters had been appointed Consultant in, I think, 1970 when he had no nephrological experience. As he said several times, he had been taught all the nephrology he knew by my predecessor, Lewis Sevitt, but his intelligence and curiosity were obvious to all. I remember meeting a physician from Cardiff who told me that there were two equally bright students in Keith’s year. One went on to become a Regius Professor of Medicine at Cambridge and the other a General Physician at Haverfordwest! What distinguished Keith was his ambition, which he wore on his sleeve. At meetings of the Renal Association, he frequently asked questions but had the odd habit of turning away from the speaker towards the audience so everyone could see and hear him. But he was generous, fun, entertaining and, most important, full of ideas.
However, the clinical organisation of the Hammersmith Renal Unit was idiosyncratic to put it mildly. The team consisted of Keith, me as Senior Registrar, Patrick Sissons as Registrar and a rotating Houseman. Among the three of us we had perhaps three years of nephrological training. Difficult to imagine that now. The organisation of the clinical services was equally idiosyncratic. Prof Shackman’s surgical unit ran both the haemodialysis and the transplant services. Therefore, we had only peritoneal dialysis to manage patients with acute renal failure until a Baxter haemodialysis machine was acquired, I think in 1972. Since there were no nurses available to run it, all acute dialysis was performed by either Patrick or me. Many were the nights when I saw the sun rise over the east of the hospital. Patients with end stage renal failure but with no place available on the Dialysis Program, either in the hospital or any other in London, were treated by peritoneal dialysis using a technique [intermittent peritoneal dialysis ] introduced by Lewis Sevitt – a sort of poor man’s CAPD.
Prof Shackman had his idiosyncrasies too. For example, when considering a live donor transplant, he would transplant a patch of skin from the donor to the recipient. If it took, the transplant went ahead. Many were the immunologists who shook their heads at this, considering it inevitable that it would provoke accelerated rejection, but Prof Shackman just continued and his results were as good as anyone’s.
My role was primarily clinical and there were a couple of patients of interest. One was a women diagnosed with MCGN who was in and out of hospital over some months. While in hospital one day she had a fit and, on a hunch while she was away for some investigation, I searched her locker and found vials DPT vaccine. It emerged that she had been injecting herself regularly over a few years. When she stopped doing so, her progression slowed but the damage already done was sufficient for her to end up on dialysis. At the time, circulating immune complexes were thought to be the cause of many forms of glomerulonephritis and animal models of the disease were caused by repeated administration of antigen. Therefore, she seemed to confirm the model.
Another was a patient with Goodpasture’s Syndrome. Keith Peters had the idea that plasmapheresis would be effective. Before he went off, probably to give a talk somewhere, he left instructions that we should employ this technique but no details of what the regime should be. I hurriedly read up on the effects of plasmapheresis and learnt that it accelerated antibody production. So I thought we should give three days of immunosuppressive therapy before beginning. Keith returned a couple of days later and told me “that’s it. You have ruined my idea”. Happily, the patient did recover and plasmapheresis became established in the treatment of Goodpasture’s Syndrome.
Of course the unit subsequently became famous for the research undertaken by Research Fellows such as Gwyn Williams and Patrick Naish from the UK and Ian Simpson and Nip Thomson among others from abroad. All under the enthusiastic direction of Keith, ably abetted by his link with Peter Lachmann that led to several studies on the role of complement in the pathogenesis of glomerulonephritis and other work in glomerulonephritis.
First published 1 June 2025.
Last Updated on July 20, 2025 by neilturn