Contents
An account of renal medicine in Leeds necessarily involves dealing with the longstanding partisanship between the two large modern hospitals there. Prof Davison’s contribution concerning St James’s (SJH/SJUH) concentrated on the period of his control, so that it is possible to ‘top and tail’ it for a wider understanding. A combined narrative was given in a compilation of the departmental histories of Leeds medicine, a volume that allowed a free selection of topic and emphasis that led to an ill-defined timeline and incomplete approach.1
There was a period of bipartisanship, over seven years from 1966 to 1974, deriving from the appointment of Dr Stanley Rosen (SMR), as nephrologist to both hospitals. His account, compiled from personal correspondence, is corroborated by the addresses given in his publications, which continued across the period of his tenure. He used either Leeds General Infirmary (LGI) or both institutions. He joined with several LGI consultants, as well as research staff, in publishing papers from the UK up to 1973.2,3
Stanley was born into a Jewish family in Leeds and graduated in Medicine from the LGI. He had worked in both main hospitals, including latterly the LGI Department of Medicine, though not with renal responsibilities. He subsequently worked and published from London with Stanley Shaldon. He had two years of USA nephrology with John Merrill, Joseph Murray and numerous American physicians, with whom he asserted excellent relationships. Certainly, he published frequently with colleagues from there in subsequent years. His US research work was largely on transplant blood flow and behaviour, to the extent that John Hopewell (JH), a surgeon at the Royal Northern interested in renal history, termed him a ‘transplant nephrologist’ (it should be added that SMR was sceptical about several other assertions by JH in his historical accounts). Stanley had knowledge of Yorkshire regional physicians, which made him a good choice for starting the maintenance dialysis regional infrastructure from Leeds.
He resigned his post in Leeds in 1974, moving to Irvine, Orange County in California, to develop a new renal unit. He was very familiar with the US healthcare system (BTA and close relatives preceded him) and was offered research facilities and clinical status. He published from there up to 1979 but then defaulted to more clinical and supervisory roles. He was directly involved in the subsequent federal funding of the US renal failure programs and the more local infrastructure of renal replacement. Stanley is a lively 93 years old and living in California. His approved account derived from lightly edited correspondence to the author follows, which is not available elsewhere.
Appointment
The Ministry of Health decided to set up Renal Services for the City of Leeds and the area of the Leeds Regional Hospital Board which included much of Yorkshire, West and North.
I was appointed Consultant Renal Physician with privileges at St James’s Hospital [SJH] and The General Infirmary at Leeds [LGI] and as such was the first Nephrologist in the NHS [to a regional programme – EJW]. The appointment was made in the summer of 1966, with 9 sessions at SJH and 2 at LGI. There was immediate transfer of responsibility for renal patients to me from the LGI Department of Medicine, who had managed them clinically.I had admitting beds at both the LGI and SJH. Out-Patient facilities were in the Brotherton Wing of the LGI. I was the sole nephrologist at the LGI and consulted on all the renal cases and had the only OP clinic. I started chronic dialysis at SJH in January 1967.
Regional referrals would be admitted to SJH. Acute renal failure occurring in inpatients at LGI would be dialysed by me at the LGI. I had been surprised that Dr. Frank Parsons was still using his modification of the Kolff-Brigham Kidney, the rotating drum design risking dialysis disequilibrium. That machine was inappropriate for maintenance treatment, providing very limited flexibility for therapy, was time consuming to set up, required priming with substantial volumes of blood and could not ultrafiltrate with any degree of predictability. It had become a dinosaur at the Brigham where it had been originally developed. There was no maintenance dialysis at LGI at that time. I was enthusiastically welcomed by the Physician staff at LGI who referred renal patients.
Ward 1 at SJH was divided into 6 dialysis stations and 6 coronary care stations but as the demand for dialysis increased, the dialysis unit took over the coronary care area.
Regional Programme
During the subsequent period of discussion on the establishment of renal transplantation, I received a letter from the Leeds Regional Hospital Board appointing me as Physician in Administrative Charge of Renal Services. I was strongly advised by many parties to be ruthless in not sharing my authority in these matters.
I continued to develop the Hospital Hemodialysis and Peritoneal and Home Dialysis services.
I established the Renal Fund [renamed several times subsequently – EJW] at SJH at the behest of relatives and friends of patients and in response to talks I gave in those communities, which included Leeds, Halifax, York and Scarborough, where the Rotary Club was influential. The Club bought a house and equipped it for Home Dialysis, enabling patients and their families to enjoy holidays at the seaside. Ultimately the talks resulted in the development of a Kidney Fund. The first donation was from Mr. Bloom, the husband of a patient, who donated £10,000. Concerts were given to raise funds e.g. Verdi’s Requiem at Leeds Town Hall.
I do not recall drawing on the Fund because at that time I did not have a need for them. My projects were generously supported by general funds from both SJH and LGI, I had excellent relationships with both Boards.
During my tenure, I had only one junior medical and no senior medical staff. The nursing and ancillary staff were trained by me.
An Administrator for Home Dialysis was appointed, who also had to be trained by me without any previous protocol. I chose an applicant who was retiring as a Deputy Chief Constable of the City of Leeds. We progressively established Home Dialysis in West and North Yorkshire as anticipated.
Research
Lab space was provided at LGI for my renin research. Cooperation with Medical Physics [Professor Spiers] ensued, including research on potassium metabolism in renal failure using the whole-body counter.
Cooperation with the University was obtained with the Professor of Psychology, who received a grant from the Medical Research Council to study the Dialysis patients.
I was invited by the Medical Research Council to participate in a national study in the use of prednisone in the nephrotic syndrome. My service provided 25% of the patients studied. A network for referral of renal problems was established through my participation in lectures at regional hospitals.
There were 21 research publications during this period, all of which were stimulated by current clinical problems. The data was presented at national and international meetings.
SJH was host to national meetings of Dialysis Units.
I was appointed the representative of the Renal Association at the Royal College of Physicians of London, with duties including appointments and selection of Consultant Renal Physicians in other University Hospitals. The Royal Society of Medicine appointed me Chairman of the Section of Measurement in Medicine of the Royal Society of Medicine.
Addition of Renal Transplantation
The progress of the Renal Services was monitored closely by a senior member of the Department of Health [Dr. Catherine Dennis], who visited SJH on multiple occasions for discussions with the SJH Administrator [Bert Inman], Leeds Regional Hospital Board Administrator and me.
One of Dr. Dennis’ concerns was the pressure she was receiving from the LGI to continue Transplantation there. I got the impression that the LGI had acquired considerable kudos in these matters and was determined to use it. I already had plans to develop Transplant Services at SJH and would have personally welcomed Frank Parsons and Philip Clark to SJH.
The LGI application was based on some research work on kidney perfusion/preservation, but it became apparent that there was no existing project application with rationale/costing etc.
Unfortunately, the medical staff at SJH were resolute in opposing Dr. Parsons; and Philip Clark was equally resolute in refusing to operate at SJH. I had no personal problem with future transplantation at LGI but was concerned in the resultant inefficiencies of use of resources.
My experience at the Brigham emphasised the importance of a deeply committed team. I had support from the Hospital, Regional Board and DOH.
I counteracted the LGI pressure for renal transplantation by inviting a high-level Cabinet Minister, Dennis Healey, for Sunday lunch at my home to meet with Bert Inman, SJH Administrator, and members of SJH Physician Staff. I was fabulously impressed by this MP for Leeds NE. I presented my case on his arrival at 12.30.
Following lunch, lubrication, and his interaction with at least 10 other guests, he was able to recall to me my supplications of the prior 2 hours. Within a few days I received a letter handwritten from Admiralty House, by his wife, Edna, expressing her pleasure at the luncheon. Subsequently, negotiations were commenced with Leeds University for establishment of a new Chair in Surgery for Organ Transplantation tenable at SJH.
The development of a renal transplant program became a high priority for me. I planned to utilize my two-year experience at the Brigham and Harvard Medical School. I cajoled Philip Smith [urology], David Pratt and Geoff Wilson [ vascular surgery] into renal transplant surgery.
I was interviewed on Yorkshire television and used the opportunity to ask for cooperation in donation of cadaveric kidneys. The first cadaveric transplant donation was provided by a hospital in Doncaster. I collected the kidney and had a police escort to SJH to prevent any traffic problems.’
Stanley Rosen’s account is noteworthy in several respects. It describes the multifaceted routines necessary to establish a new maintenance haemodialysis service at the regional level, the social and professional communication, fund-raising and patient support. These were common to founding the new regional centres in the UK after 1966, as well as the personal initiatives taken necessarily by consultants in political and organisational development.4 It emphasises the expectation of sustained academic effort by clinical nephrologists and the management challenges that threatened dialysis capabilities. The cooperation to investigate the psychological pressures on dialysis patients is of interest; it confirms the very early attention to what became known more widely after the term psychonephrology was coined in 1981.5-7
More specifically, the account reflects the mixed reaction of the established (honorary) hospital (LGI) to potential development at St James’s, the historical Leeds Workhouse, and vice versa. Such expansions and associated ambivalences were not unusual in UK cities, but the negativity seems to have been especially obvious in Leeds. The absolute resistance to working in both institutions was apparent in several disciplines, urology and especially neurosurgery. By contrast, cross-town consultant sessions had been arranged inter-war (1928) from LGI to SJH, as evidence of what might be practical, by Sir George Martin, of the later (1961) Martin Wing at LGI.8
The 1966 renal investment in SJH was the start of further site development, provoked by the failure of the ambitious LGI rebuilding plans of the early 1960s. They had failed because the GMC perceived a lack of space for medical student expansion, which was to be offered then by placements at SJH.9 St James’s was accepted as a University Hospital in 1969. Subsequently, Departments of Medicine (1969) (Prof Losowsky was a classmate of SMR) and Surgery (1973) (Prof Geoffrey Giles, a transplant surgeon having trained with Starzl in the USA) were established there.
Several reasons for the failure of LGI to pick up regional maintenance haemodialysis in 1966 have been given. They have included limited bed space, lack of medical interest, a persisting focus on acute renal failure and the inappropriate dialysis equipment (developed from 1956). The hybrid MRC funding to support research with the LGI haemodialysis machine had long been suspected of inappropriate diversion to NHS clinical service demands. A wide range of projects had been presented, but the evolution of practical, interval, support for reversible acute renal failure was integral to their realisation. There had also been MRC scepticism as to the direction and leadership of the research effort.10 The influential initiator of the MRC unit, Professor Leslie Pyrah, retired in 1963. Interestingly, as a general surgeon, Pyrah had been appointed to St James’s four years before the LGI! Whatever the residual attitudes, SMR was clear that the Assistant MRC Unit Director, Frank Parsons (FMP), made no effort after 1966 to combine their dialysis interests or clinical activity. There was also a suggestion of antipathy to FMP in the body of physicians at SJH (see above).
It is interesting that the stalled LGI rebuilding plans of the early to mid 1960s listed 11 beds for renal research in medical specialty accommodation, but there was no specified infrastructural component to indicate aspiration towards a more comprehensive renal unit provision.11 Dr Parsons was not then being seen internally or externally as the person qualified, either formally or informally, to lead such development. That was despite his undoubted technical and biochemical capacities and sustained research record of productive improvisation. The context of his own aspirations has been documented.12 New NHS investment would seem to have needed more than the reputational LGI ‘feather in the cap’ represented by the entrepreneurial but under-qualified FMP? He was essentially a talented tactical, rather than strategic, asset.
No institutional reluctance to develop renal services was apparent in the later political efforts to acquire investment in renal transplantation for the LGI.
One of the curiosities of this story is that Dr Chris Blagg, an engaging junior physician who had at one stage ‘led’ the LGI acute renal failure service, moved to Seattle and found his homespun metier as a luminary in the US maintenance haemodialysis culture.13,14
The cross-town Leeds clinical cover for nephrology was not picked up after 1974, despite permissive consultant sessional privileges. It is not clear how LGI continued the development of dialysis, and colonised the new Wellcome Wing accommodation, without credentialled nephrological supervision up to the appointment in 1980 of a nephrologist. What was adopted and sustained, for more than thirty years after 1974, was the regional responsibility awarded initially to SMR for renal replacement based on SJH. While SJUH expanded and created multiple satellite facilities in West and North Yorkshire, LGI’s external referral was largely restricted to Airedale DGH. Any programme they could develop had to be shaped by incidental in-house demand, despite the appointment of two nephrologically trained physicians after 1980. That ultimately sizeable development somewhat languished before renal service amalgamation with SJUH in 2006.
References
Author – Es Will
Last Updated on April 13, 2025 by John Feehally