As a medical student in Liverpool, with a young family, Andrew Cudworth was short of money, and joined the Army Cadet scheme. After he had qualified in medicine in 1963, and done his house jobs, he accepted enthusiastically the responsibilities he had incurred, and signed on as a Regular Army medical officer for five years, on a short service commission, rising to the rank of major. He was fond of the Army, and made and retained many friends there. After returning to civilian life he continued as a Territorial until he resigned in June 1982. It seems a strange beginning for someone who was to prove one of the outstanding figures in British academic medicine - but it gave him an experience of life and maturity of judgement which perhaps contributed later to his notable success as an organizer and administrator, as well as a scientist.
He returned to Liverpool and became a medical registrar at the age of 30, and got his Membership in 1971, at the age of 32. It is astonishing to reflect that the whole immense span of his work in academic medicine was crammed into the next 10 years. He joined the department of medicine in Liverpool, and published his first paper — a case report with immunological overtones — in 1972. His second paper — another case report, this time of a diabetic patient, was published in 1973, when he was 34. To these twin scientific threads — immunology and diabetes - was added a third, when his interest in the inherited basis of disease was stimulated by Cyril Clarke and Joseph Woodrow. He and Woodrow, with another group in Copenhagen, were independent and virtually simultaneous discoverer of a genetic marker which was linked to the severe, insulin-requiring form of diabetes. Patients with this disease had a characteristic inherited ‘fingerprint’ (as it were) - recognizable by a blood test. This discovery overnight changed a disease, which though common had been quite mysterious, into one which became amenable to proper study.
Andrew at once became a well-known figure in the field of diabetes, and in 1977 was appointed consultant physician to St Bartholomew’s and Hackney Hospitals, and senior lecturer in the medical college. In the short time that remained to him, his achievements were phenomenal. He had immense powers of concentration and hard work, allied to great scientific originality.
He realised that if the genetic prediposition to diabetes could be refined, quantified and made exact, it would become possible to predict, amongst people who had not yet developed the disease, which ones would do so. By the close study of his own patients in the district, and by collaboration with many other physicians in and around London, he was able to refine the genetic markers of the disease, and from a single blood sample establish with a very high degree of certainty two separate ‘axes’ of susceptibility, and one of nonsusceptibility, or resistance to the disease.
He realized that the exemplary childhood diabetic register established at and around Windsor by John Lister and his colleagues, provided a wonderful opportunity for capitalizing on his genetic discoveries. For the first time it became possible to predict with virtual certainty which children in diabetic families were at risk. Thus he could watch by means of further relatively simple tests the progress of the illness, and find out the details of the process by which the body turned upon itself, and destroyed the vital insulin-producing cells in its own pancreatic gland.
His work in diabetes was wide, and he made notable contributions to many aspects, but his immunogenetic work was outstanding. It revealed the unexpected and exciting fact that childhood diabetes, which hitherto had seemed to have a sudden onset, in fact developed quite slowly, over many years. This opened up new vistas of study, particularly the use of various types of ‘immune-suppressing’ drugs during the long incubation period of the disease. Andrew Cudworth’s discoveries also paved the way for genetic counselling, and other more radical approaches to the prevention of this common illness.
Cudworth, of course, became in increasing demand as a speaker and organizer at international meetings, and in 1980 was appointed editor-in-chief of the international diabetic journal, Diabetologia. Early in 1982 he was the guest of honour of the American Juvenile Diabetes Foundation, which awarded him its much coveted prize for his original discoveries. London University recognized his distinction by the award in January 1982, of a personal chair in human metabolism.
Although he was outstanding in research, he also took care of very many patients who already had diabetes, collaborating with David Galton in the diabetic clinic at Bart’s. At Hackney he set up a model and comprehensive diabetic service, and quickly established a great reputation throughout London as a caring as well as technically masterful clinician. Patients came from far and wide to seek his help, which was always freely given.
He was highly valued by Bart’s medical students and postgraduates as a teacher, in which role he was also outstanding. In particular, he encouraged his students towards study in depth of medical problems. The regular scientific presentation sessions he made them prepare — and which he attended and criticized — were very popular.
Amazingly, he was also a gifted administrator, largely because he gained and kept the complete trust of all his colleagues. The respect and trust of these colleagues were shown, amongst other things, by his appointment in 1981 as secretary of Bart’s Medical Council, and as chairman of the District Medical Division.
During his long and distressing illness (a right parietal lobe glioma) his personal courage and inner resources became inspiringly apparent. He realized at once, after diagnosis, that he had probably only a matter of months to live. Andrew had always lived each day as if his last - and he seemed to be possessed of almost superhuman equanimity as well as energy. Characteristically, he never complained about his fate — nor indeed did he ever spontaneously mention his illness to others. He needed less than any man the advice that Dylan Thomas gave his father:
‘Do not go gentle into that good night…
Rage, rage, against the dying of the light.’
He carried on working with undiminished energy and enthusiasm up to his death. Just two days before he died, he was making helpful and imaginative comments about the possible cause of a mysterious sequence of illnesses in a patient whose problems had been discussed with him, and was anxious that this line of enquiry should be followed up.
He was survived by his wife, Mary, two sons and a daughter.
None of those who knew, respected, admired and loved him, will ever forget Andrew Cudworth, whose name will live on through his important scientific contributions.
CJ Dickinson
[Brit.med.J., 1982, 285, 1434-35; Lancet, 1982, 2, 996; The Times, 22 Oct 1982]