David Pyke packed at least three lives into his lifetime: as a physician beloved by his patients, and as a paragon among his peers; as the most influential registrar of the College in the 20th century; and as an amused observer and an amusing annotator of the talents and foibles of his colleagues. But, although his family had first call on his love, medicine had first call on his time.
He was born in 1921, the year insulin was discovered. After medical training at Cambridge and University College Hospital he qualified in medicine in 1945. He then held posts in London and Oxford before being appointed consultant physician to the diabetic department at King's College Hospital, London. This was already renowned for its excellence in the care of people with diabetes. In 1970 he became head of the department and added further lustre to its international reputation through research on a large cohort of identical twins. He later attended the Queen Victoria Hospital in East Grinstead where he conducted a general medical outpatient clinic twice a week and was widely respected by the local general practitioners. His appointment in 1975 as registrar of the Royal College of Physicians dominated his life from then on until he retired from the post in 1992, long after his retirement from King's in 1986.
During his packed professional life, he also served as one of the first honorary secretaries of the medical and scientific section of the British Diabetic Association (from 1960 to 1964) jointly with John Stowers, and later as its chairman (from 1984 to 1987); as honorary editor, Royal Society of Medicine (from 1960 to 1966); as honorary secretary and treasurer of the Association of Physicians of Great Britain and Ireland (from 1968 to 1978); and honorary secretary to the Royal Society of Medicine (from 1972 to 1974).
David Pyke began his renowned study of identical twins, one or both of whom had diabetes, in the early 1960s. The study became the largest of its kind in the world, and there are still more than 500 pairs who volunteer to take part in this long term study. It helped to clarify the hitherto obscure distinction between type 1 diabetes (juvenile onset, insulin dependent) and type 2 diabetes (late onset, non-insulin dependent). Contrary to expectations, it was type 2 diabetes that showed a strong genetic basis while type 1 diabetes is probably triggered by factors in the environment that cause an immune reaction which destroys the insulin producing calls of the pancreas. Pyke recognised that modifying the immune response might prevent their total destruction. His investigations to test this hypothesis met with partial success but this technique is still neither sufficiently safe nor effective for wider application. He also helped to improve the outcome of diabetic pregnancies, and during three decades fetal mortality declined from approximately 15 per cent in the 1960s to around 3 to 5 per cent in the late 1980s.
His twin research was widely recognised and he was invited to present the Claude Bernard Lecture to the European Association for the Study of Diabetes in Vienna in 1979, and gave the Banting Memorial lecture to the British Diabetic Association at its Belfast meeting in 1985. Inevitably, invitations to speak about clinical care and his research on twins took him all over the world. Yet, despite the great demand on his time, he always treated his patients with courtesy and compassion, setting an example of good practice to his students and colleagues.
In 1975 Pyke was elected registrar of the College. The registrar is responsible for keeping a record of the College committee's activities and as an ex officio member of almost every committee he came to know the strengths and weaknesses of many physicians up and down the country. This knowledge enabled him to steer a committee's deliberations in the right (i.e. his preferred) direction.
He also kept an amused eye on the funny, absurd, surprising and scandalous things he encountered in the course of his duties and on his travels. He recorded them entertainingly but discreetly in his regular column in the College Commentary. They were the most eagerly and often the only items read by the Fellows of the College. His notes from the registrar were peppered with light hearted observations and comments but they often dealt with serious matters and he was not averse to chiding any colleague who did not maintain expected standards of conduct and practice. The collection of these comments was published by the College as Pyke's Notes (London, Royal College of Physicians, 1992). They are also an historic comment on the precipitous changes in the relation between society and the medical profession by someone who was said to have regarded "the status quo as the way forward". This did not mean that he was opposed to change in principle but rather that he regarded it as his responsibility to act as an Upper House when the implication of any proposed change could be further assessed. His first and final writings showed his political awareness and compassion for his fellow human beings.
David Pyke was a most enthusiastic teacher: generations of medical students may still harbour sore chests when he literally hammered home important points. He always insisted on courtesy and politeness and was totally intolerant of rudeness. His lectures and writings were brilliant, and his junior colleagues gained great insights from these marvellous skills: indeed, his rigorous preparations before all scientific meetings were legendary, albeit painful at the time. For some years, with colleagues including Stephen Lock, then editor of the British Medical Journal, he conducted seminars on speaking and writing in many centres across Europe.
He served as consultant editor of the King's College Hospital Gazette for many years, and year by year he organised the student-staff golf tournament. Whenever he returned from his travels abroad he always went directly from Heathrow to conduct a ward round before going home, and was always available even to the most junior doctors. He had an astonishing knack of appearing to be in two places at once!
Pyke wrote and published extensively. He started writing when he was very young, and never stopped (either writing or talking). His first essay (aged 12) was entitled From amoeba to whale. He developed an early interest in contemporary politics and history (which continued through the whole of his life) and when still in his teens he spoke on Hitler's rise and possible fall. He edited the Cambridge University Medical Society magazine (with problems from censorship), wrote two books on diabetes and edited two others. He also edited the collection of the writings of Sir Peter Medawar [Munk's Roll, Vol.VIII, p.330] - The threat and the glory (Oxford University Press, 1990).
David never really retired, and in his later years it was his meeting with Wilhelm Feldberg [Munk's Roll, Vol.IX, p.169], who had worked many years previously on nerve transmission with Sir Henry Dale [Munk's Roll, Vol.VI, p.130], which inspired him to write his last book (jointly with Lady Jean Medawar) - Hitler's gift: scientists who fled Nazi Germany (London, Richard Cohen Books in association with the European Jewish Publications Society, 2000). It was published just before his death, and deals with the extraordinary events surrounding the lives of Jewish scientists who had to leave Nazi Germany and Austria and who achieved great scientific success in and for the countries that gave them shelter and a fresh start.
David Pyke's family must have given him much inspiration. His father was an inventor and worked for the government during the Second World War. His mother (Margaret Pyke) established a reputation in family planning before it was generally accepted, and from 1952 to 1976 he was editor (after 1960 jointly with Jean Medawar) of Family Planning, the quarterly journal of the Family Planning Association. Janet, his wife, was a towering support throughout his life, right to its conclusion.
David Pyke's enthusiasm, energy and good humoured wit sustained countless friends, colleagues and patients over more than half a century. He never ceased to see the light side of events and until his last days retained the ability to laugh heartily (at himself too) and to tease (in response to my admiration of his great courage, his reply was "I always knew you were a man of bad judgement"). He will be greatly missed by all those who have known and admired him, and valued the intensity of his friendship and tremendous loyalty.
Peter Watkins
Robert Mahler
[The Independent 5 March 2001; The Times 5 March 2001]