Guy Scadding was a brilliant physician and clinical scientist who was largely responsible for launching respiratory medicine as an academic specialty in the United Kingdom. Soon after qualifying at the Middlesex Hospital in 1929 he spent five years in medical and surgical posts in respiratory diseases at Brompton. He came to regard the place with great affection, and most of his professional life was to be dedicated to it.
He recalled that at this time at Brompton there was no provision for the education of hospital doctors. Learning was by apprenticeship to numerous visiting consultants whose teaching was mostly unashamedly didactic. He learnt the useful trick of making decisions on limited evidence, and perhaps it was his skeptical turn of mind that saved him from relying on this and becoming another didactic clinician. Any such tendency was certainly discouraged when in 1935 he moved to the British Postgraduate Medical School which was being developed at Hammersmith Hospital. Francis Fraseer [Munk's Roll, Vol.V, p.141] appointed him as one of his four first assistants (others included Paul Wood [Munk's Roll, Vol.V p.456] and Peter Sharpey-Schafer [Munk's Roll, Vol.V, p.372]. Thus at the age of 27 he obtained an appointment of consultant level in an academic department in general medicine and respiratory disease, including post-graduate teaching and research. His recollections of having been involved in the early development of the Royal Postgraduate Medical School gave him special pleasure. In 1939 he was appointed physician at Brompton and continued his appointment at the Hammersmith part-time.
His war service was spent in Egypt as lieutenant-colonel in charge of a medical division of a 3000 bedded hospital dealing with many infectious diseases, including smallpox and plague. There he planned and conducted one of the first double blind placebo controlled trials (a study of sulphonamides in bacillary dysentery). In 1943 he was suddenly summoned to Carthage by Lord Moran [Munk's Roll, Vol.VII, p.407] to assist in the care of Winston Churchill who was in Eisenhower's headquarters suffering from pneumonia. When he was referred to in the British press as Churchill's doctor, Guy remarked with typical modesty that he disliked the description because he had no wish to be identified as a doctor to one person, however distinguished. After the war he became honorary consultant to the Army.
On his return to Brompton in 1945 he undertook the development of a university post-graduate institute from virtually nothing but the good reputation of the hospital. It was a part of the Postgraduate Federation of the University of London, then being developed at the specialist hospital in London by his old chief at Hammersmith, Francis (now Sir Francis) Fraser. Appointed dean and director of studies of the newly established Institute of Diseases of the Chest, he was provided with nothing more than a partitioned-off cubicle in outpatients as his office and an empty ward as a lecture theatre. By 1949 he had established the Institute in a single storey building in the grounds of the hospital. Recalling the challenging difficulties of those early days, he remembered the problem of persuading distinguished consultants to co-operate in establishing a new-fangled academic institution likely to diminish their hitherto overriding influence. He gained their acceptance because he was first and foremost an outstanding physician who was courteous and evenhanded in his relations with his colleagues.
His clinical opinion was frequently sought and he became known as the consultants' consultant. He wrote a lucid account of his views in the patient's case notes in his distinctive copperplate handwriting. His approach to patients and their illnesses was both scientifically objective and compassionate. His ward rounds and lectures were invariably stimulating and laced with his dry humour. His example set standards of clinical practice and academic excellence which evinced the admiration and affection of generations of doctors who came under his influence at Brompton and Hammersmith hospitals. His obvious unselfish integrity resulted in him being referred to as 'the nonconformist conscience of British medicine' by Moran Campbell. Over the years he obtained buildings for laboratories and teaching facilities. He attracted outstanding academic staff in both clinical and basic sciences. Easily accessible and generous with his time, he contributed the clinical background to enable his staff to pursue their own ideas and provided critical guidance for work in progress. He was appointed to the first chair of medicine in 1962 where he remained until his retirement in 1972. He devoted the major part of his professional life to establishing the Institute as a world class centre for teaching and research which has now evolved into the National Heart and Lung Institute.
His reputation was international and he held seven visiting professorships in North America. His many publications concerned numerous aspects of medicine but he is best known for his work on sarciodosis and on interstitial fibrosis of the lung for which he introduced the now generally accepted term 'fibrosing alveolitis'. Widely recognised as one of medicine's philosophers, he insisted that doctors should use words with precision. His deep analytical approach was as much philosophical as semantic and he contributed much to the accurate definition of diseases using the nominalist rather than the essentialist approach. Named lectures which he gave included the Bradshaw, Mitchell, Tudor, Edwards and Lumleian at the College, where he served as councillor and later censor and vice-president.
He was among a small group of physicians and surgeons who founded the Thoracic Society in 1946, later becoming its president and the first editor of its journal Thorax which rapidly attained international status. As president of the British Tuberculosis Association, he was a major influence in eventually bringing the two societies together as the British Thoracic Society and received the Society's medal for outstanding services to medicine in 1998.
His many other activities included membership of the standing medical advisory committee and central health services council and advisor in chest diseases to the Department of Health. He was a member of the clinical research board of the Medical Research Council and chairman of the industrial medicine panel of the National Coal Board.
Scadding was a founder member of the Medical Research Council committee set up in 1946 to study recently discovered drugs for the treatment of tuberculosis, then a common and often fatal disease in Britain. These innovative studies provided a gold standard for subsequent controlled clinical trials which were paramount in establishing chemotherapy as the cure of tuberculosis. Thereafter tuberculosis declined rapidly in Britain and many tuberculosis clinics and hospitals and the staff became redundant. The future of services for respiratory medicine in the NHS was thrown into doubt. Scadding chaired a Department of Health committee producing a report on the future of the chest services (the Scadding Report 1968) which was crucial in establishing respiratory medicine as a speciality within the NHS and for the creation of training programmes in the discipline.
Guy took great joy in his happy family life with Mabel, their two daughters and a son (now a neurologist). An accomplished pianist, he was devoted to 18th century music and delighted in making music with his family. He was an energetic hill walker, particularly fond of the Lake District. In retirement he acquired new skills as a landscape painter. His intellectual powers remained undiminished in old age and he continued to attend the grand round at Hammersmith. He gave his last lecture at the College shortly before he died at the age of 92.
Kenneth Citron
[Brit.med.J.,320,2000,189; The Independent 2 Dec 1999]