Nelson Coghill built one of the earliest gastroenterology units in the country. He did this in a district hospital, the West Middlesex, which he joined in 1947. The establishment of the NHS in the following year allowed the development of the district general hospitals and enabled them to provide specialist services, which had not previously been possible. The specialty of gastroenterology was unusual in that it was developed mainly in these hospitals. Nelson played a major role in this and continued to work towards meeting the needs of the specialty.
He was educated at Shrewsbury School, Downing College, Cambridge and Westminster Hospital. He spent most of his war service in North Africa. His unit in Benghazi had the highest throughput of medical patients in the Middle East. Nelson’s natural curiosity encouraged him to do some research during his war service, especially in dysentery, both bacillary and amoebic. It was one of his regrets that he never made time to expand that work into a thesis for an MD. After discharge from the RAMC he was appointed by John McMichael [Munk’s Roll, Vol.IX, p.341] as his senior registrar at the Hammersmith Hospital.
Nelson was a crusader for what he believed to be right. Like most effective crusaders, he followed a broad, adaptable approach. At his best he was inspirational and unstoppable. He remained totally committed to clinical medicine in the NHS, from its beginning to the day he retired, as well as to research and teaching. He always maintained his natural modesty, his quiet sense of humour and his compassion for his patients.
He was one of the first in Britain to pioneer gastric biopsy with the Wood suction tube, an invaluable tool which he modified for his principal research, atrophic gastritis. He worked on this condition in pernicious and hypochromic anaemias and in non-ulcer dyspepsia, collaborating with histopathologists and radiologists and studying auto-immunity, iron loss and cell loss by DNA in gastric washings. He encouraged his junior staff to undertake a variety of clinical research projects, working to the high standards he consistently set. With colleagues in haematology and clinical biochemistry, he also worked on upper gastro-intestinal haemorrhage, ulcerative colitis and malabsorption. At the South Middlesex Hospital he extended his wartime experience of communicable disease.
Well ahead of his time, he established an occupational health service for all resident hospital staff. This gained an enviable reputation and he ran it almost entirely by himself. Later, when the opportunity arose, he helped in the transformation of the hospital into the West Middlesex University Hospital with regular firms of students.
When he became president of the British Society of Gastroenterology he worked for higher levels of national staffing and much-needed equipment such as gastroscopes. To this end, he established an effective joint liaison committee with the Department of Health. He also chaired the society’s training and education committee and the College’s advisory committee on gastroenterology.
Nelson had a meticulous care for detail, but he also had the ability to combine thorough method with strategic vision. When things went wrong with an aspect of patient care, instead of blaming some nebulous scapegoat such as bureaucracy, he would take the role of mediator, involving as many as possible of the people concerned in an effort, ultimately, to integrate this part of the service. First, he identified the cause of the trouble. If this appeared to relate to a manager’s decision he would pick up the phone, ask questions and have a ‘positive discussion’ with him. If the problem seemed to centre on a more junior member of the hospital staff, he would make the time to go and see them, ask what the difficulties were and usually discover that more than one department was involved. He would then arrange an informal meeting to encourage the junior employees and their managers from the departments directly concerned to say what they thought was wrong with the system and to sort it out with minimal senior intervention, avoiding ‘blame culture’ and always involving the hospital manager and the personnel officer, both of whom became personal friends. The district manager and the most senior nurses over the years also became committed to the success of this approach.
His interest in participatory solutions to management problems extended outside the hospital. He was a founder member and chairman of the Action Learning Trust and chairman of the governors of a school for children with behavioural problems. He wrote books on both these aspects of his work. Later, when his wife developed multi-infarct dementia, he looked after her with less help than most of us would feel we needed.
James S Stewart
[Brit.med.J.,2002,324,1400]