Ralph Blacket, Foundation Professor of Medicine at the University of New South Wales and one of Australia’s leading researchers into heart disease, died in Sydney on 29th December 2008. Blacket was the last remaining founding head of the University of New South Wales Clinical Medicine Schools, surviving Leslie Kiloh (Psychiatry) [Munk’s Roll, Vol.XI, p.317], Donald Wilhelm (Pathology), and John Beveridge (Paediatrics).
He was born in Mosman in 1919 and grew up in Hurstville where his father started a real estate agency which still exists. He was a slim and athletic child who early on decided that he was not cut out for rugby and opted for cricket, which he played with distinction at Sydney Boys’ High School, where he was Dux in 1935. He continued to play throughout his medical training at the University of Sydney where he played first grade. He had previously played in the St George first grade team.
He graduated in medicine with first class honours in 1941 and enlisted almost immediately in the Australian Army Medical Corps from which he was seconded to the AIF 31 Infantry Training Battalion. From there he was posted to Milne Bay and thereafter served in New Guinea and Borneo for the rest of the war.
On discharge in mid 1946, Ralph did a year of residency at the Royal Prince Alfred Hospital (RPAH). After a brief stint with the Red Cross, he went to the Medical Unit at St Mary’s Hospital in London, at that time under the leadership of Sir George Pickering [Munk’s Roll, Vol.VII, p.464]. Here he got his first taste of high quality research with a team drawn from all over the world. During this time, he took three months off to visit leading research centres in the US. In this short period, he met virtually all the leading cardiologists and high blood pressure specialists there. Not only did he absorb the ethos of great research centres, but he returned to Australia in 1950 with the practical knowledge needed to establish comparable centres.
At RPAH he became the first Hallstrom Fellow in Cardiology and, together with Dr Jean Palmer, established Australia’s first cardiac catheter laboratory. In 1952 he was made an Honorary Assistant Physician at RPAH and Lecturer in Medicine at the University of Sydney. He established a busy cardiology practice but also found time to establish Australia’s first pulmonary function laboratory.
During this time, remembering his experiences with repatriated prisoners of war, he become interested in the pathological mechanisms of the heart disease beri beri, the result of thiamine (Vitamin B1) deficiency. Using the clinical investigative facilities he had established in heart and lung function, he provided the world’s first comprehensive understanding of how this nutritional deficiency led to malfunction of almost every organ system in the body. His doctoral thesis in 1956 was passed cum laude, and he was awarded the Bancroft prize for research. In 1958, Ralph was made Senior Physician in Cardiology at RPAH based in the newly established Hallstrom Institute. In 1959 he applied for the position of Foundation Professor of Medicine at the newly opened medical school at the University of New South Wales. He took up the post and directorship of medicine at the Faculty of Medicine's clinical teaching centre at the Prince Henry Hospital (PHH.) He later described the challenge of bringing a “moribund” hospital to life over the next three or four years. In this effort he received unwavering support from the Chief Executive Officer at Prince Henry, Harold (Jack) Dickinson, later Sir Harold and head of the NSW public service.
In the US, Ralph had seen the Flexnerian system of university hospital integration in action. The teaching school at Prince Henry and soon after, Prince of Wales (POW), was founded on the principle of seamless continuity between academic teaching and research and delivery of clinical care. Teaching of future doctors, it holds, is best carried out by doctors involved in research – medical practice is better served by asking intelligent and informed questions than in knowing a textbook full of answers. At the same time, research at all levels, when it involves clinicians, maintains its attachment to care of the sick. Such principles are now universal in Australia but were regarded as radical at the time by a specialist medical community used to the primacy of the honorary consultant practicing medicine remote from research and laboratories.
Ralph had become convinced of the importance of lipids, especially cholesterol, in the growing epidemic of heart attack and coronary artery disease. As well as a cardiac catheter laboratory, he established a lipid chemistry laboratory and built a team of biochemists, clinicians, dietitians and food technologists to address the problem of cholesterol in heart disease. In 1966, the group received funding to carry out the Diet Heart Study which set out to investigate whether substituting polyunsaturated vegetable fats for saturated fats in the diet would reduce the incidence of heart attack. The study showed a significant reduction of coronary disease and heart attack in the group on polyunsaturates, findings that were published in two papers in Lancetin 1974.
At the same time, Ralph had set about building up a strong multidisciplinary medical unit. He engaged leading specialists in neurology, cardiology, respiratory medicine, renal medicine, gastroenterology, infectious diseases and endocrinology. Although not devoted to meetings, at his divisional meetings he managed the competing interests and views of powerful egos with patience and aplomb. Afterwards, participants would wonder at the way virtually all the decisions had gone his way. His clinical and academic meetings were standout successes. Using local talent and his global networks, Ralph maintained a steady stream of unmissable programmes. Grand Rounds are often sparsely attended affairs but the Prince Henry series was packed out, even without sanctions for non-attendance. Ralph worked with the brilliant and charismatic director of pathology, Alex Tait-Smith, on these sessions. The lunchtime Grand Rounds were followed in the late afternoon by a hilarious and informative hour by Tait entitled “Croquis de la Semaine”, where he presented in inimitable style curiosities and salient lessons from his extensive library of pathological observations.
Right up to his retirement in 1983, Ralph was active in clinical care, research and teaching. He stood firm for academic standards at a time when political and financial considerations were already serious threats on the horizon. He was proud of the 36 graduates who received doctorates in the School of Medicine and the increasing success of PHH and POW trainee physicians in the Royal Australian College of Physicians examinations.
He was known for a dry sense of humour and a dry chuckle that went with it. He understood the importance of informal contacts with staff at all levels. After work, there were frequent conversations in his office over a glass of wine or a scotch. He entertained colleagues and visitors at home in Wollstonecraft and Clareville. In 1945 he had married Margaret McIlrath. They had five children whose memories of his dominant and opinionated personality remain very strong. Margaret was tolerant without being passive in the relationship. An excellent cook and inspired gardener, she created the serene ambience Ralph needed when he got home at night.
Ralph’s other great love was music. He was a better than average pianist with a love for the works of Beethoven and Chopin in particular. Music by both was played at his funeral.
P Blacket
G Macdonald
[Reproduced, with permission, from the Royal Australasian College of Physicians’ College Roll]