Sir Christopher Booth had several careers within medicine: haematologist, gastroenterologist, clinical scientist, research administrator, medical politician and essayist. During the Second World War, and before becoming a medical student, he was a ‘frogman of Burma’; shortly after qualifying he embarked on his most enduring career, as a medical historian – this vocation lasted until his death.
He was born in Farnham, Surrey, the son of Lionel Barton Booth and Phyllis Petley Booth née Duncan. The younger of twin sons, and the second of an eventual family of five, Booth had what was, by his own admission, an indifferent school career – it had never occurred to him to become either a physician or an historian. Early preparatory schools had left him uninspired and he trailed behind his mathematically gifted twin. Transfer in 1937 to Sedbergh School in Cumbria, close to what had become the family home in Worton in Wensleydale, provided more congenial opportunities. He enjoyed acting in school plays and particularly relished French and German, for which he had great aptitude. Much later, these linguistic gifts were used to good effect in promoting international medical connections.
Failing to get the commission in the Royal Navy that his father had wished for, at the age of 18 Booth was conscripted as an ordinary seaman – eventually joining the Sea Reconnaissance Unit. While on active service he became friendly with the unit’s doctor, David Robertson, who suggested a medical career: Robertson went so far as to fill out and send Booth’s application to his own medical school, St Andrews. This was successful, and Booth started at the university after demobilisation in 1946. Never having studied science, he had to complete the rigorous 1st MB course, but was fascinated by an unfamiliar world. He later recalled his feelings about hearing of Darwin, of Avogadro and related matters for the first time: ‘It was an absolute revelation. One’s mind was expanded.’
In the event, Booth graduated cum laude in 1951 and, after house appointments in Dundee Royal Infirmary, his then professor of medicine, (later Sir) Ian Hill [Munk’s Roll, Vol.VII p.262] advised further training in London at the then Postgraduate Medical School, Hammersmith Hospital. After a brief period as a registrar, and early exposure to gastroenterology at Addenbrooke’s Hospital, Cambridge, Booth returned to Hammersmith as a medical tutor with (later Sir) John McMichael [Munk’s Roll, Vol.IX, p.341], director of the department of medicine, where an initial interest in defective red-cell production in certain anaemias developed into a study of the function of the small intestine – in particular, the site of absorption of vitamin B12 in man. Booth’s findings with David Mollin [Munk’s Roll, Vol.IX, p.372] were the basis of his MD thesis, for which he was awarded the Rutherford gold medal at St Andrews in 1958. The seminal discovery of the role of the distal small intestine in the absorption of the intrinsic factor-cobalamin complex made use of advanced radioactive tracer techniques. While this research was conducted principally with inspiring colleagues in the laboratory of (later Sir) John Dacie [Munk’s Roll, Vol.XII, web], widely considered the founding father of British haematology, the rigorous scientific training he received served to transform Booth into a pioneering gastroenterologist.
In London, Booth had also started working for his membership of the RCP, which he obtained in 1954 (followed by a fellowship in 1964). Knowing that one of the examiners, Donald Hunter [Munk’s Roll, Vol.VII, p.288], had a reputation for asking arcane historical questions in the compulsory pathology viva, Booth read in preparation Douglas Guthrie’s A history of medicine (London, Nelson, 1945). To his astonishment, he discovered that a distinguished 18th century Quaker physician, John Fothergill, came from a hamlet close to his home in Wensleydale and had also attended Sedbergh School. This stimulated further reading, original historical research and publications; it moreover marked the start of a lifelong career in medical history. In later years, Booth turned his historical skills to uncovering the lives and influences of a distinguished coterie of medical men, notably from the Yorkshire Dales. Some had influential careers in the British colonies, and this led Booth to investigate medical education and Australian medicine, through the award of the Sir Arthur Sims Commonwealth travelling fellowship. He examined the growth and development of clinical science – particularly his own specialty of gastroenterology – including publications on diagnosis, therapeutics and medical technology. Many years later, his experiences as editor of the journal Gut stimulated a series of papers on the history of medical publishing and journalism. His election as a foreign member of the American Philosophical Society is just one indication of his distinction in this area. With five books and more than 100 papers and talks in this field alone, his historical output surpassed that of many professionals.
Christopher Booth’s work and enthusiasm as an investigator, however, remained in clinical science. In 1959 he was appointed as a lecturer in medicine at the renamed Royal Postgraduate Medical School (RPMS) and that year married Lavinia Loughridge, who he had met at Hammersmith as a fellow lecturer. (She was later appointed as a consultant physician at the renal unit at Westminster hospital.) Seven years later Booth succeeded Sir John McMichael as professor and director of the department of medicine. This post he regarded as ‘the best job in British medicine’, in a place that, as he later stated, had ‘a fizz quality – every day was like a glass of champagne’.
While his own research focused on the gastrointestinal tract, he claimed famously that he was not a real gastroenterologist, for his interests: ‘started at the pylorus and ended at the ileocaecal valve’. Booth’s discovery of the ileum as the site of absorption of vitamin B12, was followed by research into the regional differentiation of function and mechanisms of absorption of other vitamins (such as vitamin D) and nutrients. This work prompted research into the consequences of malabsorption associated with intestinal conditions with preferential regional effects, for example coeliac disease, tropical sprue, Crohn’s disease – and rarely, but more definitively, the consequences of surgical resection. The effects of intestinal resection in man led to a series of fundamental studies into adaptive responses to injury which had far-reaching implications for treating patients suffering the consequences of widespread mucosal disease or massive resection, ‘short bowel syndrome’ – a term that, with good justification, Booth despised. Booth and his colleagues also investigated endocrine-secreting tumours of the intestine – in productive collaboration with (later Dame) Julia Polak, AGE (‘Tony’) Pearse [Munk’s Roll, Vol.XI, p.442] and later, (later Sir) Stephen Bloom, who Booth encouraged to go to Hammersmith. With support for an intestinal malabsorption research group from the Medical Research Council (MRC), the scope of the work expanded to studies of immune disorders of the intestine, including coeliac disease. With William Doe and other colleagues, alpha heavy chain disease, a bizarre immunoproliferative intestinal condition in young adults of Middle Eastern and Mediterranean ancestry, was investigated. The group added Bangladesh, Greece, Libya, Pakistan and Persia to the diverse origins of patients suffering from alpha chain disease, and with the distinguished French immunologist Maxine Seligmann, improved immunodiagnostic techniques, critical for early detection and salutary chemotherapeutic responses, were reported. Exploration of bacterial overgrowth and its effects on intestinal function especially in patients with strictures and stagnant bowel loops after surgery was carried out with Soad Tabaqchali, who became his second wife (latterly professor of medical microbiology at St Bartholomew's Hospital Medical College). The book Disorders of the small intestine (Oxford, Blackwell Scientific, 1985), written with his long-standing collaborator and distinguished former Hammersmith colleague, Graham Neale, integrates much of the knowledge gained over Booth’s career.
Leaving Hammersmith in 1977, Booth succeeded Sir Graham Bull [Munk’s Roll, Vol.VIII, p.65] as director of the Medical Research Council’s Clinical Research Centre (CRC) at Northwick Park. The CRC was associated with a hard-pressed district general hospital, and was thus well-placed for the study of common diseases. Booth embraced this enthusiastically, but never lost his desire to invest in cell biology, immunology, and the newly emerging molecular genetics. However, stringent financial constraints affecting the MRC and the NHS exacerbated the enormous challenge of integrating the clinical work carried out by NHS staff and scientists funded by the Medical Research Council. Internal and external MRC reviews of the work and direction of the CRC led to its eventual closure. Booth perhaps rightly felt that he had been set up to fail or at least that under conditions of relative austerity some former colleagues with competing interests looked to preserve their own interests rather than support the grander plan he had for the CRC. Booth left in 1988, becoming a member of MRC external staff until his retirement the following year. At this time, he defiantly established the generous Graham Bull prize for distinguished young clinical investigators awarded by the RCP; the first recipient, James Scott, who had trained at Hammersmith and had been recruited from the United States to the CRC, was soon elected a fellow of the Royal Society for his research into the molecular biology of lipoproteins implicated in common arterial disease, which was carried out at Northwick Park. Some years later, Scott became director of the department of medicine at RPMS Hammersmith.
Over a long medical career, including historical research, laboratory studies, clinical duties and administrative responsibilities, Booth developed his portfolio as a medical politician on a grand scale. He served on numerous national and international advisory committees, including the tropical medicine research board of the MRC, the Royal Navy’s personnel research committee, and the inaugural history of medicine committee at the Wellcome Trust and the Medical Research Council. Additionally, he was an external examiner or visiting professor at numerous universities in the UK, Caribbean, Africa, the Middle East and Orient. Booth was, among other posts, president of the British Society of Gastroenterology (from 1978 to 1979), of the British Medical Association (from 1986 to 1987), and president of the Royal Society of Medicine (from 1988 to 1990). At the RCP, he was an MRCP examiner for six years from 1973, a member of council as pro-censor (from 1974 to 1975) and censor (from 1975 to 1976). He delivered memorable eponymous lectures, including the Oliver Sharpey in 1970 (‘The enterocyte in coeliac disease’), the Fitzpatrick in 1976 (‘Clinical science in the age of reason’) and the somewhat contentious Harveian Oration in 1989 (‘A clinician in search of the soluble’), in which he reflected on his rich personal experiences with some bitterness about the fate of the CRC.
In 1989, on his official retirement, he became Harveian librarian at the RCP – overseeing the beginnings of the library’s transformation from the quaint and historical into a modern, accessible resource. Simultaneously he was approached by the then director of the Wellcome Trust, Peter Williams, to work with Tilli Tansey on promoting historical research in modern biomedicine, which gave rise to the History of Twentieth Century Medicine Group, later the History of Modern Biomedicine Research Group in the University of London.
In his final years, Christopher Booth faced illness and repeated surgery with courage, and kept his keen intellect and penetrating wit until the end. Supported by an intensely happy third marriage to Joyce Singleton, he particularly enjoyed visits from innumerable former colleagues and ‘the boys’ – a group of protégés that included some of those most distinguished in UK medicine, including heads of medical schools and other leading figures. Many of these luminaries contributed to a memorial celebration of Christopher Booth’s life and legacy at the RCP in December 2012, chaired by Sir Keith Peters and organised by James Scott. The title was apt: ‘What’s new?!’ – reflecting Booth’s distinctive, and slightly intimidating, everyday greeting.
Booth also retained his vivid narrative style, well-illustrated by an invited account of his own clinical odyssey: ‘On being a patient’ appeared in 2010 as a moving – and chastening – opening chapter in the fifth edition of the Oxford textbook of medicine (Oxford, Oxford University Press). Even in old age and infirmity, Christopher Booth’s writing reveals a capacity for piquant observation as well as strongly held opinions; his understanding of humanity gave authority to important views about the changing face of medicine during a long and eclectic career. In a typical Parthian shot, he concluded: ‘If you are a physician, no matter how important you may think you are, you should, so far as your own illnesses are concerned, consider yourself a layman.’
Sir Christopher Booth was survived by his two ex-wives, Lavinia Loughridge and Soad Tabaqchali, his wife, Joyce Singleton, and his children (a son and two daughters).
T M Cox
E M Tansey
[The Guardian 31 August 2012; The Independent 5 October 2012; The Telegraph 7 October 2012; Brit.med.J., 2012 345 5768; The Lancet 2012 380 1142]